Before we begin the lesson on understanding all the knowledge in the world, we have one more announcement to make. It's been a while since we've had an understanding session, but our advertiser has generously gifted us with Hanwoo beef. The sirloin is truly delicious; it's the Hermes of meats. Among gifts, just having good meat is the best. What is life, after all? It's about enjoying good food. If you live diligently, you get to eat a bit more, and if you live a bit lazily, you eat a bit less. That's how it goes. 

The sirloin is characterized by being exclusively Hanwoo beef. The packaging is impressive; it comes in a luxurious case, almost like a high-end product. It's a gift of premium Hanwoo beef. However, I would like to treat myself to a gift as well.

I hope you will love us a lot in the future. We will make sure to show you our representative, and we will verify when it is really good. Also, everyone, please use the resources properly. We are getting scolded because we are not receiving enough support. We ask for your cooperation with the creative team. Thank you. Now, let's get back to the main topic. Reporter Baek Jong-hoon mentioned last time that the residents are still not returning well. The problem still lies with the large general hospitals, and now the regional general hospitals are starting to show serious situations, especially in Chungcheong Province.

The situation at Chungnam National University Hospital and Chungbuk National University Hospital is quite serious. Let's discuss the current state of major hospitals across the country. We have reporter Baek Jong-won with us. Welcome!

Hello! 

First of all, when we talk about major hospitals, we refer to those with many interns, residents, and other trainees. Naturally, these hospitals rely heavily on their trainees. However, if all the trainees have left, hospitals that previously had a large number of residents, such as university hospitals and general hospitals, especially the big four in Seoul, will be significantly affected, right?

Yes, as you mentioned, while regular hospitals may not feel a major impact, training hospitals, which we consider to be university hospitals, both public and private, are experiencing a loss of residents.

Residents account for about 40% to 50% of the roles, according to doctors. It is true that the bed occupancy rates in university hospitals have significantly decreased. The medical community has argued that hospitals are unable to operate at more than 30% capacity, leading to increased losses and worsening financial difficulties. In Seoul, major hospitals like Samsung Medical Center, Asan Medical Center, and Seoul National University Hospital have some accumulated profits, which allows them to endure the situation. However, as mentioned, regional national and private universities are struggling because the absence of residents makes it very difficult to maintain bed availability and profits. This issue is prevalent across all advanced general hospitals nationwide. Nevertheless, hospitals in Seoul are managing to hold on due to their financial resources.

Is it true that hospitals without money are struggling? Yes, that's correct. This is a claim made not only by doctors working in hospitals but also by union members. If you look at the slide, the health workers' union recently stated that about 75% of national and private university hospitals are currently in emergency management due to conflicts with the medical community. The labor union of 13 national university hospitals is also claiming that they are in a management crisis. Specifically, what does emergency management entail? According to the health workers' union, first, more than 51% of university hospitals are reducing normal operations and downsizing wards. They have also halted the hiring of new nurses, and remaining staff members, who are not doctors, are taking unpaid leave. Third, they are cutting costs by reducing expenses for materials and medication purchases, only keeping what is absolutely necessary.

There are claims being made about this situation. Among them, the most challenging case is Chungnam National University Hospital. According to the hospital's union and the hospital's management team, the bed occupancy rate at Chungnam National University Hospital is around 78%. Other hospitals are likely to be similar. The union has expressed concerns that some staff salaries may not be paid in August. 

Particularly, there is a unique reason regarding Chungnam National University Hospital. There is a branch of Chungnam National University Hospital in Sejong City, named Sejong Chungnam National University Hospital. In this case, they have announced that starting from now, they will not operate the emergency room every Thursday due to a shortage of doctors. They are essentially stating that the emergency room will have limited services, indicating that Sejong Chungnam National University Hospital is also experiencing a decrease in occupancy rates due to a lack of doctors.

There is also Chungbuk National University Hospital in Cheongju. According to reports, the ward is currently operating under a closed status, and because it is operating in a reduced capacity, profitability is declining, and management difficulties are intensifying. This is the claim being made. However, all university hospitals are likely in the same situation. So, what is the specific reason that Chungnam National University and Chungbuk National University are particularly struggling? It is indeed claimed that they are facing more difficulties. 

As I mentioned briefly, in the case of Chungnam National University Hospital, they took on a debt of about 420 billion won to establish the Sejong Chungnam National University Hospital in 2020. They borrowed money to build it. This hospital, which is a new facility, is said to be facing challenges.

