Doctors’ first strike in Republic of Korea likely to end

Doctors in the Republic of Korea voted by a narrow margin on 20 November to end a four-month long strike that has brought the country’s health care system virtually to a standstill, but divisions within their ranks suggest that further confrontation is possible in the future. The ballot comes after the Korean Medical Association reached a tentative compromise agreement with the government and pharmacists earlier in November over medical reforms.

This industrial action, the first in the history of the Association, began mid-year in protest against a new law that attempted to draw a clear boundary between the prescription and dispensation of drugs and to end a decades-old system believed to be unique to the Republic of Korea. Under this system, there has been considerable overlap between doctors, who could sell medicine, and pharmacists, who could recommend and sell a wide range of professional drugs.

By separating the two, the government aims to cut the misuse and overuse of drugs, which many health experts in the Republic of Korea believe may be the reason why the country has one of the highest antibiotic resistance rates in the world.

Although the principle of separation has been accepted by all parties, its implementation on 1 August sparked a violent struggle. Doctors, who earned up to half of their incomes from drug sales, insist that the government compensate them by raising consultancy fees. They also demand tougher penalties for pharmacists who sell professional drugs without a doctor’s prescription or prepare and sell alternative remedies for out-of-stock medicines. Pharmacists are opposed to a tightening of restrictions on the range of drugs they can sell.

The pattern of the industrial action has been different for each category of doctor. General practitioners have staged five one-week strikes and they are now back at work. The majority of residents and interns, however, have been on strike continuously since the end of July, according to the Korean Medical Association. At the peak of the industrial action, the Association says all of its 70 000 members were on strike, though they operated a rota system to ensure that emergency rooms, intensive care units and delivery rooms were kept open. All but the most urgent surgery has been postponed. According to national media, several patients have died because they were unable to receive treatment, though the Association and the government deny that the struggle has led to any fatalities. At least one doctor has been seriously injured in clashes with riot police.

At the beginning of November, the Korean Medical Association stepped up its protest. More than 80% of interns and residents refused to operate even for emergency cases. Many university hospitals had to call in professors to carry out emergency operations.

However, hopes for a resolution rose by 11 November, when the three conflicting parties reached a compromise to revise the Pharmaceutical Affairs Law. Under the agreement, pharmacists will be banned from making up substitute medicines without a doctor’s consent. To beef up regulation of the industry, the government has promised to establish a task force to crack down on over-the-counter sales of professional drugs.

In the 20 November ballot, doctors voted by 48% to 47% in favour of the proposed revision of the medicines law. Opponents of the revision are demanding a recount. But Dr Doyen Cho of the Korean Medical Association believes ‘‘there is little chance of another strike this year.’’

The Korean Medical Association said they were uncertain whether their rank-and-file members would accept the deal, but they were aware that public opinion was turning against them. ‘‘The doctors’ credibility has fallen significantly because of this miserable strike. They can no longer command the respect in society that they once had,’’ said Dr Choi Hee-ju, director of the health resources policy division of the health ministry. ‘‘I don’t know who won or lost, but this will certainly prove a turning point for the Korean health-care system.’’

Jonathan Watts, Tokyo

World Health Organization Genebra - Genebra - Switzerland
E-mail: bulletin@who.int