Ways to Ensure �Health Rights of PWDs

Oct 27, 2021

Director of Public Health Policy Institute,

Seongnam Citizens Medical Center

Contents

• Problems to ensure PWDs’ health rights

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• Measures to ensure PWDs’ health rights

1. Weak coverage of �national health insurance (NHI)

• Insufficient medical coverage with NHI
• NHI coverage rate is only 64.2%(2019) – big personal burden to a patient
• Barrier for low-income family and PWDs to access medical care
• Strengthen coverage is not enough even with government measures to ensure NHI
• But improved coverage only for severe disability and high medical cost
• No big changes for minor disability and low medical cost (moral hazard of indemnity insurance)
• Most of people buy expensive private insurance (indemnity insurance)
• Premium of indemnity insurance is huge but persons with disease history or with disabilities are difficult to buy insurance

Problems to ensure PWDs’ health rights�

2. Lack of public medical agency

• So far, the government has not much invested to establish public medical agency
• Beds of public medical agency among total: only 9.1% (2016)
• Most of medical supply has been done by the private, not by the public (government)
• Private medical agency is tended for profit-driven purpose instead public purpose
• Non-organized medical supply system makes overlapped functions and severe competitions, which leads inefficient medical system
• In Korea, legally profit-seeking hospitals are not allowed, but they are operating to pursue profits

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Problems to ensure PWDs’ health rights�

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3. Lack of patient-centered system

• Medical system is arranged based on suppliers, not based on patients
• Medical service supply is being decided according to the need of medical supplier, not the need of a patient
• Ex) Not active visiting medical service, no provide care service, short meeting time with a doctor (3 mins examination)
• This happens from the fact that most of medical suppliers are profit-driven hospitals
• No doctor-in-charge who takes care of public health
• Doctor-in-charge is a community based doctor who take responsibility of continuous and comprehensive care for public health
• Recently doctor-in-charge system for PWDs is being operated but no implemented
• Medical system in Korea is very difficult for the public and PWDs to receive medical service what they want

Contents

• Problems to ensure PWDs’ health rights

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• Measures to ensure PWDs’ health rights

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Future direction of Korean medical system

• Establish universal medical coverage
• With NHI, full medical coverage should be ensured
• Quantity expansion of public medical agency
• Expansion of regional based public hospital
• Establish public clinic
• Need to restructure into patient-centered medical system
• Introduce a doctor-in-charge system
• Need new medical supply system

Measures to ensure PWDs’ health rights

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Establish universal medical coverage system

• Without private insurance, NHI must ensure full and necessary medical care
• Policy support: Self contribution is maximum up to 1,000 USD per year
• When patient’s self medical contribution is over 1,000 USD per year, the government must fully cover the remainder to reduce medical cost burden of the public
• No self medical contribution for family and PWDs without income
• Ways to secure budget
• Expand government financial support
• Increase health insurance premium based on social solidarity (current NHI premium rates: 6.86% in 2021)
• Expand resources of health insurance payment (impose health insurance payment on all incomes)

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Measures to ensure PWDs’ health rights

Gradual policy measure for �medical cost cap of 1,000 USD

• Total required budget: 8 billion USD (with guideline of 2019)
• Gradual steps to implement
• 1step : inpatient, children below 18 years old, PWDs, persons with severe disease
• 2 step: expand to the all public
• Ways to secure budget
• Strengthen government responsibility for finance support
• Increase health insurance premium based on social solidarity
• Expand resources of health insurance payment (levy health insurance payment on all incomes)

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Measures to ensure PWDs’ health rights

Establish more public medical agency(1)

• Ratio of public medical agency must be expanded up to 30% among all medical agency
• Expand dramatically accessibility of public medical agency by establishing regional based public hospital with more than 300 beds per 70 mid-size medical service areas in Korea
• Need newly construction & renovation of existing small size public hospitals
• Be standardized function and role of a regional based public hospital
• Acquire essential medical treatment capacity like regional emergency center/ regional cerebro-cardiovascular center/ rehabilitation treatment
• Also regional based public hospitals must establish and supply good quality of public medical services for PWDs like regional disability health care center, disability-friendly medical check-up facility and disability dentistry
• *Regional disability health care center: currently operates in major city area but this should be expanded into mid-size medical service area.

Measures to ensure PWDs’ health rights

Establish more public medical agency(2)

• Need to establish public clinic (visiting health care center) operated by the government
• Visiting health care service is necessary for severe disability and bed-ridden patient who do not easy to visit to see doctor, but private primary hospital can’t provide this service due to profit issues
• Visiting health care service will be available from primary medical facility (public community clinic) established by the government
• Public clinic will be designated as a visiting health care center to provide visiting care, visiting nursing and visiting rehabilitation, and will play a role of doctor-in-charge for PWDs
• Visiting care center and doctor-in-charge system for PWDs are essential for successful de-institutionalization
• Number of medical personals (doctor, nurse and others) should increase for the expansion of public health care
• Medical service provider must be compensated based on service quality (value) not based on quantity
• Current medical unit service is being compensated by the profit principle of service provider

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Measures to ensure PWDs’ health rights

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Need to restructure patient centered medical supply system

• Public nature of medical service is in the fact that how much fulfill the need of public, not the need of supplier
• Basic principle of public health is people centered care
• Public medical agency (ex, community health care center) has supplier centered project model and system
• Important thing is that how much fulfill the service need of local people, not doing project itself
• Medical system should be systematized, managed and reformed based on the needs of patient and the interests of the public
• This trend should be done led by the public and patients and the role of organizations with PWDs is important

Measures to ensure PWDs’ health rights

Revitalize doctor-in-charge system of PWDs

• In the primary medical service area, doctor-in-charge system is a patient centered medical supply system
• Currently, doctor-in-charge system for PWDs is being conducted, but participation is very limited
• Not many suppliers and consumers to activate doctor-in-charge system => lack of motivation and information to be participated for supplier / consumer
• Need to acknowledge the limit of doctor-in-charge system of private medical agency and the public side must provide doctor-in-charge system by creating a public community clinic
• The system needs to be expanded for all PWDs, not to apply only for severe disabled persons
• The system needs to be expanded for the whole nation in the long term

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Measures to ensure PWDs’ health rights

Introduce democratic governance

• As type of disability is very various and need(requirement) based on disability characteristics is existed, reflecting opinion of PWDs in the policy making process to ensure health rights of PWDs is necessary
• From policy to objectify PWDs, to policy led by PWDS
• To ensure health rights for patients and PWDs, participation of PWDs in the process of development, decision and deliver of disability policy is required.
• Participation in governance of medical service supply agency is necessary to ensure health rights of PWDs
• Ex) Required participation of disability organizations in a steering committee of central and regional disability health care centers

THANK YOU