In the medical field, we often refer to patients as new patients. When a new patient comes in, receives proper treatment, and then returns with a different illness, these experiences accumulate, helping the hospital establish itself and operate effectively. We were hit by COVID-19 right after we opened in 2020, and we launched a branch of our hospital in Sejong. However, now, due to a decrease in bed occupancy in our specialty, we are claiming that the lack of connection with patients and a solid business foundation is exacerbating our management difficulties. It’s somewhat akin to a large franchise restaurant that opened multiple locations just before the COVID pandemic, not knowing what was about to happen. They invested a lot of money into opening the restaurant, only for it to fail completely when the pandemic hit. So, we are in a situation where we have even less money now.

The Chungnam National University Hospital and the Chungbuk National University Hospital are facing difficulties. As for the Chungbuk National University Hospital, I haven't found any specific reasons for this situation, but the hospital has stated that the reduction of seven wards due to the departure of residents has led to a decrease in medical revenue of 8 billion won per month. They are particularly highlighting the struggles of Chungnam National University Hospital and Chungbuk National University Hospital. Additionally, Pusan National University Hospital is currently managing a negative balance of 500 to 600 billion won, indicating that they have created a negative account for emergency management. Ultimately, as you mentioned, the issue is that national university hospitals in the provinces, particularly the advanced general hospitals, are struggling. The departure of residents is causing operational difficulties. Specifically, I understand that Chungnam National University Hospital had opened a large restaurant branch but is now facing financial issues.

The headache that has arisen is not just because of the current situation; it has made things particularly more difficult. As for Chungbuk National University Hospital, the operating rate is not particularly low, but they have been short on funds. This has been the case for both Chungnam National University Hospital and Chungbuk National University Hospital. Among national universities, if you look at last year's financial statements, they were not very profitable. Should I show you the financial statements? Let's see what the situation is and how much they are lacking in funds. However, the most recent financial statements are not available; only last year's are. If you look at the slide for Chungnam National University Hospital, last year they had a net loss of about 84 billion won. That's quite a significant amount, and as I mentioned earlier, a lot of this loss is due to the Sejong branch. If you look at the data, there are medical losses.

Last year, the total loss was 93.7 billion won. Originally, these general hospitals do incur some losses from medical activities. However, they make up for this with non-medical income. What does non-medical income refer to? It includes things like operating funeral homes, donations, and profits from real estate investments. This allows them to achieve a marginal net profit or break even. Hospitals in Seoul are managing to make a profit, but in the case of Chungnam National University Hospital, non-medical income has also been poor. Overall, last year, they recorded a deficit of about 84 billion won, and the year before that, they had a deficit of around 50 billion won. However, this has not been officially announced yet. The hospital director of Chungnam National University Hospital made a notice about two days ago. Since it was a notice, I am not sure if the numbers are accurate, but the director claimed that from January to May, there was a deficit of about 37 billion won.

The Chungnam National University Hospital in Daejeon is in a state of partial capital impairment, and the Sejong branch is in a state of complete capital impairment. We discussed this in a public office. Employees are worried that their salaries may not be paid properly. The hospital receives health insurance benefits from the government, and recently, it received an advance payment of 8 billion won for next January. This can be considered as an advance on salaries, similar to how employees might receive an advance on their pay. The hospital expects to receive an average annual health insurance benefit, but it will not be unlimited; they will provide about 30% in advance because giving too much could disrupt the settlement process. There is a system in place for this, and it seems that the hospital director believes that the August salaries can be paid using the funds received from the Ministry of Health and Welfare and the Health Insurance Corporation.

It's concerning how difficult the situation is. Last year, the president of Chungnam National University Hospital reported an 80 billion won deficit, and the year before that, it was a 50 billion won deficit. This year, from January to May, the hospital has incurred a deficit of about 37 billion won. The hospital president mentioned that this is actually less than last year and the year before. However, it's unclear whether this figure is solely based on medical revenue or if it also takes into account interest costs and non-medical income, as we briefly saw with Representative Jaemoon earlier. The wording itself is not precise in conveying what it means. We need to determine whether the deficit has worsened due to the current situation or if it was already expected to be problematic. Logically speaking, with many residents leaving and the bed occupancy rate likely dropping, it seems probable that the deficit has increased.

