It is time to hold discussions with policymakers

Jong-Koo Lee

doi:10.24171/j.phrp.2025.0057

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Editorial It is time to hold discussions with policymakers: Jong-Koo Lee; Osong Public Health and Research Perspectives 2025;16(1):1-2.
DOI: https://doi.org/10.24171/j.phrp.2025.0057
Published online: February 27, 2025

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: February 25, 2025 • Accepted: February 25, 2025

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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Over the past 4 years, numerous discussions have centered on preparing for future infectious disease pandemics. As we enter 2025, it is time to identify key issues for prioritized discussion and to develop persuasive policy recommendations.

First, real-time mortality monitoring is a critical issue for preparing for future infectious disease pandemics. During the fight against coronavirus disease 2019 (COVID-19), we emphasized that all-cause mortality is a crucial indicator. The fact that excess mortality exceeded the number of deaths directly attributed to COVID-19 suggests that the Republic of Korea’s healthcare system was not managed with sufficient efficiency or effectiveness, necessitating a comprehensive performance evaluation and the development of appropriate tools. This issue features papers addressing these concerns this month. Although the government, academia, and the medical sector initially united to combat COVID-19, the prolonged crisis has recently taken a dramatic turn. The current abnormal conditions in the Republic of Korea are placing enormous strain on the healthcare system. At this critical juncture, we must carefully consider how to absorb, adapt to, and transform these challenges to rebuild a resilient and sustainable healthcare system. Some predict that a full recovery could take more than a decade. The expansion of medical school admissions in the Republic of Korea, aimed at reducing regional disparities in doctor distribution, has triggered disruptions in medical education and residency training, causing delays in surgeries and treatments at major hospitals. Regardless of the validity of claims that this situation has contributed to excess mortality, the importance of establishing a real-time mortality monitoring system has once again come to the forefront. This initiative involves designating sentinel hospitals for mortality tracking and implementing real-time confirmation of causes of death through systems such as the Republic of Korea’s National Healthcare-Associated Infections Surveillance System, the Injury Statistics for Deep Dive Survey for Patient Discharge, the National Emergency Department Information System, and the hospital standardized mortality ratio assessments conducted by the Health Insurance Review and Assessment Service. A more in-depth investigation into the causes of death and a comprehensive performance evaluation of the healthcare system are essential.

Furthermore, there is an urgent need for a continuously operational alert system to monitor public health crises in real time. A precise analysis of mortality causes, followed by the evidence-based redistribution of healthcare resources, financial restructuring, and improvements in healthcare delivery at both the national and local levels—in both the public and private sectors—is required. Ultimately, such measures aim to reduce regional excess mortality and transform the healthcare system into an efficient, effective, and people-centered model. These efforts align with broader societal goals, such as economic development, social solidarity, and overall well-being, thereby necessitating urgent research and development [1].

Second, key attributes for building resilience for the post-COVID-19 period must be reinforced. The resilience of the Republic of Korea’s healthcare system and society must be emphasized in the face of catastrophic events like COVID-19. A resilient society should maintain redundancy, or surplus capacity, to effectively address crises. However, the Republic of Korea’s fee-for-service healthcare system is under constant cost-cutting pressure. This pressure has resulted in inadequate investment in critical services such as intensive care and emergency medicine, leading to an erosion of surplus capacity and an inability to accommodate excess demand during crises. Moreover, crisis-response skills and adaptive capacity should be developed through continuous education and training; yet investments in these areas have been insufficient. During COVID-19, public health professionals were tasked with a wide range of roles, often having to learn and adapt independently. This situation underscores the need for further research and development in capacity-building efforts [2].

Third, addressing the challenges of low birth rates and population aging is an important issue. The dual challenges of low birth rates and population aging—which threaten the sustainability of rural and regional areas—are becoming increasingly serious. The Republic of Korea is aging faster than any other country in the world and has already entered a super-aged society. The burden of medical expenses for older adults is rising rapidly, with senior healthcare costs reaching 37.6 trillion Korean won (KRW) in 2020 (an increase of 1.8 trillion KRW from the previous year), accounting for 43.4% of total medical expenditures [3]. During the COVID-19 pandemic, the Republic of Korea was one of the few Organisation for Economic Co-operation and Development (OECD) countries in which healthcare expenditure as a percentage of gross domestic product (GDP) increased, surpassing the OECD average and reaching 9.9% in 2023. It is expected to exceed 10% in 2024. In response, reforms across all social sectors—including pensions, education, employment, and industry—are being implemented to address the impact of low birth rates and an aging population. In the healthcare sector, key areas include aging-related medical care, regenerative medicine, elder care, self-care, and healthcare financing. Big data in health and social care and artificial intelligence can be leveraged to develop innovative solutions in these fields. Strengthening community-based participatory research—particularly cohort studies—is an urgent priority. Additionally, enhanced governance for research and better coordination of government-led research initiatives are needed.

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Not applicable.

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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None.

References

1. Papanicolas I, Rajan D, Karanikolos M, et al. Health system performance assessment: a framework for policy analysis [Internet]. World Health Organization; 2022 [cited 2025 Feb 22]. Available from: https://www.who.int/publications/i/item/9789240042476.
2. Rockstrom J, Norstrom AV, Matthews N, et al. Shaping a resilient future in response to COVID-19. Nat Sustain 2023;6:897−907. Article PDF
3. Kim JW. Fast-aging Korea [Internet]. Yonhap News; 2024 Dec 26 [cited 2025 Feb 22]. Available from: https://www.yna.co.kr/view/AKR20241226000500546. Korean.

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It is time to hold discussions with policymakers