보건복지부 영문홈페이지

Reinforcement of Essential Healthcare that Directly Relates to Human Lives

Announcement of 「Essential Healthcare Support Measures」

<10 Key Tasks to Support Essential Healthcare>

1. Restructure and expand the emergency care system to guarantee the availability of final treatment

2. Introduce a duty-rotation system between hospitals to rapidly respond to critical emergencies

3. Reorganize the treatment system for cardiovascular and cerebrovascular diseases focusing on specialized medical care

4. Introduce stricter evaluation and designation standards for tertiary general hospitals to provide a better quality of care for serious illnesses and pediatric illnesses

5. Reorganize the treatment system for mothers and newborn infants based on level of risk and severity

6. Establish a pediatric care infrastructure that can guarantee a full-range of services from primary care to the treatment of emergency and severe illnesses

* ➀ Establish a treatment system for pediatric cancer ➁ Expand pediatric emergency care system ➂ Improve medical fee schedule for pediatric inpatient treatment ➃ Enhance support for primary pediatric care

7. Introduce a public fee schedule to overcome the limits of the current National Health Insurance medical fee schedule

* ➀ Introduce retroactive payment for children’s public specialized medical centers to compensate for their financial losses ➁ Introduce a regional fee schedule ➂ Compensate night time and holiday duties ➃ Increase compensation for highly risky and complex surgeries ⑤ Compensate emergency patient transfers between hospitals

8. Restructure resident workforce deployment standards and develop a hospital bed management plan

9. Train healthcare workforce to improve essential healthcare

10. Heavier responsibility taken by the government to create a better medical treatment environment for unavoidable medical malpractice cases

* ➀ Increased share and responsibility of the government in compensating for unavoidable childbirth malpractice cases ➁ Further review to relieve the burden on medical professionals and to provide better relief to victims

 

The The Ministry of Health and Welfare of the Republic of Korea(Minister Cho, KyooHong) announced the finalized version of 「Essential Healthcare Support Measures」on the 31st of January(Tuesday).

Recently, due to a deteriorating essential healthcare system, there has been an increasing number of emergency patients who failed to receive essential treatment in time and who were forced to travel to regions outside their residential area to get treatment.

In July last year, even a nurse who suffered a stroke while she was working in a large hospital in Seoul failed to get treatment in time and died. This incident has made many people worry about the unavailability of essential medical treatment that can lead to serious issues.

Responding to the situation, the Ministry of Health and Welfare has organized more than 20 meetings* with experts in the field and in academia to get their opinions on issues related to 「Essential Healthcare Support Measures」.

* 9 meetings with subject-matter experts, 14 three-party consultation meetings

Based on such meetings, the ministry recognized that two medical fields were in most urgent need of support: severe/emergency case treatment and childbirth /pediatric care - a field most gravely threatened by low birth rate. Accordingly, the ministry came up with a draft version of「Essential Healthcare Support Measures」with increased support for those two medical fields and announced it in a public hearing* held in December last year.

* Public hearing for「Measures for Health Insurance Sustainability Enhancement and Essential Healthcare Support (Draft)」(‘22.12.8)

The ministry collected various ideas and feedback through the public hearing and reflected on them in the final version of the「Essential Healthcare Support Measures」.

The goal of the「Essential Healthcare Support Measures」is to enable all Korean people to receive essential healthcare within their golden time, whenever and wherever they are in need.
In line with this goal, the ministry has proposed three strategic objectives; to build fully autonomous essential healthcare system for each region; introduce a public schedule to increase the availability of essential healthcare; to secure a sufficient healthcare workforce.

The finalized version is focused on supporting severe/emergency case treatment and childbirth/pediatric care with the following key points:
1. Essential healthcare available whenever and wherever there is a need

Strengthen medical competence of medical institutions, build a collaborative system within the medical region, and enhance accessibility to childbirth/pediatric care.

1) Strengthen medical competence of medical institutions
Restructure the emergency medical system to be more accountable in providing all necessary treatment including surgery up to the final treatment.

