Raising the effectiveness of Health Care has been recognized as a way to enhance the performance of health care system and a national goal. This is a policy goal of significance especially in a country like Korea where healthcare resources are limited and the healthcare delivery system remains ineffective. The attending hospital system―where medical practitioners are allowed to provide a continuum of care to patients by using local hospital resources―was proposed and has been implemented since 2003 to address the problems of underutilization of specialist physicians and medical resources, and of the difficulties small hospitals have in recruiting necessary medical professionals; but its impact remains limited at best.

Main policy issues discussed with respect to the attending hospital system centered on fee system, medical dispute and related law. With regard to this, relevant improvement scheme was raised since 2001 but has not been implemented to this day. The reason behind the such failure is a lack of conviction among hospitals and clinics on the need for this system. As doubts were raised about the sustainability of the health care system, a committee was formed in 2016 to improve health care delivery system. Such effort is expected to play a role as a starting point which contributes to activate the attending hospital system. Above all, most of the main problems lie in difficulties of securing physicians and underutilization of the professionality of physician in clinics.

The attending hospital system is not only a way to address the difficulties local and public hospitals face in recruiting physicians in the short term, but an important milestone for practitioners in clinics to utilize their medical knowledge and techniques learned from medical residency programs. In the long term, it can ultimately enhance a health care supply system including a health care delivery system.

In addition, policy measures should be taken without further delay to address the issues of the fee system, medical disputes and the relevant legal framework. Apropos to the fee system, main issues are the need for newly established medical fee provisions related with attending hospital system and separation of fee between hospital and doctor. In regards to this, reasonable profit distribution rate should be arranged in the short term. In case of open hospitals which would be mainly public hospitals, the rate should be arranged in a way of endowing higher motivation to participating practitioners in clinics, considering thepublicity of public hospitals. In the long term, separation between hospital and doctor’s medical insurance fee which can be applied to Relative Value Medical Insurance Fee and reorganization including fee for patient transportation and open hospital patient management is needed.

The main issue for medical dispute should be focused on responsibility sharing between open hospitals and doctors. The sharing system can be classified into dispute solution procedure and cost sharing for compensation fee when the matter of responsibility is clarified. For dispute settlement, preparing reasonable procedure should be accompanied by supplementation of the existing Dispute Adjustment Act. In order to raise compensation fee, activation of Malpractice Liability Insurance System and operation of Medical Compensation Deduction Union should be initiated.

Lastly, it is necessary to improve the related laws, in order to revitalize the attending hospital system. Above all, laying a direct legal basis for the policy and giving permission to lease parts of hospital facilities are pivotal factors for the policy to go into effect. In addition, plan to acknowledge participating doctors as specialists needed in the legal standards of hospital should be considered. Also, participating hospitals should be given rights to indicate their participation status for an Attending Hospital Policy on organization names or advertisement. A firm establishment of health care delivery system is key to a cost-effective health system as it helps reduce unnecessary waste of health resources. This can solve the ‘high cost, low efficiency’ problem that Korea’s health care system is facing, which is a core reason to establish medical delivery system. A full implementation of the attending hospital system is expected to work as a stepping stone to a well-functioning health care delivery system.