The Korean health care system rocks

Today, I went to the hospital to get the stitches from my appendectomy taken out. There were just four of ‘em, so it was fast and easy. Then I found out I was getting billed for it. “Damn,” I thought. “Shouldn’t getting the stitches out have been included in the bill I paid last week?” I also wondered how much it would cost for that few minutes of work. $50? $100? $200? I had insurance through work, but in Korea your insurance only covers 55-70% of any given medical bill.

Turned out the bill was… wait for it… 5,080 won, of which I had to pay 3,000 won. For those of you who’ve never been to Korea, 1,000 won is a little less than a dollar. That’s right, I went in for medical treatment and paid less than $3 US. In a way it makes perfect sense, since the procedure took 5 minutes tops, but familiarity with the American health care system meant the reasonable price took me completely by surprised.

This was after I had gotten surgery and two days in a recovery room for a bill of under 3m won, of which I paid about 40%. On the phone, my parents told me that my bill for an appendectomy would have been about $10,000 dollars in the States. Wondering how the hell Korean prices for health care manage to be so reasonable, I did a Google search and discovered that, yes, in South Korea there are price controls in medicine, which are set by National Health Insurance Corporation.

I admit I was surprised to learn this. Don’t price controls lead to shortages? What I found out is that in Korea, the price controls have some drawbacks, but the drawbacks seem to be pretty mild:

This has real effects on healthcare. Think about it from the doctor’s perspective – if the price is fixed, how can they earn money? Broadly, there are three ways: (1) see more patients; (2) perform treatments that have a higher NHIC price or are not covered by NHIC; (3) find another way to get paid.

Because Korean doctors are incentivized to see more patients, they often cram in as many patients as they can, in a practice derisively called “five-minute diagnosis.” As of 2005, each Korean doctor sees three to four times more outpatients than doctors in other OECD countries. Many Korean patients complain about this practice, as they do not feel adequately cared for.

The above quote is from a Korean, and frankly I don’t think Koreans realize how good they have it. I’d much rather have to make due with a “five-minute diagnosis” (which I guess I went through, but which diagnosed my appendicitis just fine) than to be unable to afford treatment or have my savings wiped out by a hospital bill. Robin Hanson has argued that in the United States, much of our health care costs are due to paying a premium in order to feel like we’re doing something for our health. Having health care heavily regulated discourages that.

Another problem with the Korean health care system:

Because the patients can visit any doctor in the country, they often opt to visit the best doctor in the country for any petty ailment. So the best hospitals in Korea – like Seoul National University Hospital, Yonsei Severance Hospital, National Cancer Center, etc. – often have a significant waiting time not unlike the horror stories one hears about other socialized medicine countries.

I didn’t experience this, because while I was in Seoul when I noticed something was wrong, I made a deliberate decision to go to Inha University Hospital, because it’s closer to where I live and work (the latter is relevant because that made it easier for one of my coworkers to come help me navigate the system; I’ll be eternally grateful to her.) At Inha, I had to wait a couple hours for diagnosis and another couple hours for surgery, and while those were probably some of the least-pleasant hours of my life, in the end it didn’t really make a difference.

So in the end, I had a positive experience with the Korean health care system. Having had appendicitis in the US probably wouldn’t have been a disaster, because thanks to the Affordable Care Act I’m covered under my parents’ insurance for another year. But this experience has made a part of me really, really happy I live in Korea. To all my friends still in the US, here’s hoping the US health care system will one day be as good as Korea’s.

  • Pteryxx

    Hey, congrats – and good to know.

  • unbound

    Good to hear that you have successfully been patched up.

    Hospital wait times seem a bit worse than US, but the 5 minutes of doctor’s attention is actually pretty much the same anymore.

    In fact, outside of the attention of specialists that have to spend the time to diagnose, I don’t think I’ve even had 5 minutes with a doctor in well over a decade now. Plenty of time waiting in the lobby (after paying co-pays), then waiting in the exam room, then talking to the nurse, then waiting in the exam room, then finally seeing the doctor very briefly, then out the door unless you need another appointment.

  • http://peicurmudgeon.wordpress.com/ peicurmudgeon

    Glad to hear everything worked out fine for you.

    I’m not a fan of the 5 minute appointment as a standard. Sometimes, that’s all it takes for a diagnosis, but there it leaves much more room for errors. I may be in the minority, but I have been seeing the same family physician for 20 years; the same physician who saw my children until they all moved away. I have a long history opf physical and mental illness and when I see him, I don’t need to discuss my medical history. On occasion, I have seen other physicians (at the ER for example) and the 5 minute appoint I get from them doesn’t allow for any accounting of my history.

    For example, 2 years ago I had a farily severe bout of sciatica and the ER doc just dismissed the effect it was having on my mental health, even though I asked for an intake assessment. I should have, but didn’t see my psychiatrist and I know that my depression interfered with my recovery.

  • Tsu Dho Nimh

    they often opt to visit the best doctor in the country for any petty ailment

    Doesn’t the best cardiac surgeon, for example, have any way of screening out the hangnail sufferers?

