윤석열17개권역환자수용'미끼의료'실패‘응급의료국가체제'
Yoon Seok-yeol fails to convert 17 regio
윤석열 17개 권역 환자수용 '미끼의료' 전환 실패 응급의료에 '국가체제’
윤석열 체제가 대학병원 중심의 의료체계를 17개 권역과 136개 지역응급센터로 '미끼의료' 환자 수용 방식 전환에 실패하면서 ‘응급의료에 국가체제’ 가동으로 대통령실 비서관을 파견한다.
의사를 배출하는 대학병원 중심의 의료체계에 환자 흡수의 중추였던 응급실을 운석열 체제가 ‘접근 차단’하며 권역응급센터로 전문의 강제 분산 시도에서 ‘환자 분산 수용’ 전략을 적용했고, 이에 따른 의사 2천명 증원과 대학병원 환자 흡수 진입 차단 적용이 권역별 응급 치료 불능 상태에 빠지면서 형식적 응급 체제 유지를 위해 행정 관료가 직접 치료기관 감독 체제로 급선회했다.
서울 의대 병원 교수들은 5일 시국선언에서 '응급의료' '필수의료' '지역의료'를 구분했으나 이에 앞서 윤 대통령은 권역응급센터에서 '응급의료가 필수의료의 핵심'으로 규정해 의료법에 없는 국가진료 체제의 중심으로 선언했다.
대통령실이 전국 17개 광역시·도 권역응급의료현장에 대통령실 1급 비서관들을 한 명씩 보내는 방안을 추진한다고 5일 밝혔다.
윤 대통령은 4일 밤 경기북부 권역응급의료센터인 의정부성모병원에서 "응급의료가 필수 의료 중에 가장 핵심인데 국가에서 제대로 관심을 가지고 도와드리지 못한 것 같아 참 안타깝다"고 ‘응급실 국가 체제’로의 전환을 밝혔다.
대통령실 고위 관계자는 언론에 “‘응급실 뺑뺑이’는 의대 증원 때문이 아니라 응급의학 전문의가 절대적으로 부족해서 생긴 문제다. 그래서 윤석열 대통령이 의료개혁을 하자고 한 것”이라며 “전공의들이 빠져 의사 수가 부족한 부분을 군의관, 공중보건의 등을 투입해 잘 보완해가고 있다”고 ‘과목별 전문의 배제’를 동아일보에 밝히며, 응급의학 전문의에 대해 ’권역 의료체계 치료 전담 체제‘라고 발표했다.
미국이 최고로 발달한 응급의학은 전문치료를 위한 초동 장치에 후속 수술 전문 치료와 연계가 핵심이고, 어느 지역이나 911이 환자를 응급실호 후송하는 책임을 지고 응급실은 거절하지 않고 신속 치료 조치와 형후 계획 진행을 전담하고 의료 행정관료는 환자 조치후에 환자 재정 상태에 따라 응급과 치료비를 청구하는 방식을 결정하고 부족 부분은 재정 지원으로 충당한다.
한국의 의료법은 ‘상급종합병원’ 기준에 대해 < 지정 기준 충족하는 종합병원의 병상수가 보건복지부장관이 고시하는 진료권역별 소요병상수를 초과>만이 기준이고 응급실 기준을 따로 없다.
박민수 복지2차관은 5일 오전 의사 집단행동 중앙재난안전대책본부 회의에서 지방자치단체장이 반장이 되는 '비상의료관리상황반' 설치 운영한다며 “전국 409개 응급의료기관별 1:1 전담책임관 지정하겠다”고 발표해 지역별 응급의료체제에 행정 관료 관리체제 가동을 밝혔다.
의료 사태에서 박 차관은 ‘상급종합병원 환자 수용 기준’을 연이어 발표했고, 특히 ‘응급환자 기준’에서 ‘중증 제외 기준’을 통해 대학병원 이용 불가 조치를 발표로 응급환자를 의료체제 전환 수단으로 활용했다.
보건복지부의 '응급실 진료 제한 메시지 표출현황'은 5일 의대 증원 발표로 전공의가 의료현장을 떠난 2월부터 8월 26일까지 ‘응급실 진료 제한 메시지’는 총 7만2천411건이고, 작년 같은 기간(5만9천4건)에서 1만3천407건(22.7%) 급증이다.
