Is a telemedicine system truly necessary? At the crossroads of public and private interests

In 2014, the South Korean government and the Korean Medical Association faced off over the introduction of telemedicine. The debate rages over whether telemedicine is a system for the benefit of private companies or a piecemeal policy that carries public risks. Experts argue for a cautious approach.

 

In April 2014, South Korea experienced a major uproar over the introduction of a telemedicine system as the government and the Korean Medical Association clashed. The Korean Medical Association reacted strongly to the passage of the telemedicine bill in the National Assembly and declared a “reintroduction of an all-out general strike. The issue remains unresolved, and the government and the Saenuri Party are still trying to get the bill passed in the regular parliamentary session. At the center of the medical strike was the issue of telemedicine and medical fee increases.
Telemedicine is a medical system that uses telecommunication devices to diagnose and treat patients remotely. The term conjures up images of people in marginalized and underdeveloped areas that lack access to hospitals in urban centers receiving convenient remote medical care, and on the surface, it seems plausible. But telemedicine is not just for underserved areas. It will be implemented everywhere in parallel with the current medical practice, and it will be implemented in the form of second opinions using various medical engineering (ME) devices in the form of one-to-one or one-to-many. I am against this telemedicine system being introduced in Korea.
First, telemedicine is a useless system that is implemented for self-interest. It is not right to wastefully implement telemedicine in places where it is not needed. South Korea has a doctor density 20 to 100 times higher than Australia, Canada, New Zealand, and Finland, where telemedicine is practiced. In addition, basic medical care and prescriptions are available in remote and unprofitable areas. For example, a service called Yodoc is a mobile health screening solution that was adapted to address the lack of healthcare facilities and high proportion of elderly people in remote areas. Visiting nurses at each community health center provide accurate health care to at least 1000 people a year. However, companies are looking for breakthroughs in new growth industries in the healthcare industry, and telemedicine is seen as the answer. Samsung, South Korea’s leading company and the centerpiece of the country’s economy, currently generates 70% of its profits from smartphones. However, with no post-smartphone in sight, the company has a serious sense of crisis about the future of the industry and is turning to the medical industry. A recent case in point is Samsung’s decision to exempt only Samsung Medical Center from telemedicine treatment for MERS, which led to friction with doctors’ associations and healthcare unions. This is not limited to Samsung alone, but also to other companies in Korea. In a rapidly changing global economy, companies and governments are feeling desperate to prepare for the future with competitive items. However, it is questionable to look for this breakthrough in the telemedicine industry.
However, one might question why companies are opposed to self-interest here. The government and companies may argue strongly that the U-health industry, where healthcare and IT meet, is not for profit, but for the good of the Korean economy. As a medical powerhouse and an IT powerhouse, it is self-evident that health and medical-related industries are the industries of the future that are currently considered to be promising, and when health and IT are combined, they will be the industries that will be responsible for the future of Korea. Therefore, when these projects are thwarted, we must try to find other breakthroughs. This is inevitably inefficient because we have to live with uncertainty. According to the Ministry of Health and Welfare, in September 2014, a telemedicine pilot project involving 13 general clinics and five health centers showed that more than 77% of patients were satisfied with the service. Based on this, it can be argued that patients are finding it convenient and that companies and the people are in sync.
However, I am not saying that it is bad for companies to try to make a profit. What I am saying is that it is wrong for corporations to push for a system that is not in their best interest, despite the public risk it poses and the opposition of experts. There is a high public risk in telemedicine schemes: providing medical services in the absence of a registered professional increases the risk. In addition, storing and transmitting information about patients over the medium will become more frequent than it is now, and there is a greater chance of privacy breaches. In addition to this, we should also consider the opinions of experts. All healthcare professions and civil society organizations are against telemedicine. This is not a selfish opposition to protecting doctors’ pocketbooks, but an important professional opinion. Seeing and treating patients in person is fundamental, and dealing with a person’s body, mind, and life is more important than anything else. Patients may be comfortable and satisfied, but as a professional, you may miss things that need close observation or attention. For example, patients with diabetes need to manage their blood sugar. In secondary care, doctors check blood glucose readings taken by patients and routinely test glycated hemoglobin and hemoglobin levels to watch for complications. However, remote care can lead to patients lying about their self-tested blood glucose levels, which can lead to complications that cannot be properly planned for. Therefore, before this happens, the government needs to stop the typical table talk and respect the opinions of experts who oppose the scheme.
Second, the telemedicine scheme is a piecemeal policy centered on the Ministry of Economy. Telemedicine is a system that changes the market and changes the terrain. It changes the demand for medical personnel from one-to-one to one-to-many, causing great variability in the demand for medical personnel, and rural hospitals are hit harder because geographical barriers disappear. It takes 10 years and an average development cost of over 1 trillion won to develop a new drug. This is due to the need to prove the effectiveness and safety of the drug. However, it is clumsy and hasty to introduce such a huge system that will change the medical landscape and market without even basic research on the expected situation.
In this regard, the government’s proposed legislative preview will be sufficient to control the situation. It means that there will be no confusion if detailed criteria such as who can use telemedicine, medical institutions, and whether or not a specialist is required are set and medical treatment is carried out accordingly. In order to prevent the concentration of telemedicine and medical services, the amendment allows telemedicine only for patients with chronic diseases, home patients who have undergone inpatient surgery, and patients with limited mobility. In addition, the Ministry of Health and Welfare insists that telemedicine should be applied where it can complement current medical practices, not replace them. This means that if IT technology can be integrated into medical care and contribute to improving people’s health, it should be implemented.
However, the criteria outlined in the amendment are detailed but unclear. The concept is vague, and many patients will be labeled as chronically ill, and the number of patients with limited mobility will increase dramatically. The other criteria are also ambiguous and will be abused, and the idea of a one-time trial sounds irresponsible. There will be a sting in the tail if it is implemented. If patients who can’t be bothered to go to the hospital go to telemedicine specialists, local doctors and rural hospitals could go out of business. Small and medium-sized hospitals that have survived will suffer, and access to healthcare will decline. This would mean fewer and fewer providers would be able to provide care, creating a care gap. People will not be able to get the right care at the right time for their situation, and the ability to respond to emergencies will be greatly reduced. In addition, we will see a significant reduction in healthcare jobs. As care becomes remote, dispensing will also become remote, eventually eliminating pharmacies and shifting to logistics. Nurses will also lose their jobs as nursing is devalued.
In the end, a haphazardly implemented system with poorly defined standards and hidden problems will lead to a complete breakdown of the healthcare delivery system and a free-for-all among remote clinics. Considering these numerous problems, telemedicine is not a system that can be simply implemented and judged. Therefore, the proponents of the system need to be more cautious, and even then, I think it is not yet ready for implementation in Korea. In conclusion, I oppose the implementation of the telemedicine system.