Do you really know what public healthcare means?

Disclaimer: The following is a totally unauthoritative personal translation of an opinion appeared in <Hankyoreh 21> on March 25, 2013 on the meaning of public healthcare. 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.

Jinju Medical Center incident is dashing to a climax. They say they are going to close it. They say it was a conclusion after careful consideration. I hope so. They might not took it lightly to close a public institution. But were they? I hope it was not just Gyeongnam governor Jun-pyo Hong’s sole decision. I hope he conferred to many specialists and public servants in the field before making his mind. But I don’t know if he knows that OECD countries maintain public hospitals and healthcare providers to a level between 35% and 100%. The lowest levels are in US and Japan but our level is 1/10 of their levels. A few years ago, fierce public outcry broke out when UK government announced to privatize public hospitals. This, oddly, became the ground for people who claimed “we should privatize public hospitals as well.” But, in UK, it was to give away just a few % point out of 100% dominance of public hospitals. Why do they insist on maintaining portion of public healthcare providers to such a high level? Here are my own conclusions from personal experience of being a head of regional public hospital for 13 years.

5705a72b9002fe0cca8940c592b15bc4» Public hospitals, unlike private hospitals, have not pursued profitability; rather, they have taken up crucial public healthcare mission for our people. When SARS endemic was around in 2003, it was public hospitals who took up the deadly risk of caring for patients. Jong-geun Lee, Hankyoreh 한겨레 이종근 기자

Regional public medical centers, as public healthcare providers, do not look for profits

Let us see what are different from regional public medical centers, archetypal public healthcare providers, and private hospitals. According to a survey, half of staff doctors in regional public medical centers (except for public health doctors who chose regional public medical centers instead of military service) said that “I chose regional public medical centers because I can care for patients as I wish for.” What does this mean? Private hospitals, though non-profit organizations, are established by individuals. So, they have to make profits. To make profits, they run their hospitals focusing on departments like internal medicine or orthopedics that can make a lot of profits. Sometimes they lure doctors to do excessive treatments by paying them commensurate hefty incentives. But regional public medical centers, as public healthcare providers, do not look for profits. They don’t have to treat them to charge expensively. So, they don’t rake treatment fees by adding more tests or expanding the portion of uninsured treatments. Last year when accounting firms, commissioned by Ministry of Health and Welfare (MHW), assessed 34 regional public medical centers around the country, daily payments for in-house patients turned out to be about 80% of that of private hospitals of similar size. This is why low income healthcare vulnerable social class people come to regional public medical centers. Though many think that public healthcare providers exist for low income people, actually they are not; rather it evolved in that way because they tried hard to reduce the burden of treatment cost through reasonable treatment practice and low income vulnerable people flocked to regional public medical centers for that reason.

Since they charge much less compared with private hospitals, most regional public medical centers suffer from management loss. To this, many experts advise private hospitals to benchmark private hospitals’ efficiency and get out of chronic losses. But what does the high efficiency mean? For instance, let’s consider an appendectomy. If regional public medical centers charge 800,000 won and private hospitals charge 1,000,000 won for the same procedure, experts may say private hospitals more efficient in profit-to-investiment terms but they should say regional public medical centers more efficient in terms of total cost in treating an appendectomy patient.

It is impossible for regional public medical centers to pursue efficiency from the beginning since regional public medical centers should maintain necessary clinics to meet local demands irrespective of profitability. If there’s no pediatric clinics with patient ward in the region, regional public medical centers should run a pediatric ward.

Public medical centers took up all SARS patient treatment in 2003

On top of that, it is impossible for regional public medical centers to pursue efficiency from the beginning since regional public medical centers should maintain necessary clinics to meet local demands irrespective of profitability. If there’s no pediatric clinics with patient ward in the region, regional public medical centers should run a pediatric ward.  So, they had to hire pediatricians. If the profit of maintaining the pediatric ward cannot make up for the running cost, is it right to close the pediatric ward? If so, then how can we guarantee local residents constitutional rights?

Some regional public medical centers who marked profits once was able to do that not through profits from clinics but mainly through funeral service or health screen service. Therefore, regional public medical center presidents think a lot on expanding not only clinical wards but also funeral halls or health screening centers. Some bitterly satire like ‘hospital affiiliated to funeral hall’ or ‘hospital affiliated to health screen center’. Practices not to save lives through medical treatment but to make profits from healthy people or the deceased are actively pursued even presently.

But, let’s suppose that all regional public medical centers are run, like private hospitals, for the purpose of making profits. If regional public medical centers act like private hospitals, they there’s no reason for local governments to run regional public medical centers. If they close regional public medical centers for not making enough profit instead of for treating patients properly and running clinics required for local residents rather than for making profits from affiliated service, how can they say it’s different from claims for privatization of regional public medical centers.

The primary reason regional public medical centers are on the brink of forced closure is due to local governments’ unclear goal of running regional public medical centers. For the very Samcheok Medical Center where I used to run, the supervising local government Samcheok city alwasy wanted me ‘to treat this many patients’ and ‘to make this amount of profit.’ It seemed like they did not have any vision for running a public hospital; rather it seemed they only cared for avoiding the fear of losing money. But medical staffs of public hospitals have performed much more public function than they think. In 2003, the SARS endemic rushed into our country from China. As far as I remember, no private hospital took care of any of those patients because, frankly, it is quite a daunting job to treat the horrible endemic even to most medical staffs. It was public hospitals like regional public medical centers that actually accomplished this risky job. Then MHW employee in charge of SARS endemic even said that “they could not have done it without the help of public hospitals.” Governments always argue that private hospitals should help governments by performing public medical purposes by revising the law on public healthcare, I think it’s highly unlikely for private medical staffs who do not have any sense of public good to put their lives on the line to a handful of penny.

Local residents should be involved in hospital board

We should reshape the aim of establishing regional public medical centers to meet the spirit of public medicine before it gets too late. And we should endow proper mission to regional public medical centers according to specific purposes in line with the aim. Also, we should let many local residents to get involved in hospital board, the premier decision making body. It is inevitable that medical treatment to vulnerable people will be reinforced and medical expense for nearby private hospitals will be checked more once local residents supervise and oversee regional public medical centers. Since they are public hospitals, government and local government should share the cost 50-50. I hope regional public medical centers establish themselves as true public hospital by gaining love and trust from local residents.

Chan-byeong Park, former head of Suwon Public Medical Center, Samcheok Public Medical Center

Original article of this post:


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