|Implemented in this survey?|
Ministry of Health and Welfare launched a committee on health industry development, which aims to examine policy options to strengthen the competitiveness of medical service and hospital industry. Hospital industry and insurance industry maintain that privatization and deregulation, such as an extended role of for-profit hospitals and private health insurance, is the best way to health industry development, but many are worried that those changes will result in a two-tiered health care system
Government wants to strengthen the competitiveness of health care industry, to induce more innovations, to increase export in the area of medical technology and pharmaceuticals, and to increase
patients from abroad in the area of medical service and hospital industry. Government also expects that health industry development can help import substitution, such as reducing imports of medical
technology and pharmaceutical or reducing the flow of domestic patients going abroad for treatment (although the number of that types of patients is always controversial).
However the Achilles hill of the agenda of health industry development is the role of private sector in health care, particularly private health insurance and for-profit hospitals. Hospital sector and insurance industry regard the agenda of health industry development as a crucial means to extend the role of private sector in health care, namely, allowing for-profit (investor-owned) hospitals and extend the market share of private health insurance. They maintain that more active role of the private sector is the most effective way to develop health care industry and increase its competitiveness.
Develop health care sector as industry for innovations and competitiveness.
Non-financial and financial
Hospitals, Health insurance industry, Consumers
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
With moderate performance of economy, unemployment has been a lingering problem. Traditional manufacturing sectors such as electronics and automobile have failed to increase employment in spite of its good performance in export. Government now turns to biotechnology or service sector such as health and education to strengthen the competitiveness and improve employment opportunity.
|Implemented in this survey?|
Private sector in Korean health care has played a key role in the agenda setting for health industry development and competitiveness. Hospital industry has long criticized that government
regulation and tight fee scheduling are the major cause of low quality of medical care, and maintained that deregulation and privatization is the solution to health industry development. They view
that for-profit hospitals, which is currently not allowed, is a way to opt out of social health insurance system that is subject to tight regulation. They maintain that for-profit hospitals are much
better than its not-for-profit or public counterparts in the area of technology innovation and service quality.
Insurance industry also has a major stake in health industry development. Currently private health insurance pays lump-sum to enrollees based on diagnosis or inpatient days, rather than reimbursing the actual cost of medical care. Private health insurance industry thinks that policy for health industry development will lead to the increased role of private sector in Korean health care, and an extended market for private health insurance. For example, for-profit hospitals, if they are allowed to opt out of social health insurance, will be a big business market for private health insurance.
Ministry of Finance and Economy (MOFE) supports the idea of health industry development and private health insurance because it can help ease the financial burden associated with social health insurance, for which MOFE subsidizes contribution (government subsidy accounting for about 25% of total revenue of social health insurance).
Although Ministry of Health and Welfare (MOHW) launched the committee on health industry development, it has a neutral position toward privatization in health care, but it wants to pre-empt the agenda by instituting the committee. Development of health industry itself is good news, but if it is related to privatization, it can be bad news for the MOHW.
The approach of the idea is described as:
Idea of health industry development and competitiveness has called for hot debates. Progressive civic groups are strongly opposed to for-profit hospitals and the increased role of private health
insurance. They maintain that the policy has the risk of the collapse of public health insurance and public health care system because government will no longer be willing to put more resources in
the public health financing and delivery system. By the same token, National Health Insurance Corporation (insurer of social/public health insurance system) is opposed to it.
Korean Medical Association (KMA) had been a strong supporter of the idea of health industry, like Korean Hospital Association, but it has recently changed its position to ambivalent or no official position. Initially, KMA thought that health industry development and privatization will give them more profit opportunity. However, they have realized that private health insurance can be a tough negotiator in fee setting and claim reviews, as in the case of
|Ministry of Health and Welfare||very supportive||strongly opposed|
|Ministry of Finance and Economy||very supportive||strongly opposed|
|civic groups||very supportive||strongly opposed|
|progressive academics||very supportive||strongly opposed|
|Private Sector or Industry|
|Hospital Association||very supportive||strongly opposed|
|Insurance Industry||very supportive||strongly opposed|
|Ministry of Health and Welfare||very strong||none|
|Ministry of Finance and Economy||very strong||none|
|civic groups||very strong||none|
|progressive academics||very strong||none|
|Private Sector or Industry|
|Hospital Association||very strong||none|
|Insurance Industry||very strong||none|
Government decided to allow foreign (for-profit) hospitals in the free-trade zone near Incheon International airport. However, more detailed issues remain to be decided, e.g., whether to allow domestic for-profit hospitals in the free-trade zone, whether patients to those for-profit hospitals should pay 100% of the cost out of their own pocket or social health insurance should cover a given proportion of the cost, etc.
The key issue of the new committee on health industry development is private health insurance and for-profit hospitals. The impact of allowing for-profit hospitals and increasing the role of
private health insurance on the efficiency and equity of Korean health care system will be fundamental although it is still uncertain whether they are positive or negative impacts. Many agree that
for-profit entities in health care can result in health care cost inflation, but controversies continue over its impact on quality or consumer satisfaction. Service aspect of quality may improve but
objective measure or outcome-based quality may be worse in for-profit hospitals because they may sacrifice quality to maximize profit. Hospital rating/evaluation and information dissemination can be
more effective than allowing for-profit hospitals in improving health care quality.
Critics also maintain that privatization will result in unequal access to medical care, and public support for social health insurance system erodes as more people purchase private health care, eventually decreasing government resources to health care and leading to a two-tiered health care system.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|