Trust is essential for healthcare reform

With no end in sight to the political conflict sparked by the government’s unilateral 'expansion of medical students by 2,000,' The Dong-A Ilbo traveled to the Netherlands and Japan to investigate their systems for estimating supply and demand and training of doctors. The Netherlands has the Agency for the Estimation of the Supply and Demand of Medical Personnel (ACMMP), and Japan has the Subcommittee for the Supply and Demand of Doctors under the Ministry of Health, Labor and Welfare. While the Dutch government funds its ACMMP, and the Japanese subcommittee is set up under the Ministry of Health, Labor and Welfare, they operate independently without government intervention.

The Dutch ACMMP is composed of 15 people including two doctors and experts from various fields, such as mathematics, labor, education, and data. They collaborate with more than 140 experts in different healthcare professions to estimate the appropriate healthcare workforce every three years. They use 50 different data points, including basic variables such as new graduates, the duration of doctor training, and average working hours, as well as future variables such as the likelihood of infectious disease outbreaks and the healthcare needs of an aging population. The agency is so precise in estimation that it only collects data for two years or more. The ACMMP follows the principle of “plan long and estimate often,” and the government and the medical community respect the results.

Japan, which has been increasing its medical school student enrollment since 2008, was able to avoid the kind of social conflict that South Korea is experiencing through transparent discussions and gradual expansion. The Physician Supply and Demand Subcommittee, which consists of 22 members including 13 doctors, publishes the full minutes of each meeting, including a list of speakers and key points made. Based on this objective evidence that has been generated this way, Japan has gradually increased the number of medical school seats by 1,778 in phases over a period of 17 years, with the total seats amounting to 9,403 this year.

Dutch and Japanese experts who participated in the estimation of supply and demand emphasized that it is impossible to gain consensus with the medical community and convince the public without transparently revealing the decision-making process and rationale behind an increase in medical school seats and building trust. In February, the Korean government made a surprise announcement of 2,000 new medical school seats, more than Japan has added in 17 years, without clearly explaining the rationale behind the policy decision. The minutes of the meetings of the consultative committee on medical issues and the student quota allocation committee for each medical school were not available. Although the government later promised to launch a committee to estimate the supply and demand for medical personnel, the medical community has refused to participate due to the lack of trust between the parties. The government's initial missteps in expanding medical school seats have caused the healthcare reform program itself to lose momentum.