The government and medical circles are at odds over the Supreme Court’s Monday ruling partially justifying doctors’ charging extra fees for tests and treatments outside state guidelines.

While medical institutions call for extended autonomy of medics, the administration is striving to minimize the aftereffect of the ruling, which could pave the way for doctors to prescribe pricy but unnecessary treatments in the future.

The long-term rift reemerged when the nation’s top court ruled in favor of Yeouido St. Mary’s Hospital which sued the Ministry of Health and Welfare for fining it 9.6 billion won ($8.3 million) and ordering it to give a 1.9 billion won refund to the National Health Insurance Corporation. The ministry’s decision came after a group of leukemia patients in 2006 filed complaints that doctors there used treatments for breast, ovary or lung cancer on blood cancer patients.

Such out-of-the-box treatment cannot be covered through the state insurance program since its usage and safety have not been confirmed by the authorities. About 200 patients and their family members claimed they had to pay up to 19 million won more than the government-guideline because of the “excessive regime.”

The top court said it respected the government health insurance guideline, but concluded that the usage of extra drugs and treatments cannot be undermined if doctors guarantee their medical effects and safety, and win patient consent. “Still the medical service provider should be solely responsible in convincing the distinguishable effect of their extraterritorial treatments to the patients and the government,” the Justices said. Previously, the court acknowledged the authority of the state guidelines.

Civic activists and some officials worry that the hospitals will take advantage of the verdict in prescribing pricy, experimental treatments to patients, only to heavily burden patients. “If you are a terminally ill patient clinging to the slimmest chances, you won’t be able to refuse the doctors’ recommendations filled with medical jargon,” said Ahn Ki-jong, head of a leukemia patients’ organization.

The government also geared up to limit the influence of the ruling. “The fundamental message of the court is acknowledging the incumbent system,” Bae Kyoung-taek, a health official, told reporters. “We will strengthen our inspection on medical institutions to prevent the abuse of the ruling,” he added.

Moon Jung-il, head of the St. Mary’s Hospital, expressed exhilaration. As the Supreme Court has rejected the appellate court’s ruling, the Seoul High Court will have to review the case in favor of the hospital that has long locked horns with the government.

“We will seek for more uninsured treatments to be acknowledged as advisable and authentic, giving more freedom to doctors and patients in using the latest and effective treatments. This is just a start,” he said as he left the court on Monday.

However, a critic said the future of hospitals might not be too rosy. He said medical institutions may receive complaints from patients as the highly sensational trial has shed light on the fact that there have been

authorized and safe treatments cheaper than their doctors’ recommendation.

“In the worst scenario, family members of the patients who have seen mere progress in uninsured treatments will ask their doctors for a refund and demand a state-insured scheme,” an observer said.

By Bae Ji-sook (baejisook@heraldcorp.com)