The Second in a Series of Six U-Health Special Reports: Policy
Dropping the pebble of the Telemedicine Act Movement has sent ripples across the pond to lap at the shores of ubiquitous healthcare. The Health Insurance Review and Assessment Service (HIRA) has set off on a journey to make a great leap toward a u-healthcare system.
Straight from Guts
Limited number of Koreans received healthcare benefits in 1977. Within 12 and a half years, Korea miraculously succeeded in providing medical security to all citizens, breaking a world record. Here the word entire includes those without a social security number and those who cannot afford to receive a major operation in the midst of a life and death situation. By going through simple steps, local public offices will issue an alternate ID number for those who have no social security number, and the government loans or provides the major operation fees to those who are struggling financially.
Currently, the Korean medical industry is at a high quality level. “The average number of hospital visiting days per year is 16.8 per person. That clearly shows the strengths of Korean medical infrastructure where most patients visit medical institutions conveniently,” said president Song Jai-seong. A 2007 report indicated that Korea is a runner up of Mexico in terms of healthcare support amongst OECD countries, while covering W40 trillion (US$32.2 billion) out of the total W60 trillion (US$48.3 billion) in medical fees. Also, the survival rate of cancer is much higher than in the United States except in the area of prostate cancer.
In spite of the high medical standards and good environment, however, there are some notes of concern.
Areas to Improve
“Although Korean medical insurance coverage is above 65 percent on average, I believe it should be higher. Like other advanced countries, the coverage rate should be higher by tying all medical insurance costs together. In order to do that, insurance financing has to be secured and maintained. Due to the economic slow down and increase of the unemployment rate, it is difficult to accomplish this goal, but it will improve slowly,” president Song encouraged.
Another obstacle of the current medical industry is the oversupply of medical services. The medical insurance has started at a 0.6 percent coverage rate in 1977, which now is about thirty times more. Since then, over 3000 medical doctors are pouring into the country every year and over 10,000 beds are being annually increased. For every thousand people, 9 hospital beds are available, which is more than the OECD average of 6. Ironically, breaking OECD records in excellence of supplies and abundant manpower has been the cause of some of the recent struggles that hospital owners and unemployed doctors faced.
The demand for medical treatments is lower than the provided supplies, so more demand has to be created by making more content available to everyone. Although the level of medical systems and environment is equivalent to most advanced countries, advertisement and public relations-related regulations were restricted to host foreign patients, which does not help the urgent needs of a wide range of demands. Now the government opened the gate to welcome patients from overseas. “Marketing coordinators and effective advertisement should back up the government to take our advanced medical system to the global market,” president Song asserted. Currently, only the phone numbers and addresses of the hospital could be put in advertisements or guidebooks. What foreign patients want to find out is what the hospital is specialized in, and how much experience the physicians in the hospital have with a particular operation.
Knock on HIRA’s Door
For every troublemaker, there is a troubleshooter. HIRA, as a troubleshooter, is aware of where and how to begin to buck all troubles mentioned above. The key was taking full advantage of information technology as an early adaptor to digitalize its role and vision. For example, patients from overseas can visit the IPTV center of the HIRA website, read the hospital profiles to select the best fit, then soon enough the coordinator of the chosen hospital will be in contact. From there, foreign patients can even set up an appointment date.
“HIRA’s main role is to examine each hospital billing request from 78,000 medical institutions to confirm medical fees. A total of 1,700 workers thoroughly study each billing request to make sure that the medical fees were appropriately charged. If HIRA decides that a patient was overcharged for a particular medical service, it calculates and pays off the different to the patients. HIRA sends the approval request to the National Health Insurance Corporation, who then releases insurance. The data collected from 78,000 institutions is enormous, about 14 terabytes. The information could be used as a useful tool for patients at home and abroad to select the right medical institutions for themselves,” president Song said.
Great Leap Toward Ubiquitous Healthcare
In order to use the information efficiently, HIRA is planning to launch a U-Health program though IPTV. The content will be designed to help patients find the most suitable medical institution to fit their condition and to make a prompt reservation through two way communication. While HIRA will be in charge of producing content, LG Dacom will support the technology for the U-health program, and 200 selected households will be tested. The goal is to regularly check and treat patients with chronic diseases in the long term and to provide more detailed information about medical institutions.
President Song expressed with confidence, “Currently, HIRA’s hospital bill examination and evaluation system is the most efficient in the world. HIRA has the most data and all hospital bill requests are completed through an EDI [Electronic Data Interchange] system. In one year, among 1.2 billion cases of hospital bill requests, 40 percent of them are examined by the computerized system and the rest of the complex and professional examinations are conducted by 1,000 examiners and 50 doctors. There are also unofficial examiners consisting of university professors working in the field. The EDI system patent was exported to Japan and South Africa and 8 countries including the US are reviewing for international patent rights. In the next 4 years, based on a more intelligent program, HIRA is planning to raise the total examination rate to 65 percent and maximize efficiency as well as simplifying the examinations and treatments. It will be also a stepping stone to a U-health business through IPTV.”
HIRA’s other ultimate goal is to develop its own review system to further improve the cost and speed of medical treatments. By digitalizing everything, everything from the number of doctors, nurses, and facilities will thoroughly be reviewed for the sake of patients. Also, by developing Drug Utilization Review software, prescription drugs will closely be monitored. “About 34,000 kinds of drugs must not be prescribed together. There also are certain types of drugs that a pregnant woman or child should avoid. DUR software will show an alert sign to remind the doctors during the prescription process,” president Song stated.
U-healthcare supporting policies, therefore, are on a roll.
