In this blog post, we examine the pros and cons of introducing a telemedicine system in South Korea from the perspectives of public healthcare and institutional stability.
In April 2014, a major controversy erupted in South Korea over the introduction of a telemedicine system, with the government and the Korean Medical Association at odds. When the telemedicine bill was passed by the State Council, the Korean Medical Association strongly opposed it and declared a “full-scale general strike.” The issue remains unresolved, and the government and the Saenuri Party are currently working to pass the bill in the regular session of the National Assembly.
The main issues of the medical strike at the time were telemedicine and an increase in medical fees, but the core issue was telemedicine. Telemedicine is a medical system that uses communication devices to diagnose and treat patients remotely. When you hear this, you might think of people in remote and underdeveloped areas with poor access to hospitals in urban areas receiving convenient remote medical care, which seems reasonable on the surface.
However, telemedicine is not intended to be implemented only in underdeveloped areas. It will be implemented in all areas in parallel with the current medical system, and will take the form of obtaining a second opinion using various medical engineering devices in a one-to-one or one-to-many format. I am opposed to the introduction of such a telemedicine system in Korea.
First, telemedicine is a useless system implemented for private gain. It is not right to wastefully implement telemedicine where it is not necessary. South Korea boasts a doctor density 20 to 100 times higher than Australia, Canada, New Zealand, and Finland, where telemedicine is already in use. In addition, basic medical care and prescriptions are available even in remote mountainous areas, where profitability is low. For example, Yodoc is a mobile health checkup solution implemented to address the lack of medical facilities and high elderly population in remote mountainous areas. Visiting nurses from local public health centers provide accurate health management to at least 1,000 residents per year. However, companies are looking to the medical industry as a breakthrough for new growth industries, and telemedicine is seen as a solution. Samsung, a representative company of Korea and the center of the Korean economy, currently derives 70% of its profits from smartphones. However, with no clear post-smartphone era in sight, Samsung is feeling a serious sense of crisis about the future of its industry and is turning its attention to the medical industry. A recent example of this is the fierce conflict between Samsung Seoul Hospital and the Korean Medical Association and the Health and Medical Workers Union over the hospital’s decision to allow telemedicine as an exception in response to the MERS outbreak. This is not limited to Samsung, but is also true of other companies in Korea. In a rapidly changing global economy, companies and governments must prepare for the future with competitive products, and they cannot help but feel a sense of urgency. However, it is questionable whether the breakthrough can be found in the telemedicine industry.
However, one may question why we oppose companies pursuing their own interests. The government and companies may argue that the U-health industry, which combines healthcare and IT, is not being implemented for private gain, but for the good of the Korean economy. In Korea, a country with strong healthcare and IT industries, the future industries with the most promising prospects are health and healthcare-related industries, and it is clear that the combination of healthcare and IT will be the industry that will shape the future of Korea. Therefore, when such projects are frustrated, we must try to find other breakthroughs. This is an inevitable process that involves uncertainty, so it is bound to be inefficient. According to the Ministry of Health and Welfare, in September 2014, a pilot project involving 13 general clinics and five public health centers found that more than 77% of patients were satisfied with the remote medical services provided. Based on this, it can be argued that patients also find it convenient and that it is a win-win situation for companies and the public.
However, I am not saying that it is wrong for companies to seek profit. It is just that it is wrong for companies to push for a system that is not necessary for their own interests, despite the public risks that will arise when the system is implemented and the opposition of experts. The telemedicine system carries high public risks. Providing medical services without registered professionals increases the risk. In addition, the storage and transmission of patient information through media will become more frequent than it is now, increasing the possibility of personal information leaks. Furthermore, the opinions of experts must also be taken into consideration. All healthcare professional organizations and civic groups oppose telemedicine. This is not a selfish opposition to protect the livelihoods of doctors, but an important opinion based on the expertise of professionals. Seeing and treating patients directly is fundamental, and dealing with people’s bodies, minds, and lives is more important than anything else. Patients may feel comfortable and satisfied, but from a professional standpoint, it is possible to overlook areas that require careful observation and attention. For example, blood sugar management is important for patients with diabetes. When providing secondary care to diabetic patients, doctors check the blood sugar levels measured by the patients and regularly test their glycated hemoglobin and hemoglobin levels to manage complications. However, with remote medical care, patients may lie about their blood sugar levels, making it impossible to prepare proper measures for complications. Therefore, before such a situation arises, the government needs to stop its typical desk-bound administration and respect the opinions of experts who oppose the system.
Second, the telemedicine system is a hasty policy led by the Ministry of Economy and Finance. Telemedicine is a system that changes the market and the landscape. It will shift from one-on-one medical care to one-to-many medical care, causing significant changes in the demand for medical personnel, and the disappearance of geographical barriers will hit rural hospitals even harder. It takes about 10 years and an average of over 1 trillion won to develop a new drug. This is because the efficacy and safety of drugs must be proven, so caution is required. However, it is reckless and hasty to push forward with a policy without even conducting basic research on the expected situation when introducing such a huge system that will change the landscape and market of healthcare.
In response, the government claims that the situation will be adequately controlled by the proposed legislation. This means that detailed criteria will be established, such as who is eligible for telemedicine, which medical institutions can provide telemedicine, and whether initial consultations are required, and that confusion will be avoided if medical treatment is provided in accordance with these criteria. The proposed amendment allows telemedicine only for patients with chronic diseases, patients who have undergone surgery and are recovering at home, and patients with limited mobility in order to prevent indiscriminate use of telemedicine and concentration of medical services. In addition, the Ministry of Health and Welfare insists that the aim is not to completely change the current medical practice through telemedicine, but to apply it where it can complement the current medical system. The idea is to give it a try if it can contribute to the health promotion of the people by integrating IT technology into medical care.
However, the criteria outlined in the amendment are detailed but unclear. The vague concept will lead to many patients being classified as chronically ill, and there will be a rapid increase in the number of patients who are difficult to move. Other criteria are also vague, which will lead to many cases of abuse. Furthermore, saying that it should be tried once sounds irresponsible. Once the system is implemented, there will be a series of problems. If patients who find it inconvenient to go to the hospital flock to telemedicine clinics, local clinics and hospitals in rural areas may collapse. The management of small and medium-sized clinics, which have been struggling to survive, will be dealt a severe blow, leading to a decline in access to medical care. This means that the medical institutions that are actually responsible for providing medical care will gradually disappear, which may result in gaps in medical care. People will not be able to receive appropriate medical care in a timely manner according to their individual circumstances, and the ability to respond to emergencies will also be greatly reduced. In addition, we will face a situation where the number of jobs in the healthcare sector will be significantly reduced. If medical treatment shifts to remote care, prescriptions will also shift to remote care, and eventually pharmacies will disappear and be replaced by logistics, eliminating the need for pharmacists. Furthermore, the value of nursing will be lost, and nurses will also lose their jobs.
Ultimately, if the system is implemented without proper standards in place, the hidden problems will cause the medical delivery system to collapse completely, resulting in endless competition among remote clinics. Considering these numerous problems, telemedicine is not a system that can be implemented and then judged based on a single trial. Therefore, those promoting the system need to take a more cautious stance, and even then, I believe it is still too early to implement it in South Korea. In conclusion, I am opposed to the implementation of the telemedicine system.
