[Reporter's View] Telemedicine in a 5-sided tug-of-war

Telemedicine in Korea Trapped in a Pentagon of Conflicting Interests

With the election and inauguration of President Lee Jae-Myung, the Democratic Party of Korea, which successfully changed the administration, submitted a bill to revise the Medical Service Act that narrows the scope of telemedicine’s initial consultation in the current pilot program to the National Assembly.

 

As a result, the eyes of the ruling and opposition parties, public opinion, the health and medical community, and the platform industry are all focused on the bill.

 

Specifically, six key stakeholders — the ruling and opposition parties, the government (Ministry of Health and Welfare), telemedicine users (patients), doctors, pharmacists, and platform companies — are all closely monitoring the Democratic Party’s proposed telemedicine legislation.

 

The biggest issue is the scope and eligibility for initial non-face-to-face medical care stipulated in the bill proposed by Representative Jeon Jin-sook of the Democratic Party of Korea.

 

Rep.

 

Jeon Jin-sook's bill allows minors under 18 and seniors over 65 to apply for telemedicine from the initial consultation, while adults over 18 can only apply for follow-up consultations with telemedicine.

 

This has led to differing arguments among legislative stakeholders.

 

This is why the legislative battle over telemedicine, which erupted once in the 21st National Assembly, is likely to be repeated in the 22nd National Assembly.

 

Two major differences from the 21st National Assembly are that the Democratic Party of Korea, which was the opposition party at the time, has moved onto the ruling party position, and that the number of patients using telemedicine has increased rapidly due to the unrestricted pilot project.

 

In this context, the key stakeholders in the legislation surrounding telemedicine can largely be grouped into five categories: the government, patients, doctors, pharmacists, and platform companies.

 

The National Assembly, which is responsible for reviewing the revision of the Medical Service Act, must gather all the different opinions of these five stakeholders, find common ground, and then persuade and consult with each other on points of disagreement before reaching a consensus between the ruling and opposition parties.

 

The problem is that even before the bill was submitted to the National Assembly for review, the five stakeholders had such different positions that conflict constantly arose.

 

First, the MOHW had to maintain the pilot program for unrestricted telemedicine while holding party-government consultations with the ruling Democratic Party of Korea on the new administration’s plan.

 

During the Yoon Suk-yeol administration, the MOHW took the position that it would utilize the institutionalization of telemedicine as a means to resolve essential and regional medical shortages and promote the health and medical industry.

 

However, the Lee Jae-myung administration is likely to pursue a different policy.

 

The original bill proposed by Representative Jeon Jin-sook aims to conservatively legislate telemedicine as a supplement to face-to-face medical treatment, rather than as a means to promote the health industry.

 

Doctors and pharmacists are both in a symbiotic and adversarial relationship concerning this legislation.

 

While doctors and pharmacists share the same interests in minimizing the scope of telemedicine, they are busy attacking each other over the delivery of prescription drugs, with doctors in favor and pharmacists opposed.

 

For now, doctors and pharmacists are likely to maintain a cooperative stance, opposing telemedicine and prescription drug delivery under the pretext of in-person medical care and in-person dispensing, while also agreeing that intermediary platforms must be prevented from disrupting the healthcare delivery system and pharmacy ecosystem and causing medical institutions and pharmacies to become dependent on platforms.

 

Public opinion is divided regarding the legislation, but there is growing support for allowing telemedicine without restrictions, provided that safety is guaranteed.

 

Patients who have experienced the gradual expansion of telemedicine since February 2020 have grown accustomed to the convenience of telemedicine.

 

If legislation suddenly restricts access to telemedicine services they have been using, it is inevitable that there will be backlash.

 

In particular, public opinion is likely to maintain its stance that the current scope of telemedicine pilot programs should be maintained or minimally reduced, citing reasons such as improving medical access for children and adolescents during late-night hours and enhancing the right to medical care for disabled individuals and the elderly with mobility difficulties.

 

The platform industry is strongly advocating for the institutionalization of telemedicine through a negative list approach and the allowance of prescription drug delivery by courier in the 22nd National Assembly, as it had been during the 21st National Assembly.

 

The argument is that telemedicine should be prohibited only in cases where specific risks have been identified and that telemedicine should be available without age restrictions in all other cases, in order to maintain the platform business that has been in business for 6 years.

 

Ultimately, legislation on telemedicine will be reviewed by the National Assembly amid a five-way conflict of interests between the government, patients, doctors, pharmacists, and platforms.

 

Currently, there are 3 bills (proposed by Rep.

 

Choi Bo-yoon, Rep.

 

Woo Jae-Joon, and Rep.

 

Jeon Jin-sook, in order of proposal) to institutionalize telemedicine, but there is ample room for additional bills reflecting the positions of stakeholders to be proposed in the future.

 

The Democratic Party of Korea, medical associations, and the platform industry are already at odds over the scope of telemedicine for initial consultations.

 

In the 21st National Assembly, telemedicine bills failed to reach a consensus due to differing interests and were not passed.

 

After that, doctors and medical students opposed the increase of 2,000 medical school enrollment quotas and took collective action, and the MOHW has been implementing unrestricted telemedicine under the pretext of alleviating the medical shortage.

 

Some analysts say that the unconditional opposition of doctors to telemedicine and the opposition of pharmacists’ prescription drug delivery created a synergy effect, which led to the blocking of relevant bills.

 

The 22nd National Assembly must not repeat the legislative turmoil experienced by the 21st National Assembly.

 

The institutionalization of telemedicine is a common presidential campaign pledge of both ruling and opposition parties and an unstoppable trend.

 

Unlimited telemedicine without legal grounds cannot be maintained.

 

If legal loopholes are left unaddressed as they are now, it will inevitably create opportunities for illegal and irregular practices to proliferate.

 

This is why the ruling and opposition parties must work together to minimize disagreements among stakeholders and establish legislation that reduces public inconvenience and prevents confusion.

 

It is now time for the sharply divided stakeholders to gather in the National Assembly and engage in intense yet reasonable legislative discussions to achieve the stable domestic implementation of telemedicine.