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[Editorial] Telemedicine failure

Strict rules, medical sector pressure hamper contactless medical services

By Korea Herald

Published : Aug. 30, 2023 - 05:30

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South Korea’s major telemedicine service operators announced they would shutter their operations, an inevitable outcome resulting from a mix of strict government restrictions and strong pressure from the medical sector.

Telemedicine was hailed as a promising field, offering innovative remote medical services for patients. When telemedicine was temporarily allowed in 2020 to fight COVID-19, few expected that it would become very popular. During the three-year period, a total of 36.61 million medical appointments and treatments were administered via telemedicine, with nearly 30 million home care treatments for COVID-19 patients, according to government data.

Experts and patients alike demanded the government make telemedicine a part of regular medical treatment in consideration of its outstanding convenience, particularly for those who find it difficult to get to hospitals.

But lawmakers at the National Assembly hesitated to consider revising the related medical law, largely out of fear of a backlash from the medical sector, which fiercely opposes the full-fledged operation of telemedicine.

At the heart of the issue is certain medical groups and doctors worry that their expertise and interests could be eclipsed by new types of innovative remote medical services.

The government kicked off a telemedicine pilot program in June, but the outlook was negative from the very start, as there were too many onerous restrictions.

Medical platform operators strongly called for the government to expand the range of eligible patients for telemedicine from only those requiring follow-up visits to first-time patients. But their demands were rejected. In addition, the delivery of prescription drugs -- another important part of telemedicine -- remained banned due to opposition from pharmacists.

There were some exceptions for the second-visit-only rule -- such as those who suffer from infectious diseases or live on remote islands -- but telemedicine platform operators found the restrictions debilitating to the point of finding no way to expand their services.

Given that 99 percent of those who were treated via telemedicine were first-visit patients, the government’s position to maintain the second-visit-only rule was interpreted as a sign that it is unwilling to nurture the new innovative telemedicine sector.

Worse, more and more hospitals declined to treat patients through telemedicine. One reason is that doctors found it too cumbersome to follow related rules for follow-up visits, such as a 30-day period in which patients have to consult with the same doctor for the same illness.

Unsurprisingly, such heavy restrictions hampered the operations of telemedicine startups, offering them little chance to turn a profit. My Doctor, the country’s second-biggest telemedicine platform company, said it would halt its service Tuesday. Doctor Now, ranked first in the contactless medical service sector, is also considering shrinking its operations or changing its main business focus. At one point, there were as many as 30 telemedicine platform operators here. Of them, a dozen decided to halt their operations.

While Korea is close to abandoning a rare opportunity to nurture telemedicine, Japan and France are embracing such platforms. According to the Korea Institute for Health and Social Affairs, Japan has allowed telemedicine for initial consultations when doctors see it as medically viable after assessing the conditions of patients. Like Japan, France does not enforce a second-visit-only system, which allows platform operators to freely target new patients.

While Korea has restored the ban on the delivery of prescription drugs via telemedicine after temporarily permitting it during the pandemic period, both Japan and France do not impose such restrictions on the delivery of drugs.

Another important difference lies in the government policy regarding health compensation for doctors and pharmacists. The Korean government offered 130 percent of basic consultation and prescription drug fees to hospitals and drug stores. The additional 30 percent charge was the cost of managing the state-led pilot program. This compensation-based telemedicine system is unsustainable in terms of public funding. In contrast, contactless treatments in Japan and France cost largely the same or less than offline medical services at hospitals.

The government and lawmakers often emphasize that they are pushing for deregulation in favor of innovative platforms. But the current problems with telemedicine services illustrate how their words are merely lip service.