[Collapsed Pediatric Healthcare]⑥ "Rebuilding Requires New Laws and a Dedicated Government Department"

Difficulties in Reflecting the Unique Needs of Pediatric Healthcare in the Current Medical System
Japan Implements the "Basic Child Development Act" and Establishes the "Children and Families Agency"

Editor's NoteAlthough it is expected that the residents who left hospitals a year and a half ago in protest against the expansion of medical school admissions in February last year will resume their training, the situation in essential medical departments that handle critical and emergency patients remains precarious. In particular, in the case of pediatrics, low birth rates, an unreasonable fee system, and increasing legal risks are causing residents to avoid applying, while existing specialists are leaving the field. The widening gap in medical services between regions is also destabilizing the treatment system for sudden pediatric emergencies and serious pediatric illnesses that require specialized intensive care. Fewer children are being born, and there are even fewer doctors to care for them. Over the course of six installments, Asia Economy will examine the current state of the pediatric medical system and explore directions for improvement.

There are growing calls for the establishment of relevant laws and a dedicated government agency that reflect the unique characteristics of pediatric medicine and the value of child protection in order to rebuild the collapsed pediatric healthcare system. This is because, within the current adult- and disease-centered medical system, pediatric healthcare struggles to become a central topic of discussion. A leading example is Japan, which enacted related laws in 2019 and established a dedicated agency in 2023 to improve its pediatric healthcare system.

Assemblywoman Lee Jooyoung of the Reform New Party: "A dedicated law and agency are needed to fill the gaps in pediatric healthcare"

Lee Jooyoung, a member of the Reform New Party, is being interviewed by Asia Economy at the National Assembly. Photo by Kim Hyunmin

"We must act to save pediatric healthcare through a dedicated law and agency."

Lee Jooyoung, a pediatrician and member of the National Assembly’s Health and Welfare Committee from the Reform New Party, made this argument in an interview with Asia Economy on the 27th. On July 29, Assemblywoman Lee sponsored the long-awaited "Basic Child Health Act" bill on behalf of the pediatric healthcare community.

Born in 1982, Assemblywoman Lee graduated from Dongguk University College of Medicine and earned a master’s degree from Ulsan University. She is a subspecialist in pediatric emergency medicine. After working for about nine years at Soonchunhyang University Cheonan Hospital, which was the first in Korea to be designated as a pediatric emergency medical center, she entered politics.

According to Assemblywoman Lee, the Basic Child Health Act was proposed to address the limitations of the current adult-centered medical law system and to reflect the unique characteristics of pediatric healthcare. The main points of the bill are to define the responsibilities of the state and local governments for healthy child development, to establish a basic plan for child health, and to provide a legal foundation for the comprehensive implementation of child health policies.

She pointed out that inefficiencies in the pediatric healthcare system are being caused by political and policy-related reasons. Assemblywoman Lee said, "Research shows that pediatric emergency medical centers should be established as hubs in six regions, but for political reasons, hospitals have been dispersed into more than a dozen locations. If 18 specialists were working at three hub centers, 24-hour operation and backup support would be possible, but with the specialists spread across more than a dozen hospitals, none of them can operate properly."

She continued, "Because it is difficult to transfer patients, secondary hospital emergency rooms do not accept children who seem likely to deteriorate. If a transfer is not possible, they would be held responsible, so even patients who could be admitted are being turned away. As a result, only patients who are unlikely to have problems are accepted, leading parents to believe they can go to the emergency room even for mild cases. This creates a vicious cycle where the actual capacity to treat true emergency and critical pediatric patients becomes even more inadequate."

Assemblywoman Lee added, "Even just over a decade ago, secondary hospitals in the provinces used to accept and treat children with intussusception. However, after a court ruling held general surgeons (not pediatric surgeons) responsible for a case where the intestine was torn while attempting to untwist it, local emergency rooms have stopped accepting such patients. As a result, there have been absurd situations where a child with intussusception has to be airlifted from Changwon to Seoul."

