By Noh Hyun-gi

Without a doubt, the tension between the Ministry of Health and Welfare and the Korean Medical Association (KMA) is culminating this month.

Doctors are vehemently opposing the government’s plans to reduce out-of-pocket costs for patients with chronic conditions and centralize the process of settling medical disputes to preempt legal actions that came into effect in April.

Though the ministry released a compilation of questions and answers on Tuesday to lubricate the friction, much is left to be resolved.

Amidst the bureaucratic wrestling, patients are asking the public and the parties involved to consider their position.

Disagreements over diabetes and hypertension care initiave

On April 1, the government enacted the Chronic Disease Maintenance Policy which provides discounts to a patient with diabetes or high blood pressure if he designates a primary care unit for continuous treatment. The patient’s copayment level (how much a patient pays after insurance coverage) will drop from 30% (2,760 won per visit) to 20% (1,840 won).

Roh Hwan-kyu, chairman-elect of the KMA, held a conference with directors of regional medical associations to assert its opposition Sunday.

The initiative, which has been in the works for the past year, encourages patients to visit local clinics and practices and incentivize practitioners at small establishments to provide systematic care. It also strives to curb over-utilizing secondary or tertiary care units such as university hospitals.

Many view that medical practitioners are against the policy to ensure their profit margins. The Korea Association of Patient Groups is pleading with doctors to cooperate. “Is it ethical for a doctor to deter patients from receiving managed care for diabetes and hypertension at a discount with the new policy?” questioned the interest group in a statement released Monday.

In doctors’ defense, Roh emphasized that the mandate may jeopardize the quality of care and expose individuals’ medical records to leaks and abuse.

“The problem is that it attempts to separate treatment and illness management,” he told The Korea Times at the KMA office in Ichon-dong, Seoul, Monday.

While the patient receives treatment from primary units, the public health centers will gain access to their medical data and offer education and notification services. Without proper infrastructure to secure data transfer and management, personal information is at risk, he said.

“The health centers which are responsible for public awareness on disease management and oversee professional care givers are (unrightfully) already practicing medicine to an extent. On top of that, they are government bodies, which mean they prioritize minimizing healthcare costs over delivering quality service,” Roh said.

The doctors’ group worries that the centers will influence practitioners in their own clinics to become more economical.

The KMA is willing to relinquish all financial incentives (the ministry allocated 35 billion won to award physicians who participate successfully in the program) on the following grounds; 1) public health centers refrain from providing medical treatment 2) patients receive the co-pay deduction at any primary care unit and 3) the agency will not supervise practice of medicine.

The document from the ministry body argues that the new measure is not aimed at threatening a physician’s autonomy or deteriorate the quality of medical service.

The report also outlines that health centers will only provide peripheral services and the ministry will marginalize the centers’ medical responsibilities except in disadvantageous areas.

Furthermore, the official highlighted that the centers will not require medical records of patients; one needs to provide contact information to subscribe to email and text notifications.

Burden of delegating medical dispute

On Monday, the ministry launched the Korean Medical Dispute Mediation and Arbitration Agency (KMDMAA) which will handle all debates between patients and medical professionals or institutions.

The goal is to avoid taking the cases to court and to streamline procedures. According to the new agency, the number of medical disputes reached 3,600 cases in 2010; the legal actions take up to 26 months on average. The KMDMAA aims to settle disputes within 90 days.

The establishment accompanies the recently amended law that obligates obstetricians and gynecologists to give compensation in no-fault accidents. This clause takes effect in April 2013.

As the procedure can commence once both parties (patient and physician or medical institute) agree, the refusal by the doctors to participate is detrimental.

“Simply put, there are no incentives for doctors to use this service,” Roh said.

The doctor’s association urges its members to boycott the new agency; it stressed that doctors should not be responsible for any charges filed through the agency, nor should they apply for positions with it.

The most controversial and ironic clause is the one that obligates obstetricians and gynecologists to pay for no-fault accidents that cause cerebral palsy, (prenatal brain damage), or the death of mother or baby during delivery. By definition, one cannot blame physicians for no-fault accidents. Yet, the law specifies that medical professionals are liable for payment of up to 30 million won. The government will contribute 70 percent of the entire indemnity cost.

“I am not aware of any other country that makes a doctor compensate for accidents that were outside his control. We simply can’t accept this,” Roh said.

The Korean Society of Obstetrics and Gynecology published an official statement that its members will not recognize the law. The practitioners are fuming that they will be held liable for accidents when the birth rate is already low in Korea, threatening the livelihood of their practices.

Roh also pointed out that individuals with adequate medical expertise are underrepresented at the agency. Two physicians will sit on the Investigation Council that will initially review a case with two law practitioners and one official from the Consumer Rights Commission. The Arbitration Council, a body that coordinates settlements based on the investigation, consists of one health professional, two law practitioners, an official to represent consumer rights and a professor.

“We need more personnel trained in medicine to determine whether, for example, a filed case is an accident or not. The government does not trust doctors, and in a way, we are to blame for the loss of faith,” Roh said.

The method of payment is restrictive for doctors as well; the agency will pay the settlement fee and deduct the amount from the support practices receive from the ministry.

In addition, doctors fall under a myriad of obligations and restrictions — if they fail to present requested documents, they are subject to a 30 million won fine; failure to show up at meetings results in a 5 million won fine.

At any point in the process, the complainant can decide to take the case to court and file a lawsuit.