- Date2020-04-21
- Hope against COVID-19 in an Unknown Land Download
Hope against COVID-19 in an Unknown Land
The Inhabitants of Unknown Lands
In Jonathan Swift’s “Gulliver’s Travels,” Gulliver is at one point swept away to the flying Island of Laputa where he meets the curious people that reside there. Each resident worked on their own difficult undertakings in their respective rooms, and they could often be found arguing the whole day long.
In British Mathematician Lewis Carroll’s “Alice in Wonderland,” Alice also finds herself in a curious place. Tired of the banality and boredom of her daily life, she follows a talking rabbit and his pocket watch down a rabbit hole to an unknown land.
You, too, might very well be living not too far from an “unknown land.” This is the story of just such a land.
□ Anyone can dream
Life in the ashes of the Korean War was difficult in the Republic of Korea. Just having food to eat every day was enough to make people happy. Back in those days, they used to say that Koreans were “fueled by rice.” The people of the time were happy to go hungry if it meant that they could provide their children with an education. They relied on home remedies for many ailments―a needle prick to draw blood from a finger for an upset stomach or damp cloths on their heads for a fever. Hospitals were still a far off reality, yet Korea had its first big dream: a “Health Insurance Law” (Health Insurance Law enacted in 1976).
The people of this Unknown land worked tirelessly and without a second’s thought when one day Korea had its next dream: a world in which anyone, even those without decent jobs or money to spare monthly, could easily go to the hospital. For their parents who sacrificed so much, their children whose promising futures laid before them… they hoped just that all of their loved ones could simply go to the hospital with ease of mind (Expansion of National Health Insurance coverage to all citizens in 1989).
Despite this land’s arduous work ethic, the impoverished were faced with the International Monetary Fund economic crisis that caused the near-complete collapse of the nation (1997). In these times, all that was left was suffering―both of the body and the mind.
□ Building Public Services through the Power of the People
Even before all of that, a certain trend spread across the Unknown country. Talented students living in this tumultuous country were becoming doctors, lawyers, and government officials, just as their parents had always wanted. These students would go on to found hospitals, create new laws, and establish sophisticated institutions.
As a poor nation, Korea couldn’t afford to establish many public hospitals. Though 85% of all hospitals were private, a “National Health Insurance” that covered medical services was implemented in all hospitals, both public and private (Automatic Designation System for Healthcare Institutions established 1979).
Meanwhile, a system that allows medical expenses across the entire nation to be charged online according to each individual item was established (1995) and has allowed for the steady accumulation of medical information for the entire country.
□ According to whose rule?
In this world, presidents, prime ministers, kings and queens, religious leaders, and in some cases even the military can all govern a given nation. Each county has its own form of governance, and likewise each country has different methods and agents for guaranteeing the public’s health.
One day, the Unknown nation was visited by the chief of health insurance from a country with a powerful leader. They then asked,
“Who governs this country? How could something like this happen…”
But then something almost unbelievable occurred just as this Unknown country was recovering from the IMF economic crisis of the 1990’s.
○ Hundreds of insured individuals including government employees, teachers, office workers, and local associations were all united under the same insurance plan (The National Health Insurance Service founded in 2000).
○ In order to closely investigate whether medical expenses are being properly charged, a body separate and independent from the insurer was established to oversee the review and evaluation public healthcare (The Health Insurance Review & Assessment Service founded in 2000).
□ What remained after MERS
5 years ago, this Unknown land was hit by an unusual MERS epidemic and the country’s initial response was quite poor. Patients took part in “medical shopping,” wherein they would go around to different hospitals looking for one that suited their taste. Some of the hospitalized patients even had visitors from outside of the hospital. Needless to say, there were many holes in the containment of this infectious disease and cases continued to spread.
In particular, medical professionals who had to deal with newly visiting patients were troubled by a lack of essential information. There was no way for healthcare providers to determine if a patient had visited high-risk foreign countries, if they had been in direct contact with a confirmed MERS patient, or if they were hiding the fact that they had been diagnosed with MERS. Someone had put a stop to the unending cycle that fueled the spread of infection.
□ A leader behind the scenes in solving the MERS outbreak
It was this Unknown country’s Medical Information Systems that drew attention in these trying times. Among these services is the Drug Utilization Review System (DUR) which acts as a neural network to prevent pharmaceutical mishaps by conducting checks once when drugs are prescribed by a doctor and again when a pharmacist fills the prescription.