Therefore, Assemblywoman Lee argues that a law is needed to make the state institutionally responsible for children's health, so that discussions on improving the pediatric healthcare system can be led effectively. Currently, in Korea, relevant laws are divided among the Maternal and Child Health Act, the Child Welfare Act, and others, leaving a practical legal vacuum for comprehensive child health. She said, "It’s the same with government agencies. The Ministry of Health and Welfare has divisions for oral health policy, mental health management, and suicide prevention, but there is no division dedicated to pediatric healthcare."

She went on to say, "It may be difficult to create a new organization immediately for financial reasons, but the Basic Child Health Act could later serve as the legal basis for establishing a dedicated organization."

Regarding the benefits of integrated management of child health through a dedicated law and agency, she explained, "In Switzerland, the school health system consistently manages children's physical and health conditions, much like a student record. By monitoring children's development and early warning signs at school, health issues can be identified before parents notice them at home."

She added, "If Korea were to establish a dedicated agency that combines the relevant authorities of the Ministry of Education and the Ministry of Health and Welfare, it could serve as a useful reference. Early intervention helps improve conditions and also has a positive effect on the financial soundness of health insurance. Additionally, running programs such as school-based nurse counseling could help lower the suicide rate among teenagers and bring various other positive outcomes."

Japan moves to save pediatric healthcare with dedicated law and agency

The case for establishing a dedicated law and agency for pediatric healthcare, advocated by Assemblywoman Lee and long desired by the pediatric medical community, can be found in Japan. In Japan, the need for related legislation arose due to several factors: a consensus that social policies were insufficient to guarantee healthy child development amid rapid declines in the birth rate and population aging; deepening regional disparities in the medical system; and a lack of continuity in support for the process of child development (from newborn to adult) as well as fragmented cooperation among government ministries.

As a result, based on the Pediatric Health Act that the Japan Medical Association had been working to enact since 2004, Japan created the "Basic Act on the Comprehensive Promotion of Measures for the Provision of Necessary Child Developmental Healthcare, etc., to Children, Their Guardians, and Pregnant Women" (the Basic Child Development Act) in 2018. In 2023, to address the gaps in healthcare and welfare caused by vertically segmented administration among ministries, Japan also established the Children and Families Agency to oversee policies related to children.

Huh Jongho, Adjunct Associate Professor at Seoul National University College of Medicine and Research Fellow at the National Assembly Future Institute, is being interviewed by Asia Economy at the National Assembly Future Institute. Photo by Kim Hyunmin

In contrast, Korea has neither a dedicated law for pediatric healthcare nor an agency specifically responsible for or managing pediatric healthcare. The Ministry of Health and Welfare is in charge of related work, but there is no structure in which a specific organization is dedicated solely to pediatric healthcare. For example, pediatric emergency work is handled by the Emergency Medical Division, regional pediatric healthcare is managed by the Essential Medical Coordination Division, and pediatric cancer is overseen by the Disease Policy Division. Laws related to pediatric and adolescent healthcare are also divided among the Child Welfare Act, the Act on the Safety Management of Children, the Act on the Protection of Children and Adolescents from Sexual Abuse, the Framework Act on Juveniles, the Early Childhood Education Act, the Infant Care Act, the Maternal and Child Health Act, and the Youth Health Act.

Huh Jongho, Adjunct Associate Professor at Seoul National University College of Medicine and Research Fellow at the National Assembly Future Institute, pointed out, "Although Korea’s current health and medical system has formally introduced life-cycle health management projects, in reality, policies and resources are concentrated on adult diseases and disease-centered management."

Professor Huh explained, "In Japan, after the implementation of the Basic Child Development Act and the establishment of the Children and Families Agency, calls to promote children's health rights have gained momentum. In Japan's eighth round of medical reform, which began last year, there has been a clear increase in the focus on pediatric healthcare, such as the subdivision of the child development process and the intensification and prioritization of pediatric healthcare, compared to previous reforms."