As you can see, I've already mentioned the situation earlier. The Sejong branch is indeed a problem. The COVID-19 pandemic and the departure of residents have created two consecutive major challenges. The Sejong branch is struggling to establish itself, and the union claims that both the main hospital and the branch are facing difficult circumstances. As I mentioned earlier, when the Sejong branch was being built, it was located next to the Sejong City government office. A significant amount of borrowing was done, around 400 billion won. Currently, interest rates are high; while they were around 2% at the time, they have now risen to 5%, making it very difficult, according to union representatives. Therefore, at least according to the claims from the union and management, there are concerns about employee salaries at Chungnam National University Hospital, and there are worries about a potential default within this year.

There are claims that it could be possible. What about other hospitals? As I mentioned earlier, when we think of large hospitals in Seoul, particularly general hospitals, we might have certain assumptions. If you take a look at the slide I brought, for example, Seoul Asan Medical Center, which is often referred to as a big player in Seoul, had a reserve fund for its specific purpose of 3.8 trillion won as of 2022. This is a significant amount of money. Since they cannot distribute profits, they can reduce corporate taxes, which has led to various criticisms and counterarguments. Seoul National University Hospital has 84 billion won, and Severance Hospital has 370 billion won. These large university hospitals in Seoul have accumulated funds. Even if they run a deficit, they can endure for several years. I can also endure.

There is a controversy regarding this issue. From what I found out, the funds are meant to respond to the demand for expanding medical facilities or for the urgent development of medical technologies, not to be used for employee wages. The idea is to generate revenue for that purpose. For example, if the trend of specialization is declining and someone suggests using these funds for employee wages, the tax authorities might argue that this is not the intended use. In such a case, the company could face significant corporate taxes. Therefore, the purpose of the reserve fund for business operations is not just to be used as available resources. It is money that should not be used for employee salaries; it is set aside specifically for purposes like expanding medical facilities or responding to advanced medical needs. So, if employee salaries are delayed...

이런 용도로 과연 쓸 수 있는 것인지에 대해 진지하게 고민해야 합니다. 어떻게 하겠습니까? 과세 당국에서 세금을 맞더라도 돈이 없으면 써야죠. 지금 프가 그렇게 되다가 이렇게 된 거잖아요. 진짜 급하면 쓴다고 했다가, 진짜 급해도 쓰면 안 되는 돈을 안 딴 사람도 아니잖아요. 그냥 계정만 빼놓은 거지, 저건 그래도 어디 돈을 맡아 놓은 건 아니지 않습니까? 이익에서 빼놓은 거긴 한데요. 그래서 꼼수, 그러니까 법인세를 덜 내기 위한 이익이 작아 보이니까요. 그래서 법인세를 덜 내기 위한 공수 아니냐라는 지적도 있고요. 그렇다고 하더라도 지금 우리 서울의 큰 병원, 대학 병원들은 적어도 수백억 내지 2천억 원대의 단기 순이익을 작년까지 냈습니다. 올해는 이제 봐야겠습니다. 매년 그래도 상황이 나아지고 있네요. 다른 지방 대학 병원들도 마찬가지입니다.

It's difficult because most local university hospitals are in the red. For instance, Busan National University Hospital, as I mentioned briefly earlier, recorded a deficit of about 50 billion won last year. So, this means they were already in the red before the current situation. Yes, national university hospitals are structured in a way that leads to significant deficits. Therefore, the question is how much this situation has exacerbated those deficits. There are no numbers available yet, so I don't know. They say healthcare is at a loss. That's right. If a patient comes in just for a consultation and leaves, the costs for interns and residents actually exceed the income from the patient and health insurance, which ultimately results in a loss. In fact, if patients don't come in, the hospital's finances might improve. Yes, that could be a valid point. However, since the numbers for this year are coming out late, we will have to wait and see. It could be a reasonable observation. I'm curious about hospitals like Chungnam National University Hospital and Chungbuk National University Hospital.

The hospitals are now provincial national university hospitals. I don't know if they are classified as public institutions, but if we consider them as such, even if they run at a deficit, they wouldn't go bankrupt, right? So, what is really going on? Especially since Chungnam National University Hospital is struggling, when I keep asking the management team or the union side, they say that in the history of national university hospitals in our country, there has never been a default, so honestly, they don't know. That's the first answer. Still, if we were to imagine, for example, the Ministry of Health and Welfare providing some essential medical services with advance payments, wouldn't it make sense to expand that advance payment system? They might increase the health insurance reimbursement. And then, after that, it really is an unknown; we don't know what will happen. However, provincial national universities are...

