A bilingual systematic review of South Korean medical tourism: a need to rethink policy and priorities for public health?

In 2016, the Korean government introduced the "Healthcare System Expansion and Foreign Patient Attraction Support Act" to accelerate the development of medical tourism. However, despite being enacted only a few years ago, its benefits are not well understood, and the positive and negative impacts of the expansion of Korea's medical sector have not been evaluated.

Objective

Our objective is to systematically review and summarize the existing literature describing the history of medical tourism policy and legislation in Korea, while assessing the impact of this domestic policy approach on the Korean public health system.

Methods

A bilingual systematic literature review of all Korean legislative and policy literature was conducted in two academic databases, PubMed and JSTOR, using MeSH terms and other relevant keywords and following the PRISMA guidelines. Published studies that directly mentioned Korean medical tourism policy were included. To complement the results of the peer review, we also searched for grey literature using the Google search engine for relevant policy documents, information from government websites, and national statistics on medical tourism-related data.

Results

The review includes 14 journal articles and 9 websites. The majority of the literature focused on the legislative history of Korea's pre-medical tourism policies, economic considerations for the industry's development, and the specific experiences of medical tourists. There were few studies, either analytical or commentary-based, that deeply analyzed the impact of these policies on healthcare or compared the benefits and costs with other medical tourism destinations. Medical tourism advocates continue to support the government in liberalizing and expanding investment in the medical tourism sector.

Conclusion

This systematic review suggests that policy decisions can prioritize the economic growth that medical tourism brings over the negative impacts on healthcare workforce, access, and equity, and the potential to undermine the national health insurance system. While Korea continues to consider ways to further revise its laws and develop the sector, these actions should be taken with caution and by critically examining how other countries have adjusted their policymaking based on the actual costs associated with medical tourism.

Background

Medical tourism is to choose a traveler traveling across the border and receives some medical care in a country other than the place of residence. [1] The main motivation for this movement, with millions of patients around the world, is broadly divided into higher quality medical care, lower service costs, and more prompt access. All of these factors are the freedom of the individuals who receive treatment abroad, the lack of binding legal frameworks for medical tourism, regulations across borders (immigration agreements, trade agreements, etc.), ethical and patient privacy issues, etc. It is affected by macro policy [2, 3, 4, 5]. Estimating the market size and range of this specific field in the international healthcare industry is difficult because there is no definition of universally accepted medical tourism and travel. [2, 3], because the government is reluctant to share information due to concerns about market competition, there is a shortage of data that can be verified at the national level.

The Allied Market Research, which is quoted in the official report of the South Korean government, predicts that the world's medical tourism market will reach $ 143. 8 billion by 2022, with an average annual growth rate from 2015 to 2022. [6] These estimates are forecasts that, in addition to selective da y-t o-day outpatient treatments (beauty, aesthetics, dental treatment, etc.), for predictions, including patients traveling across borders for both important but not important but necessary measures. Based on [6]. Although the data that can be verified on medical tourism may be limited, some sources suggest that the main destination of medical tourism is in Asia. This includes "main destinations" in Thailand, India, Singapore, Malaysia and the Philippines, and Korea is classified as "emerging destinations." [7, 8, 9, 10, 11, 12] These rival regional economies have become a domestic approach to Korea's medical tourism policy reforms, which are explained and examined in this overload [13]. < SPAN> Medical Tourism is to choose a traveler traveling across the border and receives some medical care in a country other than the residence. The main motivation for this movement, with millions of patients around the world, is broadly divided into higher quality medical care, lower service costs, and more prompt access. All of these factors are the freedom of the individuals who receive treatment abroad, the lack of binding legal frameworks for medical tourism, regulations across borders (immigration agreements, trade agreements, etc.), ethical and patient privacy issues, etc. It is affected by macro policy [2, 3, 4, 5]. Estimating the market size and range of this specific field in the international healthcare industry is difficult because there is no definition of universally accepted medical tourism and travel. [2, 3], because the government is reluctant to share information due to concerns about market competition, there is a shortage of data that can be verified at the national level.

