Including Traditional Medicine in Frontline Services: Opportunities and Challenges

Minjung Park, Ph.D. KMD

CONTENTS

1. Universal health coverage and National Health Insurance System in Republic of Korea

2. Overview on Traditional Medicine in Republic of Korea

3. Traditional medicine as Frontline services

4. Performance of KM at the National level

5. Opportunities & Challenges

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Universal health coverage and National Health Insurance System

in Republic of Korea

UHC

UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

The universal health

coverage (UHC) cube, used

in the World Health Report

2010, reflects three

dimensions of coverage;

population coverage

service coverage

financial coverage/protection

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UHC

National health care system in R.O.K.

A single insurer, covering the majority of the population

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UHC

Benefit package

– Population coverage

– Service coverage

– Financial coverage

Source: Universal Health Coverage Data Portal

Source: Kwons(2018)

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Overview on Traditional Medicine in Republic of Korea

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UHC

Traditional Korean Medicine (TKM)

• Similar to traditional Chinese & Japanese Medicine

• Covered by National Health Insurance fee-for-service payment since 1987

• acupuncture, moxibustion, cupping

• 68 regulated herbal medicine, 56 prescription formulas

• Chuna therapy and physical therapies

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UHC Current status of KM in National Healthcare system

Degree of Integration of TKM in Healthcare system

• Integrative system

• Officially recognized and incorporated into

all area of health care provision

• Inclusive system

• Recognize but has not yet fully integrated

into all aspects of health care

• Tolerant system

• The national health care system is based

entirely on biomedicine, but some TM/CAM

practices are tolerated by law

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UHC

KM education/training system

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• Formal Korean Medicine doctor

training system for 6 years

• 11 Universities & 1 graduate school

• licensed by Health & Welfare

department

• Fostering Specialists for 8 Specialties

to Improve Medical Service

• Treatment area KM internal medicine, KM

gynecology, KM pediatrics, KM neuropsychiatry,

Acupuncture, KM ophthalmology / ENT /

dermatology, KM physical therapy, Sasang

Constitutional Medicine

• Training course 1 year of general training + 3 years

of specialty training

UHC

National Policy on Korean medicine

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• Act on the Promotion of Korean Medicine and Pharmaceuticals (2003)• 3rd Comprehensive Plan to Develop Korean Traditional

Medicine(2016-2020)

UHC

(단위: 개, %)

Year Total N of HCOKorean medicine HCO

KM hospitals KM clinics Total (%)

2012 59,519 199 12,440 12,639 (21.2)

2013 60,899 203 12,816 13,019 (21.4)

2014 63,675 234 13,135 13,369 (21.0)

2015 63,419 260 13,605 13,865 (21.9)

2016 64,999 282 13,860 14,142 (21.8)

자료: 2017 보건복지통계연보, 보건복지부

KM Hospitals and clinics

KM Clinics for primary health care

Private/public hospitals

Public community health centers providing KM service

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UHC

(unit: person)

yearTotal Medical

professions# of KMD

# of people per

KMDDual licensed

2007 375,451 16,732 2,908 179

2008 391,804 17,541 2,782 189

2009 408,491 18,401 2,659 195

2010 424,817 19,132 2,564 201

2011 441,625 19,912 2,555 205

2012 458,541 20,668 2,472 209

2013 474,546 21,355 2,395 227

2014 494,107 22,074 2,284 247

2015 515,259 23,245 2,197 268

2016 535,156 23,460 2,185 319

자료: 2017 보건복지통계연보, 보건복지부

KM Workforce

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Traditional medicine as Frontline services

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WHO TRADITIONAL MEDICINE STRATEGY2014–2023

Goals

1. harnessing the potential contribution of T&CM to health, wellness, people centred health care and UHC

2. promoting safe and effective use of T&CM through the regulation, research

and integration of T&CM products, practices and practitioners into the health system, as appropriate.

Three strategic objectives

1) To build the knowledge base for active management of T&CM through appropriate national policies;

2) To strengthen quality assurance, safety, proper use and effectiveness of T&CM by regulating products, practices and practitioners;

3) To promote universal health coverage by integrating T&CM services appropriately into health service delivery and self-health care.

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Characteristics of KM Utilization

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- High utilization rate in the elder people- Specializing in Chronic disease

- Specializing in Non-communicable disease

- Pro-poor pattern of utilization- More Accessible and

affordable to poor people

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Performance of KM at the National level

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EFFECT OF COLLABORATION TREATMENT ON STROKE

Aim of study• To compare Integrative

Medicine (IM) withWestern Medicine only (WM-only) for acute stroke in-patient care

• Data: NHI claim data

• OUTCOMES:

• Healthcare utilisation & costs

• All-cause mortality rates (3mths & 12mths)

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UHC

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Conceptual Model for Analysis

UHC

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UHC

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UHC

Receiving IM significantly increased the average adjusted length of stay by 27%.– On average, the IM group stayed in hospital 11 days longer

than WM-only group.

Regarding Costs, receiving IM nearly doubled the total cost of inpatient care.

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Results

Opportunities & Challenges

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