The president of Chungnam National University is affiliated with the university, so shouldn't there be discussions about some kind of support? The university is a school corporation, while this is a medical corporation. For example, would it really be possible to provide assistance like that? There are no such cases or precedents, which makes it seem like an unknown territory. 

The simplest thing to consider is that the government will provide more support. They won't let it fail. However, to be precise, the funds provided from the health insurance fund and the government budget are from different sources. The health insurance fund accumulates surplus, and when it runs out, it becomes a headache. 

I don't know. In the end, it seems that the government will help, but it looks like the banks will ultimately take action. Local banks are facing issues these days.

It seems that Jeonbuk Bank is helping universities and university hospitals in Jeonbuk, while Busan Bank is assisting Busan National University Hospital. However, it is worth noting that Chungnam National University Hospital is currently facing the most difficulties. They reportedly borrowed about 50 billion won in the first half of the year and have already used it all. This information was disclosed by the hospital, so it seems to be somewhat factual. Therefore, I am a bit skeptical about whether they can secure more loans. Is it really possible to get additional funding? 

I don't know about regional hospitals. There have been ongoing discussions about how regional hospitals are struggling. The reason is that large hospitals, or general hospitals, are meant to treat severe illnesses. When someone has a serious condition, they tend to go to a hospital in their area, but many are increasingly trying to go to Seoul instead. This situation makes it difficult for regional hospitals, which are smaller and have a lower population.

There is a lot of data available. When we think about it, we often imagine that people might get tired of taking the KTX or flying to Seoul. However, if we look at the data, we can see that according to the National Health Insurance Service, the number of cancer patients from Sejong City who go to Seoul for treatment is 36% of the cancer patients in that region. In the case of Gangwon Province, it is 37%, and for Chungcheong Province, it is 10%. The percentage of residents from these areas who come to Seoul for cancer treatment is quite high, in the upper 30s. Of course, this can vary depending on individual circumstances. For instance, it could be that people were advised to go to Seoul for treatment or that they were encouraged to seek care at large hospitals there. Nevertheless, the proportion of cancer patients from Sejong, Gangwon, and Chungcheong who travel to Seoul for treatment is significant.

It is true that around 30% is being taken away to Seoul. There is about 43% in Gyeonggi Province, but since Gyeonggi is geographically close, there may be questions about whether we can make a fair comparison. However, our common understanding that patients from Gangwon or Cheong do move to Seoul seems to be somewhat supported by this data. What should we do? It’s really difficult. Even if things are like this now, I’m worried about the event of specialty migration causing a default or some major issues. It seems like the doors are not opening, and the default has already occurred at Chungbuk National University Hospital. I’m waiting for Chungnam National University Hospital’s Sejong branch, but I think that situation would have happened even without this crisis.

Structurally, I wonder if there might be a situation where residents return. If they do return, wouldn't it be a bit lower? I'm not sure. Today, the Ministry of Health and Welfare announced that they will recruit residents twice a year, once in March and once in September. Our Park Jeong-eun, the head of the Korea Hospital Policy Research Institute, came out to explain this. They released the status of the September resident recruitment today. Currently, only 1.4% of the 7,600 candidates applied for the September resident recruitment across 126 medical institutions. This means that almost no one is applying; it’s close to saying that regardless of whether they are selected or not, they will not apply. It’s around 1%. About half of that 1% applied to large hospitals in Seoul, while the other half applied to local medical institutions. So, at this point, at least the local national universities are saying...

It seems that the hope of residents returning is almost impossible, at least as of today. Therefore, any special agreement moving forward seems unlikely. Since March, there has been little progress, and with the recruitment of residents in September now being a distant prospect, it doesn't seem easy for residents to return to local national university hospitals. However, it is quite concerning. In the comments of the video featuring Professor Park Jeong-hoon from last time, it appeared that many residents were expressing their frustrations. They were saying things like, You don't even look at us, and How can we return if we are not welcomed? There were an overwhelming number of comments like that. But looking at the situation today, it seems that the chances of returning are very slim, which is the most disappointing aspect.