The Allied Market Research, which is quoted in the official report of the South Korean government, predicts that the world's medical tourism market will reach $ 143. 8 billion by 2022, with an average annual growth rate from 2015 to 2022. [6] These estimates are forecasts that, in addition to selective da y-t o-day outpatient treatments (beauty, aesthetics, dental treatment, etc.), for predictions, including patients traveling across borders for both important but not important but necessary measures. Based on [6]. Although the data that can be verified on medical tourism may be limited, some sources suggest that the main destination of medical tourism is in Asia. This includes "main destinations" in Thailand, India, Singapore, Malaysia and the Philippines, and Korea is classified as "emerging destinations." [7, 8, 9, 10, 11, 12] These rival regional economies have become a domestic approach to Korea's medical tourism policy reforms, which are explained and examined in this overload [13]. Medical tourism is to choose a traveler traveling across the border and receives some medical care in a country other than the place of residence. [1] The main motivation for this movement, with millions of patients around the world, is broadly divided into higher quality medical care, lower service costs, and more prompt access. All of these factors are the freedom of the individuals who receive treatment abroad, the lack of binding legal frameworks for medical tourism, regulations across borders (immigration agreements, trade agreements, etc.), ethical and patient privacy issues, etc. It is affected by macro policy [2, 3, 4, 5]. Estimating the market size and range of this specific field in the international healthcare industry is difficult because there is no definition of universally accepted medical tourism and travel. [2, 3], because the government is reluctant to share information due to concerns about market competition, there is a shortage of data that can be verified at the national level.

The Allied Market Research, which is quoted in the official report of the South Korean government, predicts that the world's medical tourism market will reach $ 143. 8 billion by 2022, with an average annual growth rate from 2015 to 2022. [6] These estimates are forecasts that, in addition to selective da y-t o-day outpatient treatments (beauty, aesthetics, dental treatment, etc.), for predictions, including patients traveling across borders for both important but not important but necessary measures. Based on [6]. Although the data that can be verified on medical tourism may be limited, some sources suggest that the main destination of medical tourism is in Asia. This includes "main destinations" in Thailand, India, Singapore, Malaysia and the Philippines, and Korea is classified as "emerging destinations." [7, 8, 9, 10, 11, 12] These rival regional economies have become the stage of a domestic approach to Korea's medical tourism policy reform, which is explained and examined in this overload [13].

In recent years, government support has focused on hig h-quality clinical medical care, doctors' technical skills, and medical technology, and has become the top 10 in the world as a destination for medical tourism. 14, 15, 16, 17]. The rise was a catalyst when the South Korean government started "one comprehensive plan to support the expansion of medical systems and the invitation of foreign patients" in 2016. This plan indicated the stage of the policy implementation of Article 18 of the Japanese law, which was enacted in July 2016, "Law on the expansion of the overseas medical system and the support of foreign patients" (hereinafter, "law"). 。 The same law and comprehensive plan are as a result of the combination of the Korean government aimed at promoting and globalization of domestic medical industry by strengthening the competition for foreign patients in the global medical tourism market, which is considered to be a hig h-valu e-added industry. 。

In other words, expanding domestic medical services for overseas patients, enabling access to foreign patients, and appealing to the charm and convenience of safe and hig h-quality Korean medical services. The use is to use the revenue from medical services provided to foreigners as a means of national economic development. Two years after the law, in May 2018, the government announced the "Enforcement Plan 2018 to support overseas medical systems and attract foreign patients" (hereinafter, enforcement plan). Specifically, the South Korean government has made an economic and political additional evaluation, and has established an enforcement plan to adjust and reset the goals of the domestic medical tourism industry. Therefore, the flow of legislative measures, implementation by comprehensive planning, and monitoring and adjustment by enforcement plan is an important policy that should be considered in the context of global medical tourism trends and the impact on medical policy in Japan and overseas. 。 < SPAN> In recent years, South Korea focuses on hig h-quality clinical medical care, physicians' technical skills, and medical technology, and will be in the top 10 in the world as a destination for medical tourism. [14, 15, 16, 17]. The rise was a catalyst when the South Korean government started "one comprehensive plan to support the expansion of medical systems and the invitation of foreign patients" in 2016. This plan indicated the stage of the policy implementation of Article 18 of the Japanese law, which was enacted in July 2016, "Law on the expansion of the overseas medical system and the support of foreign patients" (hereinafter, "law"). 。 The same law and comprehensive plan are as a result of the combination of the Korean government aimed at promoting and globalization of domestic medical industry by strengthening the competition for foreign patients in the global medical tourism market, which is considered to be a hig h-valu e-added industry. 。

