Written By Lauren Kim
On February 6th, South Korea’s government unveiled four new healthcare policies aimed at “bringing essential healthcare back from the brink of collapse”. These initiatives seek to address a projected shortage of approximately 15,000 healthcare professionals by 2035. A problem expected to be further exacerbated by the nation’s rapidly aging population, regional healthcare disparities, and staff shortages in essential medical fields. The policies also aim to support doctors with fairer compensation and stronger safety nets for medical malpractice (A Policy Package to Bring Essential Healthcare Back From the Brink of Collapse, 2024).
Though these policies seem beneficial to doctors, they have encountered strong opposition from the medical community. Kim Tae-woo, president of the Gangwon chapter of the Korean Medical Association – which represents roughly two thirds of the nation’s doctors – voiced intense criticism, describing the essential healthcare package as “a death sentence for Korean healthcare” (Park, 2024). This reaction starkly contrasts the government’s intended goal of salvaging the nation’s healthcare system. In response to the policies, doctors have submitted letters of resignation in masses.
However, this is not the first time the South Korean government has attempted to increase the medical school admissions quota. During the initial stages of the coronavirus outbreak, former President Moon Jae-In proposed expanding the admissions cap in small increments over a 10-year period, aiming to strengthen South Korea’s response to future public health crises and prepare for an aging population (Park, 2024). Although this proposal was met with some resistance, the majority of doctors continued their efforts to protect patients during the COVID-19 outbreak. As the pandemic escalated, the government ultimately withdrew the proposal.
Public gratitude towards healthcare workers in 2020 led to more favorable perceptions of doctors during their appeals against raising the medical school admissions cap (Park, 2024). However, as accessing care has become increasingly difficult, vulnerable patients have grown weary of the ongoing strikes. The drastic decline in hospital staff has resulted in an estimated 50% percent reduction in hospital operations and the postponement of preventative care (Kim & Choi, 2024). Patients with chronic illness have been neglected, while non-striking care providers focus on treating critical care patients in overcrowded emergency rooms.
The mass resignation of doctors is now widely viewed as a violation of the Hippocratic Oath and an act of collective selfishness. Citizens are reckoning with the sheer power doctors collectively hold over their well-being. These souring public attitudes towards the mass resignations have been further emphasized by President Yoon Suk-Yeol’s statement: “It is difficult to justify under any circumstances the collective action that takes public health and lives hostage and threatens human lives and safety” (Kim, 2024). He also labeled the doctors on strike as a “vested interest cartel that opposes the common good” (Jang, 2024).
In South Korea’s merit-based society, doctors are well-respected and earn high wages. Consequently, the opposition to increasing medical admissions is perceived as a collective effort by doctors to control the supply of healthcare and maintain the high salaries and prestige associated with the medical profession (Park, 2024).
This negative perception of the medical community is supported by the extreme shortages in lower-profit essential medical fields and the large number of for-profit cosmetic private practices operating under a fee-for-service payment scheme. For these doctors, increasing the number of medical admissions means greater competition, potentially reducing the number of patients to treat and, subsequently, their profits (Park, 2024).
However, the mass resignations were initiated by junior doctors (similar to interns and residents) who refute the claims that protests are driven by reduced earning potential, instead voicing their concerns about unnecessary increases in outpatient care that would accompany a larger workforce of doctors due to the structure of South Korea’s health insurance (Yoo & Park, 2024). The National Health Insurance Service, administered by the Ministry of Health and Welfare, provides low reimbursement rates for insured treatments within a fee-for-service payment scheme that requires doctors to maximize the number of patients they see daily in order to sustain profitability.
These low reimbursement rates push hospitals to rely on the cheap labor of junior doctors to reduce costs and stay afloat. According to the Korean Intern Resident Association, junior doctors often endure grueling 36-hour shifts and work over 80 hours a week for minimal compensation. Legislation concerning their labor often employs the term “training hours” to describe their working hours, allowing employers to circumvent labor protection regulations (Kim, 2024).
Additionally, the National Health Insurance Service provides universally accessible healthcare with low insurance premiums and copays, resulting in high utilization of medical services by citizens. Notably, South Koreans seek outpatient care an average of 14.7 times per year, significantly more than the OECD average of 5.9 times per year (Yoon et al., 2024, 2589).
As a result, junior doctors are increasingly frustrated claiming the current government healthcare reforms fail to adequately address the exploitation of their cheap labor within the healthcare system, which has allowed the nation to maintain affordable, efficient, and high-quality medical services.
These frustrations are further exacerbated by the strict prosecution of doctors in cases of medical malpractice. South Korean doctors are criminally charged with professional negligence resulting in death or injury at high rates (Research Institute for Healthcare Policy, 2022).
In a healthcare system that enforces long working hours and imposes stringent punishments, young doctors increasingly choose to specialize in non-essential medical fields that are low-risk for medical malpractice charges and are not covered by national health insurance, ensuring greater job security, shorter working hours, and better pay. This shift is especially pronounced in pediatrics, where the declining birth rate and rapidly aging population makes the specialty all the more unappealing to new doctors.
