Thursday, July 24, 2014

What's up, doc?

WARNING: This post was written late at night by a man suffering from an ice cream hangover. (I'm pretty sure that's a thing.)

"Korean health care is AWESOME." - the average sentiment of many, many foreigners who live in South Korea and post their experiences on the interwebs.

Remembering this, I was overjoyed last month when I discovered a new development: An ingrown toenail. "JOY!" I thought, "it's high time to see what this Korean health care system is all about!" I then skipped to the hospital as if I were going down the yellow brick road to Oz, all the while singing, "I'm off to see the doctor."

Okay, maybe that's a slight dramatization.

Thankfully, there's a hospital less than a kilometer away from where I live.

Konkuk University Hospital, picture courtesy of

Even better? There's an international clinic. This incredibly helpful man named Edward helped me through what would have otherwise been a very confusing process.

See, in order to see a specialist about my toe, I had to go to a clinic and get a referral. Edward took me across the street accompanied me to the clinic and told the receptionist what I needed. Soon, I was heading back to the hospital, Korean document in hand.

I went to the dermatology office. I spoke to a doctor, underwent a procedure to fix the toenail (it involved anesthesia and random nail trimming devices), had my toe bandaged, and left the hospital with two prescriptions (one for antibiotics, one for ointment).

This took about 2.5 hours, and the whole thing cost me less than $100 USD. In my experience, that is awesome. Of course, I was insured, so it could have cost quite a bit more. However, in the US, I've been charged quite a bit more than that amount for somewhat similar treatment (this toe has been an absolute diva over the past year, folks) in the US.

After a few follow-up visits, the bandage came off the toe, and everything's looking good.

Korean health care, you've won an admirer...well, that's what I would have said before today.

One of my students is a urologist. Each class, we spend at least 20 minutes (ideally) on conversation. Today's topic was physical appearance, and the topic of plastic surgery inevitably came up. This student said something that has been on mind all day. I should mention that his English is quite good.

Even though the student I mentioned is a urologist, he currently spends most of his time doing Botox injections and the like at a plastic surgeon's office. He does this to make ends meet. As a urologist, for every patient he sees, he should expect to earn about $10. Yep. The wages he should expect to earn from seeing a patient would allow him to buy a Big Mac combo meal and have some change left over.

I say "should expect" because of how insurance works here. It's universal, meaning that it's run by the government. Back to this in a moment...the patients that my student sees each pay him about $3 of the total $10 as a copay. He then has to request the remaining amount from insurance aka the government. The government should then pay him the remaining $7 per patient.

There's that "should" again.

The government can apparently be rather fickle when it comes to paying the remainder of this amount. From what I have heard, the insurance representative can search for (read: create) mistakes that the doctor made as he or she was treating the patient; the representative can then use that as a reason to not pay the full amount to the doctor.

...So much for the Big Mac meal. Perhaps I could interest the doctor in a McChicken?

Back to the government. The politicians are accountable to the citizens. The citizens have to have health insurance. The politicians have an incentive to drive down costs for citizens; in my mind, the incentive is reelection. They don't have that sort of obligation to the doctors, so it's a bit easier to nickel-and-dime them.

I realize that what I have written is one doctor's experience. Other doctors here may or may not feel the same way.

But I can't help thinking about a few things.

First off, apparently the Korean health care system is affordable for patients, but it doesn't appear to provide doctors with a strong incentive to stay in Korea.

Second off, how incredibly different is health care in Korea versus health care in the US? In the US, being a doctor tends to correlate with making a very comfortable living, but patients can expect to pay a significant amount for care, especially if they're uninsured (in which case the amount is absurdly high). If they're insured, they have to deal with ironing out details with their insurance providers. In Korea...well, see the previous paragraphs. Affordable for patients, but the doctors get stiffed and have to take on extra work, such as injecting Botox, to make ends meet.

Back to my student...he ended his thoughts by saying that he was learning English for one main purpose: To get out of Korea and practice medicine in a country that would allow him to make a living wage. I didn't know this until today. Not surprisingly, he is one of the most dedicated students I've seen.

This leads to my final (for now) thought: Health care in the US is undergoing big changes. Some people like the changes, others don't. Regardless, I hope that the changes don't push US health care providers to change professions as a result of an incentive decrease.

Alright, enough of this serious business. I'm off to bed.

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