How to transform the medical care system after the COVID-19 pandemic

Jong-Koo Lee

doi:10.24171/j.phrp.2023.0382

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Editorial How to transform the medical care system after the COVID-19 pandemic: Jong-Koo Lee; Osong Public Health and Research Perspectives 2023;14(6):439-440.
DOI: https://doi.org/10.24171/j.phrp.2023.0382
Published online: December 28, 2023

National Academy of Medicine of Korea, Seoul, Republic of Korea

Corresponding author: Jong-Koo Lee National Academy of Medicine of Korea, 51 Seochojungang-ro, Seocho-gu, Seoul 06654, Republic of Korea E-mail: docmohw@snu.ac.kr

• Received: December 19, 2023 • Accepted: December 21, 2023

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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After the coronavirus disease 2019 (COVID-19) pandemic crisis subsided, social restrictions were lifted and daily life began to return to normal. However, several issues in the healthcare sector that had been dormant are now resurfacing. The post-pandemic situation has not served as a “strategic inflection point” to improve our healthcare system—instead, we are witnessing a reversion to the previous state, as if the crisis never occurred. As Professor Lawrence Gostin, who visited last month, has been pointed out in his book, Global Health Law, a comprehensive COVID-19 response involves a medical component, a public health strategy, and an approach that addresses social determinants. To find fundamental solutions, we need good governance, social commitment, and a focus on human rights, considering equity as the primary lever for closing gaps and envisioning a transformation toward a sustainable healthcare system. However, the shortage of medical personnel looms large, overshadowing all other discussions.

First, we must acknowledge the significance of investigating excess mortality [1]. According to the 2022 Cause of Death Statistics from Statistics Korea, 31,280 deaths were attributed to COVID-19 (8.4% of all deaths that year). The mortality rate soared by 522.8% to 61.0 per 100,000 people compared to the previous year, with the highest rates observed in individuals over 80 years of age. The rise in deaths from Alzheimer disease (45.6%), diabetes (24.9%), hypertensive diseases (24.2%), pneumonia (17.3%), and cerebrovascular diseases (12.6%) may be viewed as indirect consequences, although the particularly sharp increase in Alzheimer's-related deaths is difficult to categorize in this way. The potential for undiagnosed COVID-19 cases in nursing homes, long-term care hospitals, and mental health hospitals should also be considered. Excess mortality is estimated at 8.7%, potentially reflecting challenges in healthcare access, emergency care systems, and intensive care management [2]. Therefore, in addition to addressing diagnostic challenges, it is necessary to identify discrepancies between projected and actual figures to develop effective solutions.

Second, after the COVID-19 pandemic, there have been concerns regarding the shortage of physicians for essential medical care, regional disparities in physician distribution, and related excess mortality. Discussions aimed at resolving these issues have been ongoing since 2013, but progress has been hindered by differing definitions of the problem and perceptions of its urgency. Statistics and various indicators must be developed, and it is necessary to integrate and manage medical college education, resident training, and continuing medical education to determine the appropriate number of medical doctors needed by our society. The prolonged COVID-19 pandemic has also highlighted the importance of ensuring the stability and functionality of primary care even during outbreaks of highly pathogenic infections. The primary care system should involve holistic management encompassing the initial diagnosis, treatment, recovery, and prevention of secondary infections in the household, as well as the responsible management of chronic diseases such as diabetes and hypertension through outpatient and home visits. However, the current training is predominantly hospital-centered. Additionally, the use of hospital residents as inexpensive labor rather than for educational purposes has distorted the medical care system. Approximately 3,000 residents have left hospitals over the past ten years due to shortened education terms, exacerbating the workload in university hospitals [3]. Instead of relying on residents, more specialists should be employed. The policy of subsidizing residents’ wages has led hospitals to refrain from hiring specialists, resulting in a decline in academic development and a decrease in the quality of education due to heavy workloads. This issue, which is separate from the medical school quota debate, could be addressed by increasing the number of supervising specialists in hospitals. This issue is also tied to the quality of healthcare and the need to employ essential medical personnel such as primary care providers, as some opt to work in local healthcare without formal training. Restructuring undergraduate and resident education to prioritize community-centered primary healthcare education and training, rather than focusing on university hospitals, and supporting this system—including night consultations, home visits, medical consultations, emergency transportation, referral systems, and livelihood support—will transform primary care into a patient- and community-centered system.

Third, improvement is needed in the traditional vertical health program, which has focused on constructing and operating single disease control, such as tuberculosis hospital before 2000, but in COVID-19 isolation and quarantine purpose hospital to address single health issues. During the COVID-19 pandemic, the scarcity of patient isolation facilities resulted in the repurposing of public hospital beds as isolation wards. After the COVID-19 crisis subsided, these hospitals struggled to resume their roles as central regional or district hospitals. The reorganization of hospital functions to accommodate infectious patients led to the discharge or transfer of patients with other chronic conditions and reduced activity in some departments. Therefore, medical personnel were reassigned to different departments or left their positions. However, post-crisis, the inability to recruit new medical staff prevented these hospitals from restoring their previous functionality and fully meeting regional medical needs. Theoretically, hospitals dedicated to infectious diseases are beneficial for containing outbreaks and treating critically ill infectious patients. However, when outbreaks expand, the patient load can exceed their capacity, leading to collateral deaths and making it challenging for these hospitals to continue functioning post-crisis. Therefore, future improvements in this area should be considered, along with improvements in the isolation and quarantine method and diagnotic test system, which is centered around public health centers and operates separately from the traditional medical care system. In 2010, the tuberculosis management system transitioned from a public health center-based program to a public-private mix that involves private hospitals. This transition did not increase the number of tuberculosis management personnel in public health centers, but rather integrated them into general hospitals. The approach of managing symptomatic patients and their families with tracing, testing, isolation, quarantine, and chemoprophylaxis hospital-based approach has provided valuable lessons for the management of other infectious diseases, including those that are drug-resistant and sever respiratory disease as well as the prevention of healthcare-associated infections. Despite its public health importance and effectiveness, the isolation-centered management system in COVID-19 pandemic has struggled to respond during periods of high demand, limiting its utility for diverse patient management. Therefore, developing strategies to overcome these limitations is necessary.

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Conflicts of Interest

Jong-Koo Lee has been the editor-in-chief of Osong Public Health and Research Perspectives since October 2021.

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References

1. Statistics Korea. Causes of death statistics in 2022 [Internet]. Statistics Korea; 2023 [cited 2023 Dec 19]. Available from: https://kostat.go.kr/board.es?mid=a20108100000&bid=11773&act=view&list_no=427470.
2. Han C, Jang H, Oh J. Excess mortality during the coronavirus disease pandemic in Korea. BMC Public Health 2023;23:1698. Article PubMed PMC PDF
3. Joo SH. The reason why ‘about 3,000 medical residents’ disappeared from the medical field in 10 years [Internet]. Dailymedi; 2023 [cited 2012 Dec 19] Available from: https://www.dailymedi.com/news/news_view.php?wr_id=905983. Korean.

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How to transform the medical care system after the COVID-19 pandemic