The government’s new policies aim to address these concerns by implementing several key measures. These include reducing the maximum consecutive working hours for residents to twenty-four hours and establishing a 60-hour work week (Choi, 2024). The policies also exempt medical professionals from criminal punishment for medical malpractice, provided they are enrolled in the National Health Insurance program, and enhance state compensation for no-fault malpractice cases. Furthermore, the reforms seek to improve the compensation system by introducing alternative payment schemes for essential specializations that do not fit within the traditional pay-for-treatment model. Additionally, the policies plan on establishing an improved qualification plan for elective specialties allowing for stronger regulation of those fields and prohibiting patients from claiming National Health Insurance benefits if they have excessively utilized non-covered services (A Policy Package to Bring Essential Healthcare Back From the Brink of Collapse, 2024).
Doctors can’t help but question the viability of these initiatives. As the hospital system heavily relies on the exploitation of junior doctors, reducing their working hours would require employment of a greater number of doctors. However, the government has failed to address how they will finance these astronomical labor costs when upheaving the current healthcare system. Junior doctors have reiterated that the government must first address the healthcare system’s dependency on their cheap labor before attempting to make expansions, advocating for increased cost of treatment to spur this shift.
The implementation of these policies is also undermined by long standing hostility between medical professionals and the government with doctors doubting the government’s ability to ensure improved working conditions.
Since February, tensions have continued to escalate. The government has maintained its positions, ordering doctors back to work with threats of license revocation in accordance with the medical services act. In response, medical school students and professors continue to stand in solidarity with striking doctors. Many medical students have suspended their studies and refused to take their qualification exams, while medical school professors have resorted to hunger strikes in a desperate plea to the government to retract these policies.
To address doctor shortages, the government has begun to deploy military doctors to civilian hospitals and has revised legislation to expand the roles of physician assistants and nurses (Kim, 2024).
The resolution of this crisis remains uncertain. The government relies heavily on the nation’s doctors to protect their constituents, while doctors depend on the government for their income, working conditions, and are subject to regulatory authorities. Without meaningful compromise, it is evident that patients will continue to suffer the consequences (Kim & Choi, 2024).
References
Choi, J. (2024, July 28). No return of trainee doctors pushes hospital overhauls. The Korea Herald. https://m.koreaherald.com/view.php?ud=20240728050166
Jang, N. (2024, April 2). Yoon sticks to guns on med school quota hike, admonishes protesting doctors. Hankyoreh. https://english.hani.co.kr/arti/english_edition/e_national/1134927.html
Kim, J. (2024, February 27). South Korea’s Yoon says won’t back down over medical reforms as doctors strike. Reuters. https://www.reuters.com/world/asia-pacific/south-korea-nurses-take-more-medical-work-due-doctor-walkout-2024-02-27/
Kim, J. (2024, September 2). South Korea denies hospital emergency rooms collapsing as army doctors deployed. Reuters. https://www.reuters.com/world/asia-pacific/south-korea-denies-hospital-emergency-rooms-collapsing-army-doctors-deployed-2024-09-02/
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Kim, S., & Choi, S. (2024, March 10). South Korea Doctors’ Walkout Leaves Patients in Limbo. Bloomberg.com. https://www.bloomberg.com/news/articles/2024-03-11/south-korea-doctors-walkout-leaves-patients-in-limbo
Korea Herald. (2024, July 11). Health insurance deficit. The Korea Herald. Retrieved October 16, 2024, from https://m.koreaherald.com/view.php?ud=20240711050790
Park, J. (2024, February 20). [News Focus] Why do Korean doctors oppose having more physicians? The Korea Herald. https://www.koreaherald.com/view.php?ud=20240220050590
Park, S. (2024, February 16). ‘Death sentence for Korean health care’: Doctors nationwide protest increase in med school admission quota. Hankyoreh. https://english.hani.co.kr/arti/english_edition/e_national/1128663.html
A Policy Package to Bring Essential Healthcare Back from the Brink of Collapse. (2024, February 2). 보건복지부. Retrieved October 14, 2024, from https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&list_no=1480151&act=view
Research Institute for Healthcare Policy. (2022, 11 09). Penalty Status and Implications for Medical Conduct. Research Institute for Healthcare Policy. https://rihp.re.kr/bbs/board.php?bo_table=research_report&wr_id=338
Yoo, B., & Park, S. (2024, February 25). Trainee doctors explain why they protest against reforms. https://www.chosun.com/english/national-en/2024/02/25/MXLTD3FYH5DHNMGKX7GLRGQQNY/
Yoon, J., Kwon, I., & Park, H. (2024, 06 15). The South Korean health-care system in crisis. The Lancet, 403(10444), 2589. 10.1016/S0140-6736(24)00766-9