Methods

Search strategy

In other words, expanding domestic medical services for overseas patients, enabling access to foreign patients, and appealing to the charm and convenience of safe and hig h-quality Korean medical services. The use is to use the revenue from medical services provided to foreigners as a means of national economic development. Two years after the law, in May 2018, the government announced the "Enforcement Plan 2018 to support overseas medical systems and attract foreign patients" (hereinafter, enforcement plan). Specifically, the South Korean government has made an economic and political additional evaluation, and has established an enforcement plan to adjust and reset the goals of the domestic medical tourism industry. Therefore, the flow of legislative measures, implementation by comprehensive planning, and monitoring and adjustment by enforcement plan is an important policy that should be considered in the context of global medical tourism trends and the impact on medical policy in Japan and overseas. 。 In recent years, government support has focused on hig h-quality clinical medical care, doctors' technical skills, and medical technology, and has become the top 10 in the world as a destination for medical tourism. 14, 15, 16, 17]. The rise was a catalyst when the South Korean government started "one comprehensive plan to support the expansion of medical systems and the invitation of foreign patients" in 2016. This plan indicated the stage of the policy implementation of Article 18 of the Japanese law, which was enacted in July 2016, "Law on the expansion of the overseas medical system and the support of foreign patients" (hereinafter, "law"). 。 The same law and comprehensive plan are as a result of the combination of the Korean government aimed at promoting and globalization of domestic medical industry by strengthening the competition for foreign patients in the global medical tourism market, which is considered to be a hig h-valu e-added industry. 。

Inclusion criteria

In other words, expanding domestic medical services for overseas patients, enabling access to foreign patients, and appealing to the charm and convenience of safe and hig h-quality Korean medical services. The use is to use the revenue from medical services provided to foreigners as a means of national economic development. Two years after the law, in May 2018, the government announced the "Enforcement Plan 2018 to support overseas medical systems and attract foreign patients" (hereinafter, enforcement plan). Specifically, the South Korean government has made an economic and political additional evaluation, and has established an enforcement plan to adjust and reset the goals of the domestic medical tourism industry. Therefore, the flow of legislative measures, implementation by comprehensive planning, and monitoring and adjustment by enforcement plan is an important policy that should be considered in the context of global medical tourism trends and the impact on medical policy in Japan and overseas. 。

Exclusion criteria

Despite the optimistic economic growth forecast, the South Korean government has been opposed to the promotion of medical tourism industries. The Korean Health Rights and Medical Activists Association (KFHR) (KFHR), a group that promotes the rights of health, health, and the right of medical workers, democratic society for the health of workers The Korean Pharmacist Association for solidarity asserted that investment in medical tourism, which opposes the promotion of the medical tourism industry, could lead to commercialization of national public medical systems. This led to an increase in costs by expanding the civil medical department, and medical professionals' brain outflow (domestic medical professionals leave rural areas to areas with a wider and higher coverage, and public clinics. Leaving and moving to a private clinic may lead to a more advantageous medical tourism market.

Study selection

Regarding such public policy stances in Japan and the usefulness of investment in medical tourism, there are continuing differences in domestic discussions and opinions among stakeholders. However, despite the fact that South Korea offers an important case study for this topic, the literature discussing medical tourism policy specializing in Korea's experience is limited. Therefore, the purpose of this systematic review is to summarize the various economic and public health meanings of South Korea's PRO policy, which supports the medical tourism field. In addition, the Korean government is also conducting critical analysis of the Korean medical tourism industry in comparison with other Asian descriptions, such as Thailand, India, and Singapore. Based on this comparative analysis, a series of proposals will be made and conclusions will be made on the future image of South Korea's medical tourism policy attitude. < SPAN> Despite the optimistic economic growth forecast, the Korean government has been opposed to the Korean government's medical tourism industrial promotion. The Korean Health Rights and Medical Activists Association (KFHR) (KFHR), a group that promotes the rights of health, health, and the right of medical workers, democratic society for the health of workers The Korean Pharmacist Association for solidarity asserted that investment in medical tourism, which opposes the promotion of the medical tourism industry, could lead to commercialization of national public medical systems. This led to an increase in costs by expanding the civil medical department, and medical professionals' brain outflow (domestic medical professionals leave rural areas to areas with a wider and higher coverage, and public clinics. Leaving and moving to a private clinic may lead to a more advantageous medical tourism market.

Bias assessment

Regarding such public policy stances in Japan and the usefulness of investment in medical tourism, there are continuing differences in domestic discussions and opinions among stakeholders. However, despite the fact that South Korea offers an important case study for this topic, the literature discussing medical tourism policy specializing in Korea's experience is limited. Therefore, the purpose of this systematic review is to summarize the various economic and public health meanings of South Korea's PRO policy, which supports the medical tourism field. In addition, the Korean government is also conducting critical analysis of the Korean medical tourism industry in comparison with other Asian descriptions, such as Thailand, India, and Singapore. Based on this comparative analysis, a series of proposals will be made and conclusions will be made on the future image of South Korea's medical tourism policy attitude. Despite the optimistic economic growth forecast, the South Korean government has been opposed to the promotion of medical tourism industries. The Korean Health Rights and Medical Activities Association (KFHR) (KFHR), which is an organization that promotes the rights of health, health, and the rights of medical workers, democratic society for the health of workers The Korean Pharmacist Association for solidarity asserted that investment in medical tourism, which opposes the promotion of the medical tourism industry, could lead to commercialization of national public medical systems. This led to an increase in costs by expanding the civil medical department, and medical professionals' brain outflow (domestic medical professionals leave rural areas to areas with a wider and higher coverage, and public clinics. Leaving and moving to a private clinic may lead to a more advantageous medical tourism market.

