‘Privatization of healthcare’ comes from Jinju

Disclaimer: The following is a totally unauthoritative personal translation of an article appeared in <Hankyoreh 21> on March 25, 2013, reporting Gyeongsangnam-do province’s sudden despotic decision to close Jinju Medical Center, a public hospital of 103 year long history, for an ostensible reason of mounting operational loss. All rights regarding this post stay with the author(s) of the original article or with <Hankyoreh 21> and this post will be scrapped immediately at their request. In the post, I tried to match the English translation of names of people / institution(s) / position(s) to authentic one(s) as much as possible but, unfortunately, some of them still can be different. Original article of this post (in Korean) can be found in the link at the bottom.

Editor’s note: After 103 years since it opened as ‘Jinju Ja Hye Won’ under Japanese colonial rule in 1910, Jinju Medical Center, a public healthcare provider, started to take necessary steps for closure. It’s the consequence of a closure announcement by Gyeongsangnam-do (Gyeongnam) province who supervises the hospital for prolonged accumulation of operational loss. This is the first case where a public hospital that takes up public healthcare responsibilities private hospitals shun away is ordered to shut down. Since the province’s high-handed decision, patients were transferred to private hospitals one after another leaving only the most helpless ones behind forcing them to suffer uneasy hours. Doctors rejected for renewal had to leave powerlessly, only to leave employees to take to streets to appeal to provincial residents. Hankyoreh 21 visited Jinju Medical Center on March 12. If nothing happens, its closure will be finalised in about a month. All patient names are aliases.

Commotion broke up at dormant room 5108. A correspondent from a local newspaper just finished asking opinions on hospital closure to patients. Gentle face of Mrs. Myeong-hee Song (84), wife of Mr. Byeong-cheol Kim (89) who had been hospitalized for terminal lung cancer blanched with horror. “We’d rather die here. We can’t go back home. Even right now, he can’t breathe well (without oxygen mask) and water (in his lung) should be pumped out. There would be no room for him in college hospitals and other hospitals are too crowded.” Grandfather who had been sitting still without a word all day long made a loud voice. “I am about to die anyhow so where will I go? No one knows if that would be today or tomorrow.” Pouring out all his anger, he seemed like out of breath and laid his back to the bed with his oxygen mask on. Grandfather Seok-ho Moon (89) who had been lying on the bed next to his one relayed his concerns on. “I have a son and a daughter-in-law but they are too busy to be relied on. I stayed at a college hospital for several days once but it costed hundreds of thousands of won a day for nursing fee. I couldn’t afford it. But here, it’s just ten thousand won a day. They say it will take about three more months and I am worried about the cost. I can’t go anywhere else. I will stay here until permitted and will go home. When I go home, I will feel safe even if I have to crawl.”

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» It is highly likely that Jinju Medical Center will be the first closed public hospital. Ignoring backlashes from provincial residence, provincial assembly, as well as employees, Gyeongnam province pushes for its closure. Final decision will be made at provincial assembly in mid April. Yong-il Jeong Hankyoreh 한겨레 정용일 기자

Furors from abruptly kicked out patients and their families

In room 5108 are five old patients who would remain there until the hospital closes. Grandfather Young-jin Kang who had been hospitalized since last Feb. due to severe hemoptysis even said “I will go out only when I die.” But, according to hospital regulation, four patients except grandfather Byeong-cheol Kim who needed his wife’s constant care should have left hospital on last March 8 because Jinju Medical Center’s ‘Room without family guardian’ project that had provided nursing care with an affordable rate to patients over 65 years of age who did not have anyone to look after them was discontinued all at once and all nursing contractors left. It was deadly to grandfather patients who did not have any family member to care for them. But, instead of moving to other private hospitals, they moved to room 5108 where they could get help from someone there. That’s why room 5108 is occupied although all other rooms are more or less deserted.

Steps to close Jinju Medical Center were moving on brisk. Gyeongnam province did not even wink at fierce acrimony from provincial assembly and from Jinju Medical Center employees against it’s blitsing closure announcement. Rather, it forewarned a revision to “Ordinance on the establishment and management of regional public hospitals” that stroke out Jinju Medical Center from regional public hospitals of Gyeongnam province and pushed forward the final legal steps for closure. On the same day, it launched a committee for restructuring province-invested institutions that would also oversee the closure of Jinju Medical Center. It also proceeded administrative steps to paralyze Jinju Medical Center’s clinical function. It discontinued public healthcare project ‘Room without family guardian’ that it had supported and declined to renew contract for the head of internal medicine department, the only specialist general practitioner of the hospital. That was to kick out in-house patients and to stop outpatients from getting in. It was effective; the number of patients dwindled from about 200 just before the closure announcement to 133 on March 12.