중앙응급의료센터 집계에서 권역·지역응급의료센터의 ‘후속 진료 가능 여부’는 3일 기준 27개 질환별 진료할 수 있는 의료기관은 평균 103곳에 그쳐 환자 수용이 제한적이다.
권역응급진료센터 44곳에 지역응급의료센터 136곳, 지역 응급의료기관 228곳 중 24시간 운영하는 응급실은 405곳이다.
대학병원 중심으로 성장한 의료체계는 상급종합병원에서 전공의(수련의)가 응급의료와 야간 진료 상당수를 수용하며 환자가 대형병원으로 몰렸고, 수련의는 전문의를 통해 대형병원이나 개업 전문의로 진출할 기회를 삼았으나, 윤석열 체제는 권역별 응급센터 중심으로 환자를 분산 수용하고 전문의에 대한 ‘유입 전략’을 시도했으나 전공의들이 ‘상급 진출 기회 통제 정책’에 반발해 좌초됐다.
한덕수 총리는 3일 국회 답변에서 "국민의 불안은 결국 중증 환자와 난치병 환자를 떠나버린 전공의가 제일 먼저 잘못한 행동을 했다"고 ‘의료체계 보조자’로 환자와 직접 관련이 없는 전공의(수련의)에 대해 ‘전공의가 필수진료 중심자’라고 규정했다.
윤석열 의료 체제는 행정 관료가 국가재정 10조원과 국가보험 재정 10조원 투입의 재정계획에 의한 ‘고가 의료산업 전환’에서 '공급우위에 의한 총수요 확대'의 의료관련 펀드 활성화와 의료인 신분 행정부에 귀속 전략이 ‘의사 권역별 분산’ 유인에서 ‘응급실로 환자를 포로 분산 수용’의 '응급환자 미끼 방식' 적용이다.
‘의료법’은 <모든 국민이 수준 높은 의료 혜택을 받을 수 있도록 국민의료에 필요한 사항을 규정함으로써 국민의 건강을 보호하고 증진>하는 것에서 행정부는 단지 ‘의료인’과 ‘병원’에 대해 법률에 의거 허가권한만 있다. kimjc00@hanmail.net
Yoon Seok-yeol's 'bait strategy' of accepting patients in 17 regions fails, 'national system' in emergency medical care
As the Yoon Seok-yeol administration failed to change the medical system centered on university hospitals to the 'bait strategy' of accepting patients in 17 regions and 136 regional emergency centers, the 'national system in emergency medical care' will be activated and the presidential office secretary will be dispatched.
In the medical system centered on university hospitals that produce doctors, the emergency room, which was the center of patient absorption, was ‘blocked from access’ by the meteor system, and in an attempt to forcibly disperse specialists to regional emergency centers, a ‘patient dispersion and acceptance’ strategy was applied. As a result, the addition of 2,000 doctors and the application of blocking of patient absorption and entry to university hospitals led to a state of emergency treatment impossibility in each region, and administrative officials made a drastic turn to a system of direct supervision of treatment institutions in order to maintain a formal emergency system.
Professors at Seoul National University Hospital distinguished between ‘emergency medical care,’ ‘essential medical care,’ and ‘regional medical care’ in their declaration of the current situation on the 5th, but before this, President Yoon declared that ‘emergency medical care is the core of essential medical care’ at regional emergency centers and declared it the center of the national medical care system that is not in the Medical Act.