Include final treatment capability for major serious emergency illnesses as one of the selection criteria for ‘Regional Emergency Medical Centers’ to upgrade them to ‘Emergency Medical Centers for Severe Cases’ that are capable of treating severe emergency illnesses.

According to the restructuring plan, the number of ‘Emergency Medical Centers for Severe Cases’ will be increased to somewhere between 50 and 60 centers from the current 40 centers (based on the number of regional emergency centers).

From now on, only the Emergency Medical Center for Severe Cases will be qualified to be designated as a ‘Specialized Center*” for each specific Illnesses in order to provide stronger connectivity between Emergency Rooms and follow-up treatment.

* Regional Trauma Center, Pediatric Emergency Center, Regional Cardio vascular/Cerebrovascular Center, etc.

Regional Cardiovascular/Cerebrovascular Centers will be reorganized to offer specialized treatment 24 hours a day including highly-complicated surgery for high-risk cardiovascular/cerebrovascular patients within their golden time (within 2 hours) shifting away from their previous focus on prevention and rehabilitation.

In line with this, the ministry will add treatment competency as a new criteria to be considered when designating Regional Cardiovascular/Cerebrovascular Centers on top of the existing standards related to facility and workforce. The ministry will then redefine the coverage region of each center reflecting the actual demand for treatment and the availability of medical resources and redesignate accordingly.

In addition, a network will be built around regional medical specialists for cardiovascular/cerebrovascular illnesses to enable a speedy collaborative treatment including the transfer between hospitals and final treatment.

Furthermore, to enable tertiary general hospitals to serve its core purpose of treating severe illnesses (their main duty) the ministry will update the criteria for designating and evaluating tertiary general hospitals and also change the relevant preliminary indicators to enhance their capability for severe/emergency case treatment and pediatric emergency care.

In order to increase the portion of specialized treatment and reduce that of simple treatment for inpatients, the ministry will establish new sets of criteria for the number of specialists to cover inpatient and hospital bed acquisition rates for ICU’s.

2) Build a collaborative system within a medical region

Introduce a pilot program of duty rotation between hospitals for major emergency illnesses.

Up until now, there were many emergency patients who could not get the treatment in time at night or on holidays when hospitals did not have a specialist on duty, having only one or two specialists in the entire hospital who can operate or treat such emergency illnesses.

The ministry plans to build a regional collaborative system to mobilize a duty rotation system between hospitals for major medical emergencies and to promote sharing of related information with 119 emergency call services for speedy transfer of emergency patients to the hospital on duty.

※ (Ex.) Establish a night-time duty rotation schedule for final treatment of subarachnoid hemorrhage (Example: Hospital A for Monday, Tuesday, Sunday, Hospital B for Tuesday and Friday, Hospital C for Wednesday and Saturday) (Hospitals are free to offer treatment on days when they are not on duty)

The ministry believes that such duty rotation between hospitals in a region will make sure there will always be at least one hospital with a specialist on duty, preventing ambulances from having to go from hospital to hospital in search of specialists.

Emergency patient transfer system will be made more effective and the emergency medical information system will be upgraded.

Until now, 119 ambulances and medical institutions had different sets of criteria for classifying the severity of illnesses, often causing confusion in the patient transfer process. These standards will now be unified.

Emergency Medical Information System (General Situation Board) will be upgraded to provide more accurate information on the availability of ER beds and treatment for different illnesses, increasing the possibility of a speedy transfer of emergency patients to the hospital that can offer best possible treatment.

3) Enhance accessibility to childbirth/pediatric care

Reorganize maternity and neonatal healthcare delivery system focusing on the level of risk to mothers and new-born babies to support safe child birth and healthcare.

Upgrade and expand the current 「Integrated Treatment Center for High-Risk Mothers and Newborns」 and 「Regional Center for Neonatal Intensive Care」to ‘Mother and Child Medical Center for Severe Cases(Temporary name)’ and ‘General Medical Center for Mother and Child(Temporary name)’ respectively to achieve efficient allocation of medical resources in the region based on the level of severity.