Spent 24.2 billion won on Geo-Ga bridge construction

Patients and families that were suddenly kicked out of the hospital were sizzling with furror. Mr. Jin-gab Song (52), a taxi driver we met on our way to Jinju Medical Center, fumed when he heard the word ‘Jinju Medical Center.’ His story went on like this. He hospitalized his mother for dementia on February 19 under the ‘Room without family guardian’ scheme. But, on March 6, just after half a month later, he was notified “to move her to a private hospital province designated” by the Gyeongnam province, without any apology or even any explanation. “Jinju Medical Center costs ten thousand won a day; privat hospitals cost thirty thousand won a day. I can’t afford to pay nine hundred thousand won a month for her care. The private hospital said to me they would charge me as Jinju Medical Center had done but I don’t know how long they would do that. I voted for Mr. Jun-pyo Hong (Governor of Gyeongnam province) since he told us he would make life better for us poor people but I didn’t know he could eat his words this easily.”

Lives of Jinju Medical Center employees are also being torn down by this unilateral closure decision. Overall 236 people including 17 doctors (5 public health doctor) work in Jinju Medical Center. These that are to lose their work place out of blue take their matters to streets during weekends, holidays and their dayoffs since the closure decision. They go to Gyeongnam province office in Changwon city and hold a protest rally everyday. They also collect signatures against the closure from provincial residents. Nurse Ms. Mi-young Cho (45) said “It’s saddening thinking of last five years of efforts to share the pains to turn the hospital back to normal.” She, a nurse of 23 years of experience, gets just 2.5 million won a month as she used to do since 2008. And that, she time to time didn’t get any wage from the hospital for 3 ~ 4 months since last year. Even now, she didn’t get 7 months of wage. Though she and her husband both had jobs, they had to live tight and resort more to their credit lines. Unable to put up with the payment delay, young nurses left hospital one after another but she stayed there tenaciously. She said “This is my first job so I am attached to this place a lot. Especially, there are more than 50 old people who don’t have anywhere else to go in my old people ward. Now, I think more of protecting those old people.”

Depite backlashes from patients as well as employees, Gyeongnam province raises grave mismanagement for the main reason for closure decision. Mr. Han-hong Yoon, administrative deputy governor, said “Jinju Medical Center is losing 4 ~ 6 billion won every year. It has 30 billion in debt already. We can’t help but to close it.” He meant that province could not inject tax payers’ money to Jinju Medical Center who would deplete all capital within 3 ~ 5 years and go bankrupt afterwards.

But union directly confronts it saying that “The management condition is not as bad as to close it altogether right away.” Actually, according to the balance sheet, average annual loss over 5 years since it moved from Joongan-dong to current Choan-dong in 2008 has been about 5.6 billion won. But, if we discount the depreciation cost that is counted as loss in accounting but does not cost any real money, annual average net loss is just about 2.5 billion won. Gyeongnam province’s assessment that Jinju Medical Center will impair all of its 33.1 billion won capital (2012 estimate) in 3 ~ 5 years and go bankrupt is, in this sense, a huge exaggeration. On top of that, Gyeongnam province’s subsidy to Jinju Medical Center for public healthcare projects has been about 1.2 billion won on average for the last three years, which is just a modicum compared to Gyeongnam province’s payments to private construction companies for civil engineering projects like Geo-Ga bridge (annually 24.2 billion won), Ma-Chang bridge (10 billion won). Mr. Seok-yong Park, Jinju Medical Center regional head of Korea Health and Medical Workers’ Union (KHMWU), retorted “Every year about 200000 people visit Jinju Medical Center. As a public healthcare provider, we provide medical service at a price lower than private hospitals, about 3 billion for a whole year, and losses occur inevitably. But, when a nearby town of 13 thousand households starts to take new residents and an apartment complex under construction of 4 thousand households is done, then we’ve got the full potential for growth. Even in this circumstance, Gyeongnam province simply insists on closing Jinju Medical Center. We can’t get that.”

According to the balance sheet, Jinju Medical Center recorded losses of annual average of 5.6 billion won for five years since 2008. But, if we discount the depreciation cost that is counted as loss in accounting but does not cost any real money, annual average net loss is just about 2.5 billion won. Gyeongnam province’s assessment that Jinju Medical Center will deplete all of its 33.1 billion won capital (2012 estimate) in 3 ~ 5 years and go bankrupt is, in this sense, a huge exaggeration.

