With a population of 49.2 million and 1,985 neurosurgeons in active service, South Korea has 1 neurosurgeon for every 24,800 people. Since July 1, 1989, the country has been adopting a universal medical insurance system that covers all of its citizens.
Under the National Health Insurance Act, South Korea’s medical insurance system administers treatment, medical checkups, treatment expenses and hospital charges. Fees, including those for neurosurgical services, are based on a relative-value point system. As for drugs and treatment material expenses, the government is responsible for setting the ceiling and effecting reimbursement. Patients pay approximately 20 percent of the total medical expenses as their share of the cost, and the rest is covered by government insurance. In case of certain medical examinations and treatment, the medical expenses in their entirety are paid by patients. Medical insurance for patients in the lower income brackets is entirely covered by the state through the medical benefit system. A system of private medical insurance currently is not available.
South Koreans have easy access to a variety of neurosurgical treatments. However, people feel strong resistance to being charged for the cost of treatment, while doctors are very discontent with their level of reimbursement. The problem originates with Health Insurance Review and Assessment Service, which sets the medical fees and determines what constitutes quality medical performance.
Korea’s medical delivery system breaks down into primary treatment (public health centers and clinics), secondary treatment (hospitals, general hospitals and general hospitals with specialty) and tertiary treatment (general nursing centers). Currently, about half of all neurosurgeons are practicing in the primary and secondary treatment field, with the rest working in the tertiary treatment area.
There is a general unpopularity for the specialty of neurosurgery among Korean medical students. They consider the training course to be strenuous and out of proportion to the compensation, which is relatively low because the reimbursement for neurosurgical treatment is unrealistically undervalued. The neurosurgical training in Korea consists of a four-year resident course after one year of internship. Neurosurgical residents work approximately 72 hours per week; however, actual time may be far greater depending on the workload of hospitals. Fellowship and its training period are optional after achieving board certification by the Korea Neurosurgical Society.
The increasing amount of medical malpractice litigation is a serious problem in South Korea. The number of medical malpractice lawsuits has increased exponentially, rising to about 8,000 at an average annual rate of 36 percent from 2003 to 2007. While neurosurgery ranked fourth—after obstetrics and gynecology, internal medicine, and orthopedics—with regard to number of lawsuits and amount of legal cost, the legal cost per neurosurgeon than was higher than for all other physicians.
In summary, tough training conditions, relatively low compensation and high risk obstruct recruitment into neurosurgery in South Korea.
Hee-Won Jung, MD, is professor in the Department of Neurosurgery at Seoul National University College of Medicine, Seoul, South Korea. The author reported no conflicts for disclosure.
For Further Information
Choi JU: Proposal for the promotion of Korean neurosurgery. J Korean Neurosurg
Soc 43:1-4, 2008