  • left0ver1under

    Actually, the Korean medical system sucks. I lived there for a few years, and I know from experience.

    Most of their doctors attended Yonsei University in Seoul, which is christian and preaches “young earth creationism”. How can you call a doctor competent when he doesn’t accept the basic fundamentals of biological science?

    The only Korean doctors there which I found competent where those trained overseas or who did some practice and residency overseas. Those doctors did not participate in the medical plan and were expensive, but they provided better treatment.

    Korean dentists, on the other hand, are nearly all western trained at universities which accept the fact of evolution. Neither I nor other foreigners I spoke to had problems with a Korean dentist (aside from my own fear of dentistry in general).

    • http://www.facebook.com/chris.hallquist Chris Hallquist

      What bad experiences did you have with the Korean health care system?

      Yeah, I’d rather have a doctor who accepts the fundamentals of modern biology, but as far as I can tell that didn’t negatively impact my experience in the hospital.

      On the other hand, there seems to be a problem in Korea with over-prescription of antibiotics, which is likely to lead to the evolution of more antibiotic-resistant bacteria down the road. So maybe I’ll take back those words some day as I’m dying from an infection of multiple drug resistant whatever.

      • left0ver1under

        I wasn’t avoiding your reply, I just didn’t get around to answering.

        My own experience included one in an ER who said my collarbone wasn’t broken after being hit by a car running a red light and sent flying, and I just needed a bandage. I insisted on getting a second doctor who confirmed the break, x-rayed my shoulder and treated it properly. It wasn’t just that I’ve had other breaks and know what it feels like, the bone was visibly deformed under the skin. This was more than laziness on his part.

        Another oddity is the Korean attitude towards tattoos, many think those who have them are “gang members” or “satanists”. A GP I had been to regularly refused to treat me anymore – on religious grounds – after learning I had a tattoo. Other westerners told me similar stories.

        And related to what you said about anti-biotics, the next GP I went to (after the tattoo bigot) refused to supply enough anti-biotics for a throat infection from the “yellow wind”, something I bet you’ve experienced. It got worse and I went elsewhere for better treatment – not at a second doctor, but at a third. The second said “You’re already seeing another doctor”, and refused to treat me.

        Other westerners I met there or afterward related similar stories of numerous failures to diagnose or treat properly. The number of Korean quacks is a single digit percentage, but it’s still far too many to deserve people’s trust. Many seem less like scientists and more like memorizers following a script.

        I also don’t miss the brown skies and pollution, I don’t miss the “road pizza” everywhere on weekend mornings, and I don’t miss the 80-90% of men and 40-50% of women smoking. Since your bio says you teach in Korea, I’ve got stories about my own experiences teaching there. I’ll send them by email, if they’re welcome. Teaching here in Taiwan is sooooo much better.

        • http://www.facebook.com/chris.hallquist Chris Hallquist

          Yeah, not thrilled by all the pollution here. I’d be happy to hear your stories by e-mail, also your experiences in Taiwan and how you got that job.

  • mandas

    Why does this rock?

    I had my appendix out just before christmas and didn’t pay a cent. But that’s Australia for you.

    • http://www.facebook.com/chris.hallquist Chris Hallquist

      Okay. Rocks compared the the United States.

    • Nele

      Same in “socialist” Germany – I had a very stubborn sinusitis a couple of months ago. The whole therapy included several visits to the doctor, two x-rays of head and lunges, heavy doses of antibiotica and painkillers; I paid exactly zero euros for all of this.

      Since I am a civil servant, I got full pay continued during sick-leave. I have had been in the private sector, my insurance would have compensated most of the missed pay (Krankengeld).

      Yeah, we poor Germans suffer dearly under the iron boot of “socialist” health service… (Yet people over here whine and complain all the time which I actually can’t understand.)

  • Roger

    The poor maligned NHS in the UK has provided me with a triple heart bypass, managed some ensuing complications, and mended a fractured spine in the last couple of years, totalling about eight weeks in hospital, quite a bit of it in intensive care or high dependency. Also a hell of a lot of drugs. Total cost £0.00.

  • Zugswang

    Just a curiosity that came to mind last night:

    With doctors having to see more patients, how does that affect access to healthcare in areas with low-population density, i.e. small towns and villages? Do those people have to travel more to see a doctor, or does Korea have something in place to ensure that such areas still have adequate care?

  • Nashwin

    I would agree would you for most of the things especially the 5 minute diagnosis, unfortunate for me i got the sucky end of the deal. i fell down some stairs and injured my shoulder. the local countryside orthopedic ruled it out as a sprain, a few days later i went to a larger city to see a more professional orthopedic and yet again it felt like i was biting a bullet. he diagnosed it as an ac joint injury. according to typical research, my recovery time would be approximately 6 weeks. 12 weeks later im still in a sling with reduced range of motion. i forwarded my xrays n mri’s to a doc friend and he said it looks like a dislocation. the orthopedic said ” hey dont worry, i think it is maybe muscle stiffness, just go for physical therapy”…
    now im ready to snap but im going to a university hospital in seoul to see if the errors can be fixed…wish me luck….

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