"Treating 'Airway Foreign Body' Cases as Mild Poses Life-Threatening Risks... ENT Disease Groups Need Reclassification and Higher Reimbursement"

Korean Society of Otorhinolaryngology Criticizes Distorted Severity Classification, Warns of Reduced Tertiary Care
Calls Out Thyroid Surgery Policy Favoring Certain Specialties
Pushes for Inclusion of Hearing Loss Screening in National Health Ex

A claim has been raised that a significant portion of severe otolaryngology (ENT) treatments are being classified as mild diseases, leading to a contraction of ENT services in tertiary general hospitals. As hospitals seek to increase the proportion of severe cases they treat, ENT specialists are leaving for private practice, which, in turn, is causing a sharp decline in clinical instructors and a shortage of supervising specialists at training hospitals in regional areas—ultimately leading to the collapse of the educational system.

At a press conference held on the 18th at Kintex in Goyang, Gyeonggi Province, during the 100th Scientific Conference of the Korean Society of Otorhinolaryngology, Director Jaewon Koo of the Society is speaking. Photo by Jo In-kyung

The Korean Society of Otorhinolaryngology held a press conference on April 18 at Kintex in Goyang, Gyeonggi Province, and called for the advancement of the unreasonable "disease severity classification system" that is shrinking ENT services at tertiary general hospitals, as well as for appropriate reimbursement rates for high-difficulty surgeries.

The Society first pointed out that the current patient classification system (KDRG) fails to reflect the complexity and expertise required in the medical field. Since the classification criteria rely solely on statistical figures such as length of stay or medical costs, there is a distortion in which genuinely high-difficulty patients are being classified under simple disease groups.

Kim Joungho, Director of Education at the Korean Society of Otorhinolaryngology and Professor at Konyang University Hospital, said, "Patients who are transferred to tertiary general hospitals because of uncontrollable nosebleeds or children who have foreign objects lodged in their airways require highly specialized and urgent surgery or procedures due to the risk to their lives. However, these cases are still classified as mild diseases for the same diagnosis and are subject to lower reimbursement rates."

Park Chansoon, Director of Insurance at the Society and Professor at St. Vincent’s Hospital, stated, "The requirement for 'at least 300 annual claims' to separate new disease groups remains in place, which fails to reflect the clinical reality of rare and intractable diseases that occur infrequently but require a high level of expertise, or of certain specialized departments."

To resolve this, the Society proposed the adoption of an "ENT-specific modified severity classification system." For rare diseases or high-difficulty surgeries, the Society argued that the claims volume requirement should be relaxed and that a peer review process by expert groups should be used to classify cases based on clinical value. They also suggested further subdividing severity according to patient risk factors—classifying patients over 80 years old, infants under one year old, patients with severe comorbidities, or those undergoing reoperation as general risk factors, while acute airway obstruction, multidisciplinary integrated treatments, or extremely high-difficulty microsurgeries would be defined as ultra-high risk factors, thereby raising the severity level accordingly.

The Society also pointed out that the irrational disparity in reimbursement rates for procedures such as thyroid surgery needs to be addressed. In cases requiring high-difficulty treatment of the vocal cords or cervical thyroid gland, otolaryngologists possess outstanding skills in handling complex anatomical structures. However, due to policy reimbursement rates limited to certain departments, ENT surgeries are often avoided within hospitals or patients are referred to other departments instead.

This challenging ENT care environment is further threatening training conditions in the wake of the 2024–2025 medical policy crisis. The number of supervising ENT specialists at 83 training hospitals nationwide decreased by 10.1%, from 575 in 2023 to 517 last year, and the number of clinical instructors plummeted by 63.3%, from 79 to 50. Seo Jaehyun, Director of Training at the Society and Professor at Seoul St. Mary’s Hospital, said, "It is unlikely that clinical instructor staffing will recover in the short term, and there are signs that clinical instructors leaving regional areas are moving to tenure or clinical faculty positions in the Seoul metropolitan area. If this trend continues, even if the government allocates more residents to regional training institutions, the imbalance in educational capacity may worsen."

In addition, the Society announced plans to strongly promote the introduction of professional hearing tests for citizens at the age of 66 as part of dementia prevention efforts. As global medical research has identified hearing loss as the number one risk factor for dementia, they argued that a national-level screening system is necessary to protect the quality of life for the elderly population and reduce healthcare costs.

Jaewon Koo, President of the Society and Professor at Seoul National University Bundang Hospital, emphasized, "Otolaryngology is an essential medical field responsible for all aspects of public health, including the management of upper respiratory infections, hearing loss, head and neck cancer treatment, and pediatric ENT diseases. We will fulfill our role as a professional society contributing to public health and national healthcare policy."

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