[KS] Is There A Doctor In The House?
adam&eve at henny-savenije.demon.nl
Thu Aug 31 12:35:08 EDT 2000
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Is There a Doctor in the House?
By O. Seong Kweon and Casey J. Lartigue Jr. Mr. Kweon, director of public
policy at the South Korea-based Center for Free Enterprise, is a visiting
scholar at the Cato Institute, in Washington, D.C. Mr. Lartigue, a staff
writer at the Cato Institute, worked as an educator in South Korea for more
than five years.
"Please don't get sick and don't speed while driving," said a sign posted
in March at a medical center in Asan, South Korea. This isn't typical
medical advice in South Korea -- it was a warning to South Koreans that a
major strike by medical professionals was set to commence.
For the last five months, the 70,000-member Korea Medical Association has
paralyzed health care in the country with a series of labor strikes. As a
result, an estimated 90% of the nation's 19,000 hospitals and clinics have
closed at one time or another, reportedly leading to the deaths of several
people seeking medical help, the arrests of doctors leading the strikes,
and a major rift between doctors and patients.
Medical professionals in South Korea are mostly angry about one thing: The
government-created monopoly that has allowed doctors and pharmacists to
line their own pockets at the expense of consumers may be coming to an end.
The seeds of the crisis were planted in 1977, when the medical insurance
system was first introduced. In exchange for price controls on medical
care, doctors were allowed to supplement their incomes by selling medicine.
Doctors have complained to the succeeding South Korean administrations that
their fees are "unreasonably low." A government spokesman recently
acknowledged that medical fees fail to cover about 20% of actual medical costs.
In addition to having a system that fails to cover medical fees, the sale
of over-the-counter medicine is also prohibited in South Korea. If you have
a headache or a stomachache in South Korea, you can't buy medicine at the
local supermarket or 7-11. Your only "choice" is to visit a pharmacist or
doctor. This government-created monopoly has been good for both pharmacists
and doctors, who were allowed to write prescriptions and sell medicine to
The result is that doctors and pharmacists have been over-prescribing
medicine. Expenditures on pharmaceutical products reportedly account for
about 30% of total medical costs in South Korea, much higher than the 8.4%
spent in the United States and 15% in the United Kingdom.
To make matters even worse, the South Korean government drives up the cost
of medical care by restricting the supply of doctors. Based on 1997
figures, there were 12 doctors for every 10,000 Koreans (compared with 58
doctors in Italy, 34 in Germany, 30 in France, and 27 in the U.S., for
every 10,000 people, respectively). In a concession to angry doctors
already practicing, the South Korean government has proposed restricting
even further the supply of doctors.
The South Korean government has sought to tackle some of its problems. It
recently announced it would curtail over-prescribing by dividing the duties
of medical professionals. Since Aug. 1, doctors have been prohibited from
selling most medicines and pharmacists have been prohibited from selling
medicine without a doctor's prescription.
This restriction, which re-ignited the strikes, makes sense within the
confines of the current system. As long as the sale of over-the-counter
drugs is prohibited, doctors and pharmacists should be keeping tabs on one
another instead of hanging on to prescription regulations and price
controls concocted by the government during the 1970s. And yet, while
reducing some of the over-prescribing, monitoring alone isn't the answer.
When it couldn't get the doctors and pharmacists to agree to its reforms,
the government started arresting doctors leading the strike, as well as
pharmacists selling medicine without prescriptions written by doctors.
Positions have only hardened. The Korean Medical Association has made it
clear that it will reserve the right to strike as long as doctors are not
allowed to sell medicine and possess the exclusive right to write
prescriptions. The nation's 50,000 pharmacists warn that they will go on
strike if the government gives in to demands by doctors. And President Kim
Dae Jung has drawn a line in the sand, insisting his administration "can
never tolerate selfishness on the part of interest groups through illegal
and violent means."
Few South Koreans are happy or satisfied with their health care system. Why
should the government be deciding what the roles of doctors and pharmacists
should be? Who should decide this, and who will decide who makes that
decision? For far too long the Korean government has been doing the
deciding, acting as judge, jury and negotiator.
There are three things the South Korean government needs to do to help end
what appears to be a stalemate and head off a major medical crisis. First,
it should stop meddling in the health care industry. The government has had
a stranglehold on the market, acting as the sole regulator of prices and
services. But that would mean recognizing that its previous policies are
what led to the current disaster in the first place. Its latest
recommendations and concessions (such as prohibiting pharmacists from
selling certain medicines unless they sell them in bulks of 30) hurt
consumers. The government needs to change its role as a micromanager of the
system to one limited to providing information. Doctors take the
Hippocratic Oath, "First Do No Harm." Mr. Kim's government needs to take a
Two, the government should allow the sale of over-the-counter medicine.
This will help to break the monopoly doctors and pharmacists have over
medicine, giving their captive customers a third option. What consumers
need are more information and choices, not knowledge monopolies and
Finally, the government needs to reform the entire medical insurance
industry. Holding down prices seemed to be a good bargain for consumers,
but price controls are now hurting them even more. Prices are out of
control and are what sparked the antipathy between doctors and pharmacists.
There is a Korean saying, "Every net has a hole." Doctors and pharmacists
have shown that they'll find a way around price controls, or go on strike
when the hole in the net is temporarily covered.
There is no perfect solution to the impasse. But by busting the monopolies
and allowing medical fees to find their natural pricing in a free market,
it is much less likely that South Korea's doctors will be posting signs in
medical centers telling patients to go away.
-- From The Asian Wall Street Journal
Henny (Lee Hae Kang)
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