[The Editors' Verdict] The Truth the Health Minister Must Tell

The debate over increasing the number of medical school admissions is chaotic with many conflicting opinions. This column examines the issue from the perspective of healthcare as a business, emphasizing the essence that "doctors are self-employed, and hospitals are service establishments."

Every year, half of the medical students who enroll later register as individual business owners and become private practitioners. As of last year, among the 100,819 active doctors in Korea (excluding 11,502 medical school professors with faculty status), 48%, or 48,584, are self-employed practitioners running clinics.

The revenue structure of private practitioners is similar to that of car repair shops. The number of establishments is also comparable. In 2021, there were 35,580 private clinics nationwide, and 36,693 automobile repair shops. Auto repair shops receive repair fees from mandatory automobile insurance, while private practitioners receive treatment fees from health insurance, which functions like a quasi-tax. Increasing medical school admissions effectively increases the number of self-employed individuals supported by this "de facto tax." The number of clinic-level private practitioners has already increased by more than 4 percentage points from 2013 to 2022. Correspondingly, health insurance benefits have also increased. According to Romer's Law, a major theory in health policy, "if the number of health insurance hospital beds increases, the number of patients also increases accordingly." This was proven by Professor Milton Romer of UCLA School of Public Health.

In any industry, oversupplied self-employed individuals are eliminated. Doctors escape to non-insurance luxury markets such as plastic surgery and dermatology to earn more money. These are not car repair shops but beauty salons in Cheongdam-dong. While car mechanics cannot switch to becoming beauticians, pediatricians and adolescent medicine doctors are already moving into dermatology. The medical community's expectation that "increasing medical school admissions will cause a concentration in popular specialties instead of essential medical fields" is persuasive given the self-employed nature of the profession.

General hospitals, where non-private practitioners are employed, have a revenue-profit structure similar to that of lodging businesses. Health insurance-covered treatments at general hospitals are low-priced and often run at a deficit, making it unsustainable to rely solely on core medical services. The accumulated deficit of over 100 billion won at the National Health Insurance Service's directly managed Ilsan Hospital is evidence. General hospitals earn money through premium rooms (hotel suites), non-insurance treatments (additional paid services), and ancillary facilities such as in-house shops, funeral halls, and parking lots. This revenue structure is similar to that of hotels.

Korea ranks third among OECD countries with 1.24 doctors per square kilometer of land area. The urban-rural doctor distribution difference is 0.6 doctors per 1,000 people, the second smallest among OECD countries. The medical community's claim that healthcare accessibility is excellent and that primary care supply in rural areas is sufficient is reasonable.

Just as a luxury hotel in Seoul receives guests from all over the country, the top-tier hospitals for rare and severe diseases are optimally located in Seoul, where patients nationwide can be diagnosed and directly admitted. President Yoon Seok-yeol's statement to "develop provincial national university hospitals to the level of Seoul's Big 5 hospitals" is a fundamental remark. It is more appropriate to further elevate the Big 5 to world-class status and facilitate provincial patients' access to treatment in Seoul. This is similar to building direct routes nationwide to Incheon Airport rather than expanding provincial airports to the scale of Incheon Airport.

The medical community's opposition to increasing medical school admissions clearly contains elements of collective self-interest. While enjoying the benefits of reduced admissions obtained in exchange for accepting the 2000 separation of prescribing and dispensing of medicines, there has been some forgetting of the Hippocratic Oath. The medical community should cooperate with the government to analyze how many essential doctors will be needed domestically in the future and accept a reasonable increase in admissions. Before this, Minister of Health and Welfare Cho Kyu-hong should inform the public that increasing medical school admissions means increasing the number of self-employed individuals supported by the health insurance premiums paid by the people and obtain their consent. I point this out to prevent it from quietly passing just before the general election.

This content was produced with the assistance of AI translation services.