In addition, there will be more support given to regions left with less childbirth services; mothers in such regions will be given more pre-natal education and medical services in such areas will be strengthened with a better response to emergency cases.

Healthcare services for pediatric patients will be upgraded.

Five new regional hub hospitals for pediatric cancer will be designated to receive intensive support. By working with existing public specialized medical centers for children, those new regional hub hospitals for pediatric cancer will provide effective collaborative care for treatment and recovery.

Through such efforts, the healthcare system will be upgraded so that pediatric cancer patients and their families living in other regions don’t have to travel to Seoul frequently to receive treatment.

Also, increase the number of Pediatric Emergency Medical Centers and add pediatric care in the set of criteria for evaluating emergency medical institutions to strengthen their ER capability for pediatric care.

So far, the limited number of medical institutions offering pediatric outpatient care at nights and on holidays (Moonlight Children Hospitals) has created a lot of inconveniences for parents. To resolve this pain point, the number of such medical institutions will be increased and the compensation for night care will be increased as well.

 

2. Fair Compensation for Essential Healthcare Services

To build an autonomous essential healthcare system within each region, a fair compensation for essential healthcare services will be provided by introducing the ‘public fee schedule’ system.

The ‘public fee schedule’ is a new reimbursement system for health insurance designed to overcome the limitations of current fee schedule for each medical practice and to provide sufficient medical services in essential healthcare areas that directly impact peoples’ lives and safety.

The ‘public fee schedule’ is designed to provide intensive support for enhancing healthcare infrastructure for high-risk and severe illnesses; promote collaboration among medical institutions while maintaining healthcare infrastructure in medical fields suffering from demand shortage.

The ministry plans to continue to enhance the ‘public fee schedule’ to facilitate essential healthcare services necessary for peoples’ health and life by continuously collecting expert opinions and identifying new methods of improvement.

 

1) Intensive support for building healthcare infrastructure for high-risk and severe illnesses

Provide fairer compensation for essential healthcare workers who have to bear a heavy workload of working night/holiday shifts, often working very long hours.

Increase the compensation level for night/holiday emergency surgeries/treatments, for cerebral aneurysms, major trauma, etc., to be higher than the level of compensation for weekday daytime shifts. Also, a new fee called ‘ER-Only Ward Maintenance Fee’ will be introduced to facilitate the process of acquiring ER wards for severe patients who come to ERs and to provide them with speedy follow-up care.

To enable ‘Public Specialized Healthcare Centers for Children’ to focus on treating severe pediatric illnesses, which is their core purpose, without having to worry about their financial soundness, a new pilot project to provide retroactive compensation to such institutions in order to make up for their deficit will start this year.

In addition, further compensation will be made for hospitalization/surgical treatments that have been underestimated compared to other activities and additional support will be given to high-risk/high-complexity surgeries. In consideration of the level of complexities and allocation of resources, current level of fee schedule for each medical practice will be broken down into more detailed levels to provide a higher payment for high-risk practice. The ministry plans to apply these new level of fee schedule for each medical practice first on cardiovascular/cerebrovascular illness and gradually expand them to other areas in the future.

2) Support for infrastructure maintenance in the face of demand shortage

In order to resolve inconveniences caused by an imbalanced allocation of medical resources across the country, a new ‘Regional Fee Schedule’ that provides different levels of reimbursement for different regions will be introduced.

The ‘Regional Fee Schedule’ is expected to resolve some of the financial difficulties for local medical institutions that provide baby delivery services in cities and counties and satisfy certain facility and workforce-related criteria.

The ministry will evaluate the impact of such improvement plan and consider rolling it out to other areas including the emergency and pediatric severe case treatment.

The ‘Safety policy fee schedule’ will be introduced to create a safer environment for baby deliveries that includes preventing childbirth-related malpractice cases.

In this context, the ministry is planning to look for further ways to provide fairer compensation for high-risk surgeries and ICU care services provided by baby-delivering medical institutions (University hospitals) that meet certain criteria of high-risk delivery facilities and workforce.

