South Korea: Worries Over Apocalypse Health Care Reform May Bring

As South Korean government moves a step closer to execute a health care reform, bloggers have erupted online, strongly criticizing the idea of reform as neither effective nor egalitarian.

South Korea's national health insurance offers the so-called universal health care to every citizen, whom automatically registered as the insured as they  born. As South Korea government leans into small government after the worldwide economic crisis in 2008, gigantic projects causing budget deficits had been trimmed down and among them is the national health insurance coverage. South Korean bloggers have understood this a clear move toward the privatization of public health sector, urging government to remain status quo.

A photo of local hospital in Korea

A Naver blogger Ahimsa 93, mother of a kid and South Korean currently living in the United States voiced her worries on shifts in Korean health care system, praying it not to resemble the notorious US health care model.

미국의 의료 보험이라는 게..정말 별로라는 것을 대한민국 사람들도 좀 알아야 합니다. 미국에 처음 와서 제일 열심히 공부해야 했던 것 중의 하나가 의료보험이었다는 기억이 납니다…홈페이지를 뒤지든지 병원마다 전화를 걸어서 너네 이 보험 받니? 라고 일일이 물어봐야 되는 거죠. 제가 바로 지난 주에 아기 손에 난 두드러기 때문에 한 맨 처음 일입니다. 그냥 아무 병원이나 갔다가 보험 거절당하면 그냥 손 한번 들여다보고 약 처방 하나 해주는데 약 100불은 훌렁 깨지는 거죠. (미국 경우는)진짜 한숨 납니다. 대한민국 보험은 어찌되려는지.

Korean people should have to know that American health insurance system is really crappy. One of the hardest things I had to ‘study’ on in US was (how to get and apply) the health insurance…I have to browse over several hospital homepages and call each of them asking whether they accept my insurance. That was what I did first thing last week to cure my baby's rash in the hand. If I went to any random hospital which does not accept my insurance, the doctor would just take a quick glance over the baby’s hand and prescribe a pill; that simple process will cost more than 100 US dollars. (commenting on US health care system) This is just lamentable. I don’t know how Korean health insurance will turn into.

More Korean people are expressing their anxiety over the side-effect health care shift would bring by taking a privatization turn. A Tistory blogger Avoidance 25 commented that the health care reform will eventually push people to sign up for the private insurance.

어제 저도 몸이 안 좋아서 병원을 다녀왔는데 5일치 약값이 총 4100원 나왔거든요. 약봉지에 영수증해서 (이렇게) 나왔더군요. 약제비 총액: 13,770원, 보험자 부담금: 9670원 본인 부담금: 4100원…그렇다면 민영화가 되었다(하면). 민간의료보험에 가입되지 않은 사람의 경우 13,700원을 5일치 약값으로 전부 본인부담으로 내야합니다…(그렇게 되면) 민간의료보험을 가입을 할거에요.

Yesterday, I went to hospital because I did not feel well, and the prescribed pills for five days amount cost 4100 Korean Won(USD 3.4) in total. The receipt shows like this; Total medical fee: 13,770 Won(USD 11.5), Deduction from the Insurance: 9,670 Won, Paid by Consumer: 4,100 Won, if the privatization in health care system took place, one without private health insurance will have to pay all 13,700 Won out of pocket…(And later eventually)people will sign up for private health insurance.

Another issue derives from private insurance is, the discriminatory standard the insurance company will hold to thin out the insurance receivers. A Naver blogger Mim predicted the insurance corporate will spurn the poor, desperate people.

국민건강보험은 국가가 법률에 따라 운영하는 사회제도이므로 국민 누구나 건강보험에 가입합니다. 예전에 어떤 질병을 앓았더라도, 아무리 중한 질병을 가지고 있더라도 차별하지 않고 당연히 가입하여 건강보험의 혜택을 누릴 수 있습니다. 그러나 민간의료보험은 그렇지 못합니다. 영화 ‘식코’에서 보신 바와 같이, 예전에 어떤 질병을 앓았던 적이 있으면 민간의료보험에 가입하려 해도 보험사로부터 거절당하게 됩니다. 희귀난치질환 환자나 장애인은 말할 것도 없습니다. 심지어 부모의 질병에 따라서는 자식이 민간의료보험 가입이 거절되는 경우도 있습니다.

The national health insurance is a social welfare system that runs by Korean national laws and that includes everyone. No matter a person have had suffered from certain disease or carrying a serious illness, everybody is accepted and benefited from it without discrimination. On the other hands, the private health insurance, people get rejected from the insurance companies based on their prior health records, as you may have seen from the movie ‘Sicko’. People suffering rare and incurable diseases and the handicapped will be discriminated against for sure. Moreover, in some case, people got rejected by the private health insurance companies because of their parent's health records.

Even after people qualified for a private health insurance, the exponential increase on the medical expenses remain as each individual's problem. A Cyworld blogger Wise 21 Sky expressed his concern on a sudden increase of medical fee, quoting an example of the endoscopy surgery.

지금도 병원 다녀오시면 비싸다고 하시는 분 많으십니다. 그러나 의료보험이 민영화 되고 당연 지정제가 붕괴되면 위내시경 4만원 하던 것이 미국처럼 100만원으로 올라갈 수 있습니다. 의료 보험 민영화로 누가 가장 이득을 보게 될까요? 가장 이득은 영리 병원들의 기업이 될 것이고 가장 큰 피해자는 돈 없는 서민이 될 것입니다.

