The Ministry of Health and Welfare has introduced a system to treat patients with serious medical issues within 15 minutes since September in order to break the ‘three-minute treatment’ that is prevalent in the medical industry. The section chief of the Bureau of Health Insurance Policy of the Ministry of Health and Welfare commented that “In order to solve the problems of the three-minute treatment, we are planning to implement an in-depth medical treatment system in two to three hospitals including the Seoul National University Hospital.” The Sungkyun Times (SKT) now introduces the current status and problems of Korean medical care, the new 15-minute treatment system, and the controversy surrounding it.
The Medical Status of Korea and Related Problems
Medical Status of Korea
In Korea, there are two main problems that should be solved regarding medical status. First of all, Korea lacks a physician workforce. In other words, Korea has fewer doctors than other countries. According to Health Statistics 2015 research by the Ministry of Health and Welfare, the number of doctors per 1,000 Korean people was 2.2 in 2013, which was less than the OECD average of 3.3. Korea also has a small number of physicians compared to the number of patients. According to Seoul National University Hospital statistics, there were 1,372 physicians in 2016, while the average number of daily outpatients was 8,500 with 1,700 inpatients. Unfortunately, the small number of physicians seemed to influence the wait time before medical consultation. Generally, the average consultation time in Korea is about three minutes. The internal medicine professor team belonging to Professor Lee Chan-Hee of the National Health Insurance Service Ilsan Hospital surveyed 1,105 patients last year and the average consultation time per each outpatient was found to be 4.2 minutes. Currently, doctors are trying to keep track of patient’s information, viewing or recording documents on computer. This three-minute medical treatment leads to high medical accessibility. Korea’s medical accessibility is good compared to other countries. Citizens of developed countries can wait more than a month to see a specialist. According to International Health Policy survey conducted by Commonwealth Fund in 2010, the rate of patients waiting for more than a month was 55% in Sweden, 59% in Canada, and 47% in France. In contrast, Korea ranked in 23rd place because it had easier access to primary health care among 195 countries in 2015.
Moreover, the medical charge is not influenced by consultation time in Korea. This means that there is a possibility of affecting the average consultation time. Regardless of the treatment time, whether it is three minutes or longer, the medical charge is the same in Korea. Therefore, it is considered to be economical to treat many patients in a short time. A 15-minute consultation suggested by the Health Insurance Review & Assessment Service is not strictly implemented. Consequently, the custom where doctors concentrate only on a patient’s current symptoms to hurry diagnosis has appeared. As necessary medical treatments are often omitted and the number of misdiagnoses increases, the criticism toward the effectiveness of three-minute medical consultation is getting stronger.
What is 15-minute Treatment?
Currently, the most prominent Korean medical problem is the short time of medical consultation. The 15-minute treatment plan is going to be introduced as a way to solve the problem of time constraint during consultation. The physician who first presented the concept of 15-minute treatment was Professor Lim Jae-Jun of the Division of Pulmonary of Seoul National University Hospital. Professor Lim personally started the 15-minute treatment from March 2016, assuming that the cost of medical care will be reduced if there is enough time for doctors to explain and have conversation with patients during their consultations. The 15-minute treatment system guarantees a fair medical fee and in-depth treatment provided by the Health Insurance Review & Assessment Service. The system will be introduced to two or three large advanced general hospitals such as Seoul National University Hospital from September, 2017. Doctors will reduce the number of outpatients that they were supposed to treat, having a separate time to meet patients for in-depth treatment. Priority is given to serious patients such as those who require care using internal medicine and pediatrics or those who have rare and incurable problems. The purpose of the 15-minute treatment plan is to minutely diagnose and care for patients with severe diseases in advanced general hospitals. The hospitals are planning to gradually increase the number of departments implementing 15-minute treatment in accordance with the conditions of each department.
Position that Agrees with 15-Minute Treatment
Dispersion of Patients with Mild Issues to Small-Scale Clinics
Firstly, patients with mild cases can be dispersed to small-scale clinics. The 15-minute treatment is intended to treat patients with severe issues intensively in large hospitals so that it can disperse patients with milder issues to smaller clinics. As larger hospitals are also accepting mild patients, patients are concentrated in large hospitals. If medical needs are dispersed through 15-minute treatments, the time and medical expenses of patients with mild issues will decrease. There is a proven case that the concentration was alleviated thanks to 15-minute treatment. According to the Seoul National University Hospital’s analysis of 36 patients who received 15-minute treatment and 29 patients who received three-minute treatment during August to September of 2016, the proportion of the patients who were sent to the small-scale clinics increased from 32.5% to 55.6%.
