South Korea’s Medical Liability Crisis -By Fransiscus Nanga Roka

The brutal truth is that a healthcare system cannot be sustained when the most important people needed to save lives are also ones most vulnerable to destruction. What is going on is more than a staffing issue, it is a collapse of the fabric of trust in high risk clinical science. The why it matters is obvious: patients lose access sooner than they lose treatment, when pediatricians, surgeons, obstetricians and emergency doctors live in fear of lawsuits over sickness.

That puts you in a place where the target is on Who. Doctors, hospitals, families, insurers and the government. The immediate casualties are the frontline specialists burdened with soaring malpractice premiums, aggressive lawsuits and ever-present risks that one bad outcome could lead to civil or criminal liability. The collateral damage will fall on regular citizens reliant on vital services that are becoming even more challenging to man. Where is this unfolding? In hospitals as high-risk specialties become less appealing among young physicians in South Korea. WHEN did the crisis become impossible to deny? When legal exposure and insurance costs had risen so much that they distorted the choice of specialty and impaired needed care capacity. How has the government responded? To stabilize the workforce, the government should intervene through the Ministry of Health and Welfare: fully covering liability premiums for high-risk specialties.

That intervention is necessary. But it is also an indictment.

There is no need for a country to subsidize fear in order to keep pediatric wards running and operating rooms resourced. If by charging 100% of malpractice premiums for these specialists places a financial burden on the state, then the insurance pricing is not the only issue. This is one of the environment that has created medical risk intolerable as it is a legal and institutional framework Bad outcomes in South Korea have become too often regarded as events deserving punishment within a system that has found itself entrenched, in spite of the uncertainty, difficulty and imperfections that are inherent in medicine.

Herein lies the danger paradox: The more society asks for perfect outcomes, the less likely it is to actually find doctors who will perform in specialties that have the greatest likelihood of failure. How does that protect patients? It abandons them.

It earns marks for being straightforward. For example, the government lowers the burden of the doctors in pediatrics, obstetrics, surgery, thoracic and cardiovascular surgery and emergency medicine by fully covering premiums It also protects hospitals from the unexpected catastrophe claims, and can even help restore some of the confidence among younger doctors that have been shying away from the core important specialties. This should buy some time and in the meantime keep the critical services from getting to a wider fall-out crisis.

But subsidy, in itself, is not strategy.

Your solution should be structural at probably a deeper level. The first step is that malpractice handling in South Korea should clearly distinguish between gross negligence and honest adverse outcome. A fourth is to use a more prompt, less adversarial and less financially punishing method of settling medical disputes nationwide. Third, compensation rules must be reengineered to ensure patient safety, without making every complication a career catastrophe. Fourth, work force incentives in the long-term and permanent setting for areas of high risk rather than crisis subsidies. Fifth, we need to improve medical education and health systems so that fewer doctors practice defensive medicine under enormous duress.

Policy, only, does, buy time; returns impending crisis. When fear itself is a target of reform, the system can regenerate.

South Korea does not just write the check for insurance premiums It is the cost of a legal culture that has driven essential medicine to the brink. The question is, does such an intervention become a bridge to reform or simply a taxpayer funded bailout of a dysfunctional system.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya and Managing Partner Law Firm Victorious Indonesia