Results

Search results

Regarding such public policy stances in Japan and the usefulness of investment in medical tourism, there are continuing differences in domestic discussions and opinions among stakeholders. However, despite the fact that South Korea offers an important case study for this topic, the literature discussing medical tourism policy specializing in Korea's experience is limited. Therefore, the purpose of this systematic review is to summarize the various economic and public health meanings of South Korea's PRO policy, which supports the medical tourism field. In addition, the Korean government is also conducting critical analysis of the Korean medical tourism industry in comparison with other Asian descriptions, such as Thailand, India, and Singapore. Based on this comparative analysis, a series of proposals will be made and conclusions will be made on the future image of South Korea's medical tourism policy attitude.

This systematic review was conducted in January 2021 following the Preferred Reference Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [18]. A Medical Subject Headings (MeSH) search was conducted using the unique identifiers “Medical Tourism” (ID: D057193) and “Korea” (ID: D007723) in the PubMed and JSTOR databases for English and Korean articles published before January 18, 2021. Search keywords other than MeSH included “Tourism, Medical”, “Health Tourism”, “Tourism, Health”, “Tourism, Health”, “Surgical Tourism”, “Tourism, Surgical”, “Medical Tourists”, “Medical Tourist”, “Tourist, Medical”, and “Tourist, Medical” combined with “Korea” or “Korean”. In addition, to supplement the scientific literature, we reviewed grey literature using Google search engines in English and Korean and conducted a policy analysis of primary literature available online. In the structured web search query, we used the same keywords used in the literature review and added the equivalent terms in Korean: 의료관광, 관광정책, 국제의료관광 코디네관광, 관광정책, 국제의료관광 코디네관광. To better understand the policy basis of medical tourism industry promotion activities in Korea, p

The review included articles that discussed and analyzed Korea's medical tourism policy, including comparisons and contrasts with other major Asian medical tourism destinations. Major themes included analyses of barriers to policy implementation, challenges regarding the operational status of medical tourism policies, barriers to service provision in the medical tourism field (e. g., differences in cultural and social backgrounds), customer motivations for participating in the medical tourism industry (e. g., loyalty), and evaluation of the impact of medical tourism policies in Korea (e. g., internal benefits, economic impacts). This study included research articles, reviews, case studies, comments, and letters to the editor.

Studies that implemented or discussed medical tourism policies focusing on other countries (e. g., Japan, the United States, Mongolia, etc.) and articles that discussed other important medical issues in Korea (e. g., HIV, Middle East Respiratory Syndrome, etc.) but did not focus on medical tourism were excluded. Articles that did not focus on medical tourism but discussed other important health issues in Korea (e. g., HIV, Middle East Respiratory Syndrome, etc.), articles that focused on migrant health issues in other destinations (e. g., Korean American health in other countries), and articles that focused on other health issues related to the globalization of medicine (e. g., transnational organ transplant industry, stem cell tourism, etc.). No literature was excluded based on specific content types or study designs.

All studies were extracted and assessed for validity independently by QX and VP to minimize errors and reduce potential bias. Disagreements regarding study eligibility were resolved by discussion among all authors to reach a final consensus. The Cochrane Collaboration's Risk of Bias (RoB) tool was used to assess bias in the selected randomized controlled trials (RCTs) [19]. When comparable quantitative indicators were revealed between studies, the impact of publication bias had to be assessed using channeling graphs. For other types of studies, the impact of previously reported biases on health policy research was qualitatively assessed.

Based on the review and search criteria, a total of 123 articles (22 journal articles and 100 Google search results) were examined (see Figure 1). After excluding one, 21 published articles were returned in PubMed and JSTOR, which were then examined for relevance to the study inclusion and exclusion criteria. As a result of the review, seven articles were excluded based on a review of the focus of the article after review of the abstract, and then a full-text review was conducted. The main themes identified in the literature were (a) a formal policy review of the Korean medical tourism industry [20], (b) an analysis of the current barriers, challenges, and successes facing the Korean medical tourism industry [21, 22, 23, 24, 25], (c) recommendations for evaluating the performance of the Korean medical tourism industry [26], and (d) an evaluation and assessment of the medical education system to support the further development of the medical tourism industry [27]. (e) examining the relationship between employee satisfaction and the performance of medical tourism facilitators [28], (f) analyzing the impact of price and health awareness and satisfaction associated with medical tourism experiences in Korea [29, 30], and (g) factors associated with the reasons why some patients choose to participate in medical tourism in Korea [31, 32, 33].

