Kim Rahn is the managing editor of The Korea Times. Since joining the company in 2003, she has covered various beats including the presidential office, Seoul city government, the Bank of Korea and the tourism industry. In 2014, she won the Society of Publishers in Asia (SOPA) award for her coverage of the ordeals of migrant women in Korea.
Court allows 'optional treatment'
By Kim Rahn
The top court has partly allowed hospitals to provide patients with new medical treatments that have not yet been approved by the national health insurance and thus won’t cover the costs.
In the suit filed against the Ministry of Health and Welfare and the National Health Insurance Corp. by Yeouido St. Mary’s Hospital, the Supreme Court said on Monday an “optional treatment” can be permitted in exceptional situations, referring the case back to the Seoul High Court for re-examination.
The ruling overturned the top court’s precedent in a 2005 ruling that such optional remedies should not be allowed under any circumstances. The new decision is likely to spur new debates in the medical circle.
The case ignited in December 2006 when 200 leukemia patients and bereaved family members of former patients filed a complaint against the hospital, saying it used an anti-cancer medicine which was actually for breast cancer patients, as an optional treatment and overcharged them.
Like in other countries the national insurance covers some medical treatments and patients must pay for the ones that it doesn’t. Of the medical services that are not covered, some are permitted by the health authorities, while others, listed as “optional,” are not. The optional treatments include new remedies and hospitals can use their discretion for pricing.
The ministry then inspected the hospital in question and ordered it to pay a total of 11.6 billion won in fines. In response the hospital filed the suit to annul the penalty.
“If we consider the purpose of the national health insurance system, any uncovered optional therapy is improper in principal. But doctors are obliged to provide the best treatment they can, the court said.
“So such treatment can be permitted in exceptional cases when it is medically safe and effective; when patients need it urgently although it takes a long time the insurance system hasn’t acknowledged the new cure; and when doctors fully explain it to the patients and get their consent,” it continued.
But the court said it is the role of the hospital to prove whether optional treatments satisfy the three conditions, demanding the appellate court review whether Yeouido St. Mary’s did this.
Before the ruling, the optional remedy issue incited heated debate on whether it gave patients and doctors more freedom to choose therapy or instead damaged the stability of the national health insurance system.
Doctors welcomed the decision, saying they will be able to apply treatments which were proven to be safe in other countries but not yet possible here because the health authorities have been slow to recognize them.
“It is evident that there is a need for optional treatments. We urge the government and the National Assembly to revise the insurance system,” the Korean Medical Association said in a statement.
Concerns exist that hospitals may abuse optional treatments, such as using remedies of which the efficacy hasn’t been fully proven, or pressing unnecessary or expensive remedies on patients who don’t have enough medical knowledge.
“No seriously ill patient will refuse an optional remedy if doctors say it is necessary. The ruling may financial burden such patients,” a member of a leukemia patients’ group said.