The presidential office announced on the 5th that it will push forward a plan to send one first-class presidential office secretary to each of the 17 metropolitan city and provincial emergency medical sites nationwide. On the night of the 4th, President Yoon announced the transition to a “national emergency room system” at Uijeongbu St. Mary’s Hospital, the emergency medical center for the northern Gyeonggi region, saying, “Emergency medical care is the most essential of essential medical care, but it is regrettable that the state has not been able to properly provide assistance.” A high-ranking official in the presidential office told the press, “The ‘emergency room spin-off’ is not due to the increase in medical schools, but rather the absolute lack of emergency medicine specialists. That is why President Yoon Seok-yeol proposed medical reform,” and “We are making up for the shortage of doctors due to the absence of specialists by bringing in military doctors, public health doctors, etc.” He explained the “exclusion of specialists by subject” to the Dong-A Ilbo, and announced that “emergency medicine specialists are the ‘regional medical system treatment specialists’.” The most advanced emergency medicine in the United States is the initial device for specialized treatment, and the key is to connect with follow-up surgical specialized treatment, and in any region, 911 is responsible for transporting patients to the emergency room, and the emergency room does not refuse, but is in charge of rapid treatment measures and post-treatment planning, and the medical administrative officer decides how to charge emergency and treatment costs based on the patient's financial status after the patient's treatment, and the shortfall is covered with financial support.
The Korean Medical Act only stipulates that <the number of beds in a general hospital that meets the designated criteria exceeds the number of beds required by treatment area notified by the Minister of Health and Welfare> as the standard for a 'higher-level general hospital', and there is no separate standard for an emergency room.
On the morning of the 5th, at the Central Disaster and Safety Countermeasures Headquarters meeting of the Doctors' Group Action, Park Min-soo, 2nd Vice Minister of Health and Welfare, announced that an 'Emergency Medical Management Situation Team' will be established and operated with local government heads as the team leaders, and "We will designate a 1:1 dedicated manager for each of the 409 emergency medical institutions nationwide," thereby announcing the operation of an administrative bureaucratic management system for regional emergency medical systems. In the medical situation, Vice Minister Park announced the ‘Standards for Accepting Patients at Higher-Level General Hospitals’ in succession, and in particular, announced the ‘Exclusion Criteria for Severe Cases’ from the ‘Standards for Emergency Patients’ to prohibit the use of university hospitals.
According to the ‘Status of Messages Restricting Emergency Room Treatment’ by the Ministry of Health and Welfare, from February, when residents left the medical field due to the announcement of an increase in medical schools on the 5th, to August 26th, the total number of ‘Messages Restricting Emergency Room Treatment’ was 72,411, which is a sharp increase of 13,407 (22.7%) from the same period last year (59,004 cases).
According to the Central Emergency Medical Center’s statistics, the ‘possibility of follow-up treatment’ at regional and local emergency medical centers is limited to an average of 103 medical institutions that can treat 27 diseases as of the 3rd. Among 44 regional emergency treatment centers, 136 regional emergency medical centers, and 228 regional emergency medical institutions, 405 emergency rooms are open 24 hours a day.
The medical system, which grew around university hospitals, had residents (trainees) at higher-level general hospitals handle a significant portion of emergency medical care and night care, and patients flocked to large hospitals. Intern residents took advantage of the opportunity to advance to large hospitals or become private specialists through specialists. However, the Yoon Seok-yeol administration attempted to disperse patients to regional emergency centers and implement an ‘inflow strategy’ for specialists, but residents opposed the ‘policy to control opportunities for advancement to higher levels’ and this was thwarted.
Yoon Seok-yeol's medical system is a strategy of 'conversion to expensive medical industry' by administrative bureaucrats through a financial plan of 10 trillion won in national finance and 10 trillion won in national insurance finance, activating medical-related funds and assigning medical professional status to the executive branch, and applying the 'emergency patient bait method' of 'capturing and dispersing patients to emergency rooms' inducing 'dispersing doctors by region'.
Prime Minister Han Duck-soo said in his answer to the National Assembly on the 3rd, "The public's anxiety was ultimately caused by the first wrongdoing of residents who left severely ill patients and incurable patients,"
Regarding residents (trainees) who are not directly related to patients as ‘medical system assistants,’ it was stipulated that ‘residents are the ones who provide essential treatment.’
The 'Medical Act' is to <protect and promote the health of the people by regulating matters necessary for national medical care so that all citizens can receive high-quality medical benefits>, and the executive branch only has the authority to permit 'medical professionals' and 'hospitals' according to the law.
17 regions, bait medical care, Yoon Seok-yeol, emergency medical care, emergency medicine, emergency patients, medical industry, medical system, medical fund, intern, specialist
