APAC Series Ep. 4: What is Fueling Hesitancy Towards Telemedicine in South Korea? (Mira Kang)
While the rest of the world is increasingly looking at virtual care and telemedicine for healthcare sustainability and ease of access to healthcare services, telemedicine will likely be forbidden again soon, since the pandemic has ended.
In Korea, life expectancy at birth was 82.7 years in 2017, higher than the OECD average of 80.8. At the moment, Korea has one of the youngest populations among OECD countries, with only 13.8% aged 65 or over. This is expected to increase considerably in the next decades.
At HIMSS 2023 in Chicago Mira Kang, Vice Chief Medical Information Officer at the Samsung Medical Center in South Korea, explained why a country that is an IT powerhouse and has fast-speed internet is widely available, isn't embracing telemedicine. Koreans access a lot of services through their mobile phones, hospital as introducing AI, robots and data-driven precision medicine.
Good access to healthcare
The health security system in Korea has two components: mandatory social health insurance, which provides healthcare coverage to all citizens and is funded through contributions from those who are insured, and government subsidies. The second part is the medical aid program, which is a form of public assistance that uses government subsidies to provide low-income groups with healthcare services.
Roundatable discussion about virtual health at HIMSS 2023. From left to right: Tjasa Zajc, Brad Reimer, Mira Kang, Shannon S. Crotwell.
As Mira Kang explained, accessibility to healthcare services is high: ”Korea has the highest level of medical accessibility in the world. The distance between medical facilities and patients can be the measure of accessibility. In Korea, the accessibility distance to hospital is 2 to 4 miles (roughly 3-6.5 km) in big cities and within 12 miles (20 km) even in rural areas. The average in-person visit number is over 14 times per year. Relatively low medical costs would have played a role. Remote healthcare services may give the patient convenience and reduce their time. However, there is still no report that it reduces the overall medical expenses and no evidence that it decreases the average visit number in Korea.”
Low out-of-pocket costs
Healthcare services are also highly affordable. “You may not believe it, in case of in-person consultation visit in Korea, the cost for primary care is only 10 dollars per visit and the co-payment of a patient is 30% which should be 3 dollars. In the case of a tertiary general hospital, the cost is 30 dollars per visit, and the co-payment is 60% which should be 18 dollars. The fee per visit doesn’t matter how much time physicians spend,” Mira Kang explains.
The affordability of healthcare in South Korea is one of the reasons that’s holding telemedicine back, says Mira Kang. “Physicians are skeptical about whether appropriate reimbursement will be paid for telemedicine. After the end of the pandemic, there has been a debate on whether to continue using remote healthcare systems, and there are different opinions among stakeholders.”
Business concerns around telemedicine
As Mira Kang explains, from the patient's perspective, patients want to continue using remote healthcare services because they have become accustomed to the convenience during the pandemic.
Traditional pharmacists have a concern that patients will flock to large pharmacy chains in the remote healthcare system and many of the small pharmacies will go out of business.
Physicians recognize that telemedicine is an undeniable trend of the times, but they prefer to limit the application to follow-up visits in patients with chronic disease because they have concerns about medical liability. Physicians show reluctance to use telemedicine for initial diagnosis, Mira Kang says.
How is Samsung Medical Center leveraging technology?
Samsung Medical Center is highly digitized - it basically reached all the highest levels of digital maturity based on criteria such as achieved Stage 7 achievement of HIMSS maturation model projects for the Infrastructure Adoption Model (INFRAM), Digital imaging Adoption Model (DIAM), and Electronic Medical Record Adoption Model (EMRAM). Naturally, they did use telemedicine during the pandemic, along with other technologies.
Samsung Medical Center (SMC) implanted specialized telemedicine in several ways.
A ward rounding robot supporting non-in-person rounding using voice instrument, camera, and EMR solution. The robot can be used in case when a patient is isolated or the attending physician is far away from a patient.
Teleconsultation is provided for overseas patients utilizing the Samsung Group-wide video conferencing system, “Knox meeting“. SMC physicians can cooperate with the patient’s physicians in their own country and show EMR and PACS images to them. As teleconsulting is not yet allowed for domestic patients currently, it is applied only to overseas patients.
Korea's technological level is sufficient for telemedicine services, but there are non-technical barriers with debates and economic issues among stakeholders such as pharmacists, hospitals, and primary care physicians.
But there is a private market is evolving.
“Private markets connect physicians and patients online. Physicians telecommunicate with patients and transfer prescriptions to the pharmacy virtually. These new markets are focused on non-reimbursed areas, such as obesity treatment, postmenopausal hormone replacement therapy, or cosmetic medicine for hair loss and acne. Nevertheless, refills is not allowed.”
Remote patient monitoring or teleconsultation between physicians is only allowed in special cases for the prisoners or the Coast Guard dispatched to the Dokdo island 153 miles away from the mainland, or sailors on the ocean.
So while many countries, especially the US are actively stepping up their efforts to provide remote monitoring and virtual care to decrease the pressure on physical infrastructure and costs, it doesn’t seem Korea will follow just yet.
Mira Kang: “Remote healthcare services have begun since 1998 in Korea, but they have been provided only as part of national pilot projects for decades and could be used under restrictive conditions. The pandemic had opened a window forward to telemedicine, and remote healthcare services have been widely expanded. However, the temporary allowance by the infection prevention law is likely to be forbidden within a month because the COVID-19 pandemic has ended. In general, it requires more effort to communicate in remote meetings compared to in-person meetings. Physicians prefer in-person consultations rather than telemedicine because they worry about regulatory challenges and lack of reimbursement policies. This is probably why hospitals are not actively embracing telemedicine and large corporations are not showing much interest. Policy issues related to patient identification, the responsibility of medical professionals, and appropriate reimbursement must be resolved to legalize telemedicine.”