[Contribution] It’s the quality of healthcare, stupid. < Opinion < Article

During the 1992 presidential election, Bill Clinton coined a slogan that has stood the test of time: “It’s the economy, stupid!” The catchy phrase was recognized as a wise statement that captured the zeitgeist, and Clinton was elected as the 42nd president of the United States.

Likewise, an insightful healthcare professional would characterize the Yoon administration’s healthcare reform in 2024 by saying, “It’s the quality of healthcare, not the quantity (number of doctors)!”

Number of doctors (quantity) is a component of the healthcare system (quality)

The number of doctors may or may not need to increase. In other words, an increase in the medical school enrollment quota may or may not be necessary. A consensus in our society is that the issue should not be determined solely by doctors’ claims as healthcare providers but should reflect the government’s policy and the opinions of the public as consumers.

An essential premise is that the number of physicians is a subset of a larger healthcare system.

For example, our healthcare system has always operated under a fee-for-service system. Each medical procedure, such as a doctor’s visit, CT scan, or surgery, is billed separately. A single insurer, the National Health Insurance Service (NHIS), sets the fees for treatments and drugs with medical service providers, and all medical institutions follow this system.

This efficient system has helped Korea achieve the triple aim of high quality, accessibility, and low healthcare costs while boasting the third-highest life expectancy in the OECD and the highest number of outpatient visits in the Organization for Economic Cooperation and Development (OECD).

However, dark problems and challenges are ahead for the Korean healthcare system. Over the past few years, the media has reported a series of gloomy news, including “open run” (waiting outside pediatric clinics before they open), “ER wandering” (going around emergency rooms for vacant beds), the collapse of the provincial healthcare system, and the mounting burden of caregiving costs.

In the medical community, we call them by many names: avoidance of specific departments, a broken delivery system, a crumbled emergency medical system, the contradictions of fee-for-service represented by the three-minute treatment, a healthcare system distorted by actual cost insurance, a broken patient-physician relationship, medical litigation, and current medical expenses that exceed the OECD average.

Will increasing the number of medical students by 2,000 solve these systemic problems, as the government claims? The medical community suggests that if we improve the quality (healthcare system) sufficiently, maybe the quantity (number of doctors) won’t be a problem.

The government cited three papers as evidence on Feb. 6, 2024, when it announced the “2,000 more students” from the existing 3,058 medical school enrollment quota.

The three papers are “Study on the Adequacy of Physician Manpower to Prepare for the Future Society” (Professor Hong Yun-chul, Seoul National University, 2020), “Projection of the Ripple Effect of Population Change on the Labor, Education, and Healthcare Sectors Reflecting the 2021 Future Population Projections” (Seoul National University Office of Research Affairs R&DB Foundation, 2023), and “Comprehensive Healthcare Manpower Planning and Mid- to Long-term Supply and Demand Estimation Study” (Korea Institute for Health and Social Affairs, 2020).

The researchers who led all three studies disagreed with the government’s 2,000-student increase in several discussions and media interviews. Their reports never suggested the number 2,000, and they said the socioeconomic costs of increasing the number are far greater than the benefits, given the educational environment.

The researchers also acknowledged that their estimates are likely inaccurate because they assume the healthcare system is as it is today and that their estimates could change if healthcare reform is enacted. Some researchers emphasized that improving healthcare use behavior and the healthcare delivery system is more urgent than the supply of doctors.

In a statement issued on Oct. 21, the Seoul National University Faculty emergency committee, which represented the medical community, argued that “supply and demand estimation studies require appropriate data, realistic assumptions, and scenarios that reflect improvements for a desirable healthcare system.” It also said that “the three studies were conducted under the assumption that the supply and demand for medical services will continue,” noting that it is necessary to conduct new estimation studies by introducing scenarios that consider the effects of improved healthcare policies.

‘Korea has sufficient doctors if it changes the healthcare system’

At the Korean Association of Medical Colleges (KAMC) conference on Nov. 22, Professor Hong Yun-chul of Seoul National University School of Medicine revealed some of the results of the new estimate of the number of doctors. According to the study, the number of doctors can be sufficient if the medical system is changed without expanding the medical school enrollment quota.

The original paper, which was the basis for the expansion of medical schools, used data from 2018 and predicted a shortage of around 10,000 doctors in 10 years. It assumed that the supply and demand of doctors would be in balance or that doctors’ productivity would decline by 75 percent after 65.

The study, based on data from 2020, considered various scenarios for changing the healthcare system, including “value-based medicine” that reorganizes the payment system along with “advances in medical quality,” a “primary care physician” system that knows individuals’ illnesses well, and the restoration of the “healthcare delivery system” between clinics, hospitals, and tertiary general hospitals.

In various scenarios to change the healthcare system (quality), the conclusion was repeatedly drawn that there is no need to increase the number of doctors (quantity).

It’s time for the government to remind itself, “It’s the quality (healthcare system), not the quantity (number of doctors)!” It should proactively reform the healthcare system and determine the quantity (number of doctors) through a neutral estimate of the number of doctors that involves experts from various fields and provider-consumer participation over the next few years.

The government’s push for increasing medical students has already lost credibility and momentum. This is the common opinion of the medical community as providers, citizens, and patients as consumers.

To prevent further unnecessary social disruption and to avoid training 7,500 doctors, which is impossible, the government must “pause” medical school recruitment for 2025. Healthcare consumers and providers will have to come together to channel the current social attention into improving the healthcare system in desirable ways.