Patients are indeed a concern. It seems that discussions like this are only happening among the management of general hospitals, hospital unions, and doctors. Ultimately, patients may experience discomfort, which is quite worrying. Moreover, the reality is that residents are not returning. So, general hospitals need to function, right? Yes. Then, is there no alternative, such as increasing the number of specialists? Is there no plan to normalize general hospitals? It doesn't seem like there is a specialized policy for national university general hospitals. In some reports yesterday, it was mentioned that more specialists should be recruited into university hospitals, specifically professors, rather than interns or residents. They are considering selecting from those who have already opened their practices to increase the number of medical school professors, thereby enhancing the capacity of advanced general hospitals, which we envision as universities.

There is currently a discussion in the presidential medical reform committee about transforming hospitals into facilities that specialize more in severe illnesses. However, this is somewhat separate from the crisis faced by local citizens. We are experiencing an oversupply of medical services and medical shopping based on comprehensive insurance in general hospitals. The idea is to reduce the number of hospital beds in general hospitals and instead increase the number of professors and specialists, so that the hospitals are staffed with many specialists rather than interns and residents. This way, they can focus on treating severe cases. Meanwhile, we should increase the number of hospital beds in local areas to address less severe illnesses. However, there are doubts about whether this will actually work. It seems that it won't be easy. The idea itself is headed in the right direction, as there may not be any other options, but first, we need to ensure that residents return to the field.

In the situation, there is a discussion about reducing the proportion of residents in large university hospitals from 450% to 20%. The idea is to increase the number of specialists. There are claims among the residents that the operation of general hospitals is fundamentally flawed. They argue that simply doubling the number of interns and residents and having them run around is not a normal way for a general hospital to operate. Even though becoming a specialist involves a training process, the criticism is that this method is not a sustainable model. It's true that what was accepted ten years ago is not necessarily accepted now, which indicates progress and development. However, personally, I still find one aspect a bit strange, and that is the problem.

It is correct, but the sound has been a problem for a long time. It was an issue last year, and the year before that as well; it was the same problem. This time, if we try to address it, we might not be able to fix that issue. It has always been a given. However, since the same problem existed last year and the year before, I don't understand why, when we talk about increasing resources, we bring up the same issues from those years and say we can't do it. If it suddenly became difficult, then yes, we can say we can't do it in such poor conditions. But when we bring in the resources, if it's too difficult because of the poor conditions, I don't know if it's because we dislike the poor conditions or if we dislike the increase in resources. It seems like we might dislike both. However, if it's ultimately a matter of justification, there are various issues, and it could be something that triggered this situation, but I'm not sure.

Anyway, the issue of medical school quotas is still a sensitive topic. Regardless of how it is, hospitals need to operate normally so that citizens can experience less inconvenience. However, they are reducing the operation of emergency rooms, which directly leads to more inconvenience. These days, many people who have visited hospitals have reported significant discomfort. In rural areas, it’s obvious that emergency rooms are being reduced, so where are people supposed to go? I live in Seoul, and in the past couple of months, I had to go to the emergency room. When I went, there were naturally fewer people in the emergency room, which means there are fewer doctors, and they say that they are only accepting very serious cases. They don’t accept cases that are below a certain severity threshold.

However, it's not just that; actually, there are small to medium-sized hospitals like Munhyeon right now. I wondered if it would be okay to write that you can go there, and it turns out the door was really open, and they actually helped me. So, it's not a hospital that was suddenly created, right? I didn't know that. And even in the past, if it was like this, you could just go to that hospital. I guess it was a situation where you just had to go there without question. Of course, there are various alternatives in places with different levels of hospitals, and I've heard that those places are doing well these days. So, there are hospitals right below the advanced hospitals, you know? They are not large advanced hospitals, but rather slightly bigger hospitals with emergency rooms, and I've heard that those are doing well. There are hospitals I didn't know about that keep coming to my attention. But also, the chat is going well.

If you look, ambulances are still having difficulties, and there are still some inconveniences. However, it's better than before. In the past, there were many stories about a lack of doctors in emergency rooms, and ambulances would circle around without being able to treat patients. Nowadays, especially with the closures of some facilities, it has become even more pronounced. I understand those issues. Thank you, reporter Baek Jong-woo. Anyway, there have been such incidents in local general hospitals recently. Thank you for the information. Thank you.

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