Sunday, October 31, 2010

Conference on conflicts of interest in medicine



A remarkable conference, held in Seoul and the reason for my visit. This shows several speakers for the conference at the entry to a side building of the Asan Medical Center.


Asan is a massive (~2,700 bed) hospital in Seoul, founded by the Hyundai corporation.


Korea is working through a number of very complicated issues related to funding medical care - as is the US - and the focus on the role of industry in education and practice is intense.


A new law, referred to as "dual-punishment" will make it possible to punish both physicians and companies for kickback arrangements. Yet many physicians (including those who believe kickbacks are unethical) say that insurance payments are less than the actual cost of delivering care and kickbacks have become an integral part of how care is financed...


The group organizing this conference - the Korean Society for Medical Ethics - is concerned that without public trust the profession cannot succeed in lobbying for increased payments, but that the profession can't bolster public trust while receiving kickbacks. If it's true that payments are less than the actual cost of care, then suddenly stopping kickbacks would cause physicians to go bankrupt, so a sudden cessation is not possible without first seeing an increase in payment rates.


This is what we in the U.S. call a Catch-22 (a term from Joseph Heller's book about WWII, which inspired both the movie and TV show MASH, about the Korean war, incidentally!).

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