For pediatric care, the ministry will introduce further measures to provide fairer compensation for clinic/hospital-level newborn units’ hospitalization fee, while increasing the age-adjusted rate and hospitalization fee for neonatal ICUs in order to maintain pediatric hospitalization and healthcare infrastructure.

To facilitate pediatric care provided by community clinics and hospitals, the ministry is planning to introduce a pilot project to encourage pediatricians in the community to provide personalized education and counseling services for individual child (under 36 months) related to overall infant development, health and childcare.

 

3) Network building for collaboration/connectivity among medical institutions

To enable ‘Tertiary general hospitals’ to concentrate on treating severely-ill patients, the ministry plans to introduce a pilot project to encourage those tertiary general hospitals to build a network for collaboration/connectivity with other medical centers in the region in order to decrease their portion of outpatient care services by compensating them if and when such an objective is met.

Support will be provided to facilitate effective collaboration needed for speedy and accurate transfer of patients between emergency medical centers, and the ministry also plans to introduce a pilot project to provide compensation for effective collaboration between Regional Emergency Medical Centers and regional hospitals as well as for the performance per individual specialized treatment team to promote speedy treatment to emergency patients with cardiovascular/cerebrovascular illnesses.

 

3. Secure sufficient healthcare workforce

The training for new specialist healthcare workers requires more than 10 years. In consideration of this fact, the ministry will encourage inflow of healthcare workers by improving the working environment and balanced allocation across regions and subject areas; at the same time, the ministry will expand the number of specialists.

 

1) Improvement of working conditions

Continue to improve working conditions and reduce the workload for essential healthcare workers.

Identify the detailed working conditions for each region and subject and analyze the overall workforce supply and demand to improve the overall working conditions and resolve the problems of long working hours for specialists.

Further efforts will be made to relieve the burden on healthcare workers for unavoidable malpractice cases and to improve relief measures for the victims.
A new award titled ‘Physician of Korea Award (Temporary name)’ will be introduced to recognize outstanding contributions in essential healthcare made by dedicated healthcare workers.

2) Minimize workforce gap between regions and specialty areas

In order to reduce the gap in workforce availability among different regions and different essential specialized departments, an increasing number of residents will be deployed to local hospitals and mandatory specialty areas.

In this regard, the ministry will adjust the quota of specialized medical departments and establish a rule for quota allocation.

Furthermore, in order to fix the regional imbalance in the number of available hospital beds, the ministry will establish the ‘Basic Policy for Hospital Bed Availability’ for more efficient management of hospital beds by region in collaboration with city and provincial governments.

As the non-benefit market grows at a rapid pace, the essential healthcare field lost some of its workforce to this rapidly expanding, non-benefit market. In order to minimize such a loss of workforce, stronger and stricter management of the non-benefit market will be carried out. This will be done by providing quality safety and efficacy-related information on top of the price information to the consumer for major non-benefit categories. Additionally, the monitoring and checking of the overall status of the non-benefit treatment and the introduction of a stronger connectivity with affordable health insurance including through the negotiation of better payment standards will reduce the workforce loss.

 

3) Training and Expansion of Supply of Healthcare Specialists

Essential healthcare training and practicing in the overall training program covering medical school student, residency, and specialist phases will be enhanced, and the ministry will support the restructuring of the specialist training program as proposed by related academic societies to promote the integrated treatment of related illnesses across medical specialties.

Furthermore, the ministry will come up with a detailed action plan to reduce the imbalance in the availability of healthcare workers between regions and specialty areas by consulting the medical community to secure a sufficient supply of healthcare workers.

* Discussion between the Ministry of Health and Welfare, Korean Medical Association, and Medical Issue Council started on Jan. 16th, 2023

Last not but least, further efforts will be made to secure a sufficient nursing workforce and to streamline management and operation of supporting healthcare workers.

Minister Cho KyooHong of the Ministry of Health and Welfare said, “Strengthening the foundation for essential healthcare is one of our most pressing national agenda, and these measures are our first step in this direction.” He added, “Our ministry will continue to adopt additional measures as necessary.” ///