사진 확대

Ahead of the enforcement of the revised medical law, which contains the legal basis for non-face-to-face treatment in December, differences in views from all walks of life over detailed implementation standards are becoming clear.

The Korean Pharmaceutical Association is in the position that strict regulations on the number of first-time prescriptions and non-paying drugs are needed to prevent misuse of drugs. On the other hand, the medical industry, industry, and patient organizations are demanding flexible system design suitable for the clinical field, saying that uniform regulations can limit patients' treatment opportunities and only increase inconvenience.

At the "Policy Debate for Enactment of Subordinate Laws of Medical Law Related to Non-face-to-face Treatment" hosted by Rep. Kwon Chil-seung of the National Assembly on the 13th, opinions from all walks of life clashed over the seven-day limit on the number of first-time prescriptions, the scope of the drug ban on misuse, drug delivery, and securing medical continuity by linking past medical records. The debate was organized to establish non-face-to-face treatment as a medical service that complements chronic disease management and face-to-face treatment.

The biggest issue was to limit the number of prescription days for first-time patients to 7 days. The pharmaceutical industry believes that it is a minimum safety measure to prevent misuse of non-paying drugs.

"According to PPDS (Public Prescription Delivery System) data, there is a high concern of misuse, as the proportion of non-paying drugs among non-face-to-face prescriptions reaches 60.5%," said Jang Bo-hyun, director of the Korean Pharmaceutical Association. "To prevent this, we need to limit the number of first-time prescriptions to up to 7 days, and to prevent the prescription of certain non-paying drugs such as hair loss and obesity."

The medical community countered that uniform numbers should not limit doctors' right to treat and patients' right to treat. Kim Heon-sung, a professor of endocrinology at Seoul St. Mary's Hospital, said, "To properly compare the proportion of non-payment, we should not only look at the statistics of the non-face-to-face platform, but also look at how many hair loss and obesity drugs are prescribed by face-to-face treatment at general clinics. It is a typical statistical illusion to highlight only the proportion of platforms while ignoring the reality that many non-payment prescriptions are made face-to-face."

"Hair loss drugs or diet pills should be prescribed according to medical opinions and doctors should take responsibility," he added. "We should not undermine the value of non-face-to-face treatment, which shows as much treatment effectiveness and continuity as face-to-face treatment in the field of chronic diseases, citing some non-payment problems."

Professor Kim also explained the reality of the clinical field in detail. In the case of chronic diseases, patients can be prescribed for months without having to come to the hospital directly as long as blood pressure and blood sugar data or records through their guardians are confirmed, he said. "Numerical regulations such as a 7-day limit for first-time patients or a 30% limit on the monthly non-face-to-face treatment rate are meaningless in the clinical field."

"If you are anxious about a prescription for more than seven days, the doctor should not provide non-face-to-face treatment on his own," he said, adding, "We should give clinical discretion and autonomy to doctors so that they can treat them as they believe, but strengthen their responsibilities."

The industry also argued that rather than uniform restrictions, a method of selecting and regulating some high-risk drugs (negative) and a management system that can monitor misuse are needed. "There is a lot of demand in the field, such as office workers who have difficulty in face-to-face treatment during the day and gestational diabetic patients who have to control their insulin dose every day," said Lee Seul, co-chairman of the Telemedicine Industry Council. "If you repeat non-face-to-face treatment every seven days when the drug runs out, you can only increase the patient's out-of-pocket and health insurance expenditure."

"Dangerous drugs such as drugs are already prohibited from prescribing under the current guidelines, but it distorts the field to frame the entire non-face-to-face treatment as a "prescription vending machine" by highlighting only some non-payment cases," he added. "We should prepare subordinate laws based on tens of millions of empirical data accumulated over the past six years rather than retreating the system rather than pilot projects due to vague concerns."

Drug delivery was also discussed as a key issue that will determine the effectiveness of the non-face-to-face treatment system. Although drug delivery is an issue that requires revision of the Pharmaceutical Affairs Act, not a sub-law of the medical law, it is pointed out that it is difficult to see it separately considering the entire process of non-face-to-face treatment from treatment to prescription and drug receipt.

The patient complained of the reality that treatment was stopped because he could not get medicine even after receiving treatment. Seo Seung-yong, who attended as a patient's representative, said, "Even after receiving non-face-to-face treatment, I had to go out to the city by car after searching for a pharmacy that opened to receive prescription drugs."

Based on the results of a recent survey conducted by the Wonsan Association, co-chairman Lee said, "More than half of non-face-to-face medical users are experiencing great inconvenience in the process of receiving drugs, and one out of four did not receive them eventually," adding, "We need to expand the range of allowances at home so that patients can safely receive drugs in the way they want while ensuring the function of professional preparation and medication guidance for pharmacists."

The Pharmacy Association called for a careful approach, citing safety concerns in the drug delivery process. "Since drugs are not just industrial products, they can cause fatal risks that are directly linked to the patient's health if they deteriorate, delivery errors, or misuse during storage and delivery," Director Jang said. "In order to protect the patient's safety and improve the completeness of medication guidance, limited receipt through regular pharmacies that know the patient well is necessary rather than relying on private delivery."

How to ensure continuity of treatment was also presented as a major task. In particular, it was pointed out that it is unreasonable to classify patients who treat the same disease as administrative first-timers and apply prescription days or drug restrictions just because the doctor in charge has changed.

Lyndon Goddard, chief legal adviser at eucalyptus, an Australian healthcare company that presented overseas cases, said, "The continuity of care is not the continuity of a relationship in which a patient's medical records are linked seamlessly anytime, anywhere, not every time." "Like Australia and the United Kingdom, we need to use the national clinical record system to prevent fragmentation of care," he added.

The government is also in a position to consider ways to ensure the discretion of medical staff and patient-centered continuity of treatment. Park Jung-hwan, head of the medical artificial intelligence data policy division at the Ministry of Health and Welfare, said, "I deeply sympathize with the difficulties of uninterrupted treatment and receiving medicine. Even if the doctor in charge changes, we will deeply consider how to define and achieve continuous treatment for the same disease."

He added, "We will actively consider establishing a system to link past medical records with the 'Health Information Highway (Medical Data Public Platform)' so that medical staff can lead non-face-to-face treatment with clear leadership and discretion and contain corresponding responsibilities."