“Other provinces may follow suit”

Other regional hospitals show extreme interests on Jinju Medical Center incident. Management crisis is something all regional hospitals experience similarly. In fact, according to Ministry of Health and Welfare’s ‘Assessment report on management of regional public hospitals’ in Jul. last year, mere 7 regional hospitals (out of 34) made profits in 2011. And that, the net profits were just 100 ~ 600 million won range. Kimchon Hospital where medical staffs worked unpaid in Saturdays was the only hospital that marked profit from medical service area. Furthermore, hospitals like Kunsan Hospital (41 billion won), Pusan Hospital (36.8 billion won), Seoul Hospital (31.4 billion won) had more debts than Jinju Medical Center (25.2 billion won), which means there can be the second or third Jinju Medical Center in the future.

Currently, it is not likely that Gyeongnam province will overturn it’s closure decision. The provincial assembly that is supposed to handle the ordinance revision in mid Apr. is favorable to Gyeongnam province. 40 members (out of 58) are from Saenuri party. Mr. Ji-hyeon Yoo, the leader of KHMWU, said “We never thought that they would close a public hospital on the ground of profit. Now, they have a precedent and other regional governments may think they can close public hospitals. It can damage public healthcare and privatisation of healthcare is coming closer and closer.” It means Jinju Medical Center incident is not something that can happen to others only.

Reporting by Bo-mi Seo 서보미 기자 spring@hani.co.kr
Photo by Yong-il Jeong 정용일 기자 yongil@hani.co.kr

Jinju Medical Center may be used for 2nd provincial office

Why did ‘Chief Hong’ provoke?

Gyeongnam province Governor Jun-pyo Hong was called ‘Chief Hong’ while he was a member of national assembly. Irrespective of whether it was a compliment or a derision, it menas he has balls to break through resistance. But his sole decision to close Jinju Medical Center without conferring to either hospital employees or Jinju city council or Gyeongnam provincial assembly is criticised way over the line and considered even as despotic. Why did Chief Hong provoke like that?

There are three assumptions. First, pure execution of his election promise. This is based on the assumption that we trust Governor Hong wholy. This is an assumption that he decided to close Jinju Medical Center while trying to solve province’s debt issue as he had promised during his election campaign. But this does not seem plausible. Mr. Hyeon-seung Park, the KHMWU Ulsan region Gyeongnam headquarter organization manager, said “booked asset value of Jinju Medical Center is 61 billion won but it could be 100 billion won now considering recent substantial price spike of hospital site and building. When debts are paid, the net fund that Gyeongnam province will get from the transaction is about 70 billion won. I don’t know how much help they can get from this money in resolving Gyeongnam province’s debt problem which amounts to 1 trillion and 300 billion won.”

Next, ‘Jinju Medical Center, a scapegoat theory.’ Governor Hong, intending to lure Western Gyeongnam voters, promised “to build second provincial office in Jinju” during his election campaign. After being elected as Governor, he even nailed the time ‘within 2 years.’ The theory goes on like this: Governor Hong, having promised recklessly this way, found out that he does not have either money or time to build the second office in Jinju. Then, he came up with Jinju Medical Center idea. Jinju Medical Center constructed in 2008 is a 9 storey building in 54806㎡ area, which is more than enough to house second provincial office. Ms. Kyeong-sook Kim, member of Gyeongnam provincial assembly (Unified Democratic Party), said “I think Governor Hong must have come up with the pressed idea of closing Jinju Medical Center to regain people’s trust at regional election in Jun. next year. Last time when I called Gyeongnam province employee in charge of closing Jinju Medical Center and asked if they had any plan to use Jinju Medical Center for second provincial office, he replied that was one of the plan after closure. At present, that’s the most plausible theory.

There is another ‘collusion with regional wealthy land owners theory’ that goes another step. When second provincial office comes in to Jinju Medical Center, price of real estate near it will naturally spike high. This is a good news for wealthy local land owners. On top of that, to change a hospital into an office needs a remodeling almost like a rebuilding, which is another lucrative prey for local constructors. The theory says Governor Hong decided to close Jinju Medical Center which is a ‘two-bird-with-one-stone’ move to get second provincial office and widen his regional support base. Believe it or not.

Original article: http://h21.hani.co.kr/arti/special/special_general/34149.html

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