The system also enabled medical professionals to determine whether a patient was a confirmed MERS patient, had been in contact with a confirmed MERS patient, had previously visited another hospital, or even if they had visited a high-risk area (2015). Additionally, the International Traveler Information System (ITS) was later developed (2017).
The Unknown land suffered from MERS only to recover with a stronger and newly developed immune system that was ready to face the next plague, whatever it may be.
□ Faced with New Hardship: COVID-19
This Unknown land is neighbored by a grand nation with a vast population. One winter, a new infectious disease spread to the Unknown country from this grand nation. The people of the Unknown nation who would work on their own difficult undertakings in their respective rooms and could often be found arguing the whole day long got to work. They decided to work together to prevent the spread of this disease. And this is what they did:
1. (Legal Framework) Revised Infectious Disease Management Act, Quarantine Act, and Medical Act
2. (Money Issues) Provide diagnostic test and treatment free of charge for all
Koreans and foreigners
- (Financing) National Health Insurance 80%, National & Local Government 20%
- (NHI Fee Schedule) Newly establish or revise the prices of services to treat covid-19
3. (Medical Workforce)
Ease the regulations for medical volunteers in Taegu & Kyungpook regions.
Dispatch personnel to Incheon Airport, Taegu City Hall, and the Central Disaster Management Headquarters.
Telephone monitoring for overseas entrants.
4. (Medical Facilities)
Designate of COVID-19 Safe Hospitals.
Track current status of negative pressure wards.
Manage healthcare providers that are vulnerable to infection control (long-term care facilities).
Monitoring current status of hospital wards by region and healthcare provider.
5. (Medical Equipment)
Postpone examination of diagnostic radiology equipment re-allocate to COVID-19 screening centers.
Track current status of ventilators and ECMO (extracorporeal membrane oxygen)
6. (Pharmaceuticals)
Expedite the review of COVID-19 related drugs for NHI listing.
Distribute the drug inventory data by region and wholesaler
7. (Personal Protective Equipment)
Ease the “Mask Crisis” in early stages with HIRA’s e-government system
8. (E-government System)
Drug Utilization Review (including International Traveler Information Service).
Release COVID-19 Clinical Big Data.
Develop nationwide COVID-19 patient management system.
Mask distribution system (to check stock and prevent repeat purchases).
9. (Healthcare Institution Financial Difficulties)
Provide advanced payment to healthcare providers (90% of claimed amount).
Increase the prices payed related to COVID-19 treatment.
10. (Community Contributions)
Donate mask & hand sanitizers to vulnerable social groups.
Offer tele-monitoring jobs to foreign migrants.
□ “Who to save?”: A solution to the doctors’ dilemma
There is a dilemma that appears in Michael Sandel’s book “Justice: What's the Right Thing to Do?” It goes as follows:
1. There are five people standing on the tracks of a train that a train driver is currently driving on. The tracks are split, and down the other path there is one person standing on the tracks. Down which track would you drive the train?
2. There is a kidnapper and a wounded detective. The kidnapper is the only one who knows the whereabouts of the child he kidnapped. If you could save just one person, who would you save?
Availability of medical resources that are essential for the treatment of patients of infectious diseases (medical personnel, facilities, equipment, medicine, and PPE) must be reinforced. Quick decision-making must also be made to track available medical resources in real time and ensure that they are allocated to national and regional institutes in a timely manner (Case in point: when negative pressure wards were lacking in the Daegu area, patients were successfully moved to a hospital in Jeonju for treatment).
Medical staff all around the world are currently facing the dilemma of “who to save” as they continue to be swarmed by an ever-increasing number of confirmed COVID-19 patients. Does there exist any kind of national-level medical system that can help to solve such a dilemma?
□ A time to share knowledge and experience
The news on TV has been non-stop. In every country, community infections continue to soar, medical systems collapse under the pressure, and more people are lost than even in war. We see the tears of those who aren’t even able to give a funeral to lost loved ones. This is truly a tragic time. If there were ever a time when we all need to share our knowledge and experience, wouldn’t that time be now?
Thank you for your time and attention. If you would like to know more about what is happening in this curious and Unknown land, please contact us below.
◇ Health Insurance Review & Assessment Service (HIRA)
○ Moosung Kim, Acting Director General of International Cooperation Department
(+82-33-739-1701, mskim1242@gmail.com)
○ Eunkyong Ko, Deputy Director of International Cooperation Division
(+82-33-739-1703, eunkyongko112@gmail.com)