Furthermore, the dispersion can also solve economic problems of small-scale clinics. Small-scale clinics are in severe financial situations due to low demand. According to the Korean Medical Association’s survey of 1,031 primary medical institutions in 2010, the average medical hours of small-scale clinics was decreased by one hour compared with that of the previous year, 50.1 hours, and the average number of patients was only four per day. Consequently, the average debt of small-scale clinics was ₩350.79 million. With 15-minute treatment dispersion, however, these problems could be solved.
Accurate Diagnosis of Doctors
The 15-minute treatment can reduce the possibility of misdiagnosis. If the consultation time is increased to 15 minutes, doctors will be able to fully understand the patients’ medical history and symptoms by thoroughly reviewing medical records. Physicians also say that generally it takes more than 15 minutes to provide even a basic medical examination such as physical examinations or stethoscopic examinations and to go over a patient’s medical history.
In addition, with 15-minute treatment, early diagnosis and proper treatment for patients with rare conditions can be implemented. According to a research by Park Kyi-Su, the Gyeongsang National University professor in 2008, due to three-minute medical treatment, 251 out of 330 rare disease patients, which is accounted to be 76.1%, answered that they experienced misdiagnosis. For example, a 20-year-old man named Kim Jin-Soo had felt pain in his chest when he ran since his childhood. At first, he visited a small-scale clinic, and just received an advice to take a rest and the explanation that the symptom might be derived from stress because of the college entrance exams. After going to college, however, his chest pain got even worse. Recently, Kim was diagnosed with a rare disease called ‘Marfan syndrome’ at a university hospital. It was the large hospitals’ relatively longer and thorough treatment that helped find the exact disease he was suffering from, so the 15-minute treatment can support early discovery of rare diseases. Moreover, providing optimal treatment to patients with severe conditions can also be possible. Seoul National University Cancer Hospital’s thorough prophylactic counseling for patients who have problems regarding the stomach, large intestine, liver, breast, lungs and blood cancer for 15 minutes brought many of these patients satisfying results. Furthermore, the 15-minute treatment could reduce the damage caused by first misdiagnosis. Even if there was misdiagnosis at the first treatment, the 15-minute treatment can give comprehensive information about what kind of observation and management is needed. As a result, the treatment can be instantly changed if something is deemed to be wrong. Likewise, more specific medical examination is possible by in-depth consultation. The content of the 15-minute treatment is being changed to be more specific than the three-minute treatment as shown below.
|The Difference between Three-minute Treatment and 15-minute Treatment/ news.joins.com|
Concerns toward 15-Minute Treatment
Concentration of Patients with Serious Illnesses to Large Hospitals
Patients with advanced diseases may crowd into large hospitals meaning that the waiting time will be prolonged. 15-minute treatment may attract more patients with severe conditions and some might even demand to get three-minute treatment. Thus, the number of physicians needs to be increased. In the aging Korean society, the number of medical personnel should be increased to meet the higher demand of medical care.
Cost Problems Associated with the Promotion of the 15- Minute Treatment
The cost related problem can be divided into the arguments of patients and that of the government.
First of all, in the case of patients, the health insurance premium will be increased if the 15-minute treatment is introduced. Citizen’s burdens are expected to be increased, but the government’s supporting policy regarding this problem has not been announced yet. Currently, medical expenses including that of selective treatment are not fully paid by the health insurance, so the patients who visit advanced general hospitals are paying the total amount of ₩24,040. Meanwhile, in-depth treatment increases the treatment time to 15 minutes, raising the cost of medical treatment from ₩90,000 to ₩100,000, which is four times more expensive than the current medical expense. During the trial period, 5% to 10% of the difference between current medical expenses will be complemented by the patients and the remaining ₩60,000 to ₩70,000 will be paid by health insurance. After the termination of the trial plan, however, the benefits that were covered by health insurance will be reduced and this will lead to an increase in patients’ burden.
Secondly, in the case of the government, the budget for 15- minute treatment may be lacking. Seoul National University Hospital’s 15-minute treatment implementation period for trials will be one year. Recently, the government has announced a policy to strengthen health insurance coverage, which requires a huge budget. The Korean government may lack budget regarding health which is necessarily needed to support the 15-minute treatment. The intention of the law is to lower the burden of patients, by changing certain aspects such as expensive tests or drugs that cannot be paid for with health insurance or their monthly health insurance payments. Approximately ₩31 trillion is expected to be put into this policy and in accordance with the announcement, there are concerns that the budget for the introduction of the 15-minutes treatment system will be deficient.
The 15-minute treatment will bring social changes in Korea. There are currently various medical reservation services available which are set to improve the medical treatment environment which could have been once inconvenient for patients. When the 15-minute medical treatment is introduced, these services will spread and be available for use in large university hospitals and private hospitals. The SKT hopes Kingos will find the time to think about the social changes that will come along with the development of these technologies and the 15-minute treatment consultation.
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