Now, there are still people complaining on medical price after they went back from a hospital, but if the health care sector got privatized, and the automatic designation system meltdown, an endoscopy surgery which cost 40 thousand won (USD 33.5) for now will go up 1 million won (USD 836) just like in US. Who will be getting profits from the health care privatization? The biggest beneficiary is the for-profit hospitals and biggest victims would be poor, ordinary citizens.

Another Naver blogger Mo pointed out the possible benefits from privatization while listing pros and cons of the reform.

의료보험 민영화의 목적은 갈수록 늘어만 가는 건강보험의 재정 부담을 지는 것이 작은 정부를 지향하는 정부 입장에서는 부담이 되고 또한 보험료 인상이라는 국민적 지지를 얻기에는 더더욱 어려운 상황이기에 당연지정제를 폐지하고 민간의료보험을 도입함으로써 건강보험의 재정적 안정화를 이루려는데 있다…이렇게 의료가 경쟁산업으로 변모하게 된다는 것은 그만큼 의료 기술의 수준 또한 높아질 수 있을 것이라 전망할 수 있다. 따라서 의료 서비스를 제공받는 수혜자들은 보다 양질의 고급화 된 의료 서비스를 제공받을 수 있을 것이다.

The purpose of the health care privatization are these; the universal health care is a huge financial burden for the government aiming to convert into small government. It much harder to get people's approvals on the universal health care due to an increase of the insurance fee. To secure the financial stability on the health care plan, it is beneficial to abolish the automatic registration system and adopt the private insurance model…The competition in medical industry will improve the entire level of Korean medical industry (technology). The beneficiary (consumer) will be able to get a higher quality service from it.

Korean government momentarily stands a step back from the full-out privatization, limiting for-profit hospitals’ boundaries on few designated spots. Cheong Wa Dea, South Korean presidential office posted a several paragraph-long post in its homepage bulletin, answering a question about privatization. Cheong Wa Dae said the government's recent move is not for privatization but rather a renovation of the old system into a more competitive model.

지난 4월 6일 국무회의에서 의결된 의료법 일부 개정 법률(안)의 주요 내용은 원격진료 허용, 의료법인 부대사업 확대, 의료법인간 합병근거 마련 등이며, 일부에서 우려하는 소위 의료보험 민영화 관련 내용 (당연지정제 폐지, 대체형 의료보험 도입 등)은 전혀 반영하고 있지 않습니다.

The health care reform bill (draft) passed in a Cabinet meeting in April 6 grants permissions on a distant-medical treatment and an extension of medical corporation’s facilities and setting legal backgrounds for future merger between medical corporations, which however, neither includes the privatization practices like scrapping off the automatic designation system nor implementing alternative health insurance system as some people are worrying over.

A Yahoo blogger Know_blog analyzed that even though the health reform's primary purpose is solid, how it will be turn out to be is unpredictable under Korean environment. If worse, he warned things can get off the track.

왜냐하면 일단 현재의 정부 쪽은 영리병원 건립은 추진하겠지만 의료보험 당연지정제는 유지하도록 하겠다고 했기 때문입니다. 관세 제도를 유지하며 예외적인 관세 특구를 지정하듯, 의료보험 당연지정제를 유지하면서 예외적인 병원을 일부 지역에 건립 허가 하겠다는 게 주요 골자입니다. 의료산업 활성화가 주요 목적이며 이를 통한 질 좋은 의료서비스를 제공하겠다는 것 역시 중요 포인트이죠. 사실 정부가 이를 통해 제대로 통제만 해준다면 나쁘지는 않은 선택일 수 있습니다…하지만 분명 건립되면… 각 대형 병원들이 영리병원을 추진하기 위해 경주할 것이 뻔해 보이긴 합니다. 만약 거기서 정부가 제대로 억제를 하지 못하고 하나 둘 풀어주면 대형 병원은 영리병원으로 국민건강의료보험에 적용되지 않아 치료비가 비싸지고, 작은 병원들은 현행 상태로 남게 될 겁니다. 그럼 감기 치료비는 싼데 암 치료비는 지금보다 수배 수십 배 비싸게 될 수도 있습니다. 최악으로는 이걸 빌미로 국민건강보험은 허울만 남게 될 수도 있습니다. 너무 안 좋게만 보았나요?

Currently the Korean government announced that even though it may pursue for-profit hospitals, the automatic designation system will continue. Just like a government preserving the tariff while designating certain place a duty free zone, there can be some exception for some hospitals in special zone while the automatic registration system remains intact. The government expects the change to activate the medical industry and to offer quality medical service to people. If it really went as expected and controlled as the government planned, this change will be a good decision. However, once for-profit hospitals built, all the big hospitals will obviously work rigorously to convert themselves into for-profit hospitals… If the government let the situation to further drift away by letting loose those hospitals to be shifted as for-profits one by one, the medical price will increase a lot in big hospitals since once a hospital were converted into a for-profits, it is not covered by national health insurance. And the small hospitals stay where they are now. Then weird situation will occur; like it takes almost same money to cure a cold while it takes several times much, even several ten-folded much amount of money to cure a cancer. And it will lead into a de facto destruction of the national health insurance system. Do I sound too pessimistic?

The irony of South Korea pushing the medical sector into wide market while the United States rescuing it from the capitalism jungle make people confounded. A controversy on the health care reform deal will likely to continue as the government and people have yet reached a sweet spot in the midst of two extremes.

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