Risk of bias

Figure 1

Overview of history of South Korea medical tourism policy

Flowchart of study selection

Based on the search method of Google Online, the search results of the first 100 (50 Koreans, 50 English) were examined. After deleting duplicate search results, he searched for 32 unique English and 38 Korean websites, examined the relevance, and included it in this study. The results of the English website included two government websites, five news articles, two online articles, and 23 advertising websites. The Korean website included two government websites, 18 news articles, nine online articles, and nine advertising websites. After excluding 32 advertising websites related to this research, 38 websites of ful l-content are identified, and directly in the Korean medical tourism industry, including evidence and updates related to medical tourism policies and related data in Japan. Related 9 websites (English 7, Korean 2) have been identified. The gray literature review has gained additional details in the literature on specific motives, evidence, and strategies for the Korean government to pursue medical tourism policy. A total of 14 magazine articles (see Table 1) and 9 websites (see Table 2) were included in the research.

Table 1 Research on Korean medical tourism

Table 2 Korean medical touris m-related website

In the following sections, these different sources include the history of medical tourism laws and policies in Korea, the rise of the medical tourism industry, the results of the medical tourism industry, criticism, and issues related to issues, and future potential traits. Expect how it is associated with. Based on the < Span> Google Online search method, we examined the first 100 search results (50 Koreans, 50 English). After deleting duplicate search results, he searched for 32 unique English and 38 Korean websites, examined the relevance, and included it in this study. The results of the English website included two government websites, five news articles, two online articles, and 23 advertising websites. The Korean website included two government websites, 18 news articles, nine online articles, and nine advertising websites. After excluding 32 advertising websites related to this research, 38 websites of ful l-content are identified, and directly in the Korean medical tourism industry, including evidence and updates related to medical tourism policies and related data in Japan. Related 9 websites (English 7, Korean 2) have been identified. The gray literature review has gained additional details in the literature on specific motives, evidence, and strategies for the Korean government to pursue medical tourism policy. A total of 14 magazine articles (see Table 1) and 9 websites (see Table 2) were included in the research.

Table 1 Research on Korean medical tourism

Table 2 Korean medical touris m-related website

In the following sections, these different sources include the history of medical tourism laws and policies in Korea, the rise of the medical tourism industry, the results of the medical tourism industry, criticism, and issues related to issues, and future potential traits. Expect how it is associated with. Based on the search method of Google Online, the search results of the first 100 (50 Koreans, 50 English) were examined. After deleting duplicate search results, he searched for 32 unique English and 38 Korean websites, examined the relevance, and included it in this study. The results of the English website included two government websites, five news articles, two online articles, and 23 advertising websites. The Korean website included two government websites, 18 news articles, nine online articles, and nine advertising websites. After excluding 32 advertising websites related to this research, 38 websites of ful l-content are identified, and directly in the Korean medical tourism industry, including evidence and updates related to medical tourism policies and related data in Japan. Related 9 websites (English 7, Korean 2) have been identified. The gray literature review has gained additional details in the literature on specific motives, evidence, and strategies for the Korean government to pursue medical tourism policy. A total of 14 magazine articles (see Table 1) and 9 websites (see Table 2) were included in the research.

Economic considerations of South Korean medical tourism

Table 1 Research on Korean medical tourism

Table 2 Korean medical touris m-related website

In the following sections, these different sources include the history of medical tourism laws and policies in Korea, the rise of the medical tourism industry, the results of the medical tourism industry, criticism, and issues related to issues, and future potential traits. Expect how it is associated with.

In our review, we did not disclose RCTs for bias assessment using the Cochrane Collaboration guidelines. Previous publications have suggested that publication bias [34], surveillance bias [35], contextual bias [36], and omission bias [37] may be relevant in health policy research. The quantitative indicators uncovered in this systematic review could not be compared across studies among the small subset of studies in which quantitative indicators were reported. Therefore, we were unable to address traditional methods used to assess these biases. Nevertheless, consistent with past literature, it seems worthwhile to make conceptual room for the possibility that these biases may have influenced the main findings of this review, as follows: (1) There may have been unpublished reports describing the lack of economic and public health impacts of medical tourism in Korea. (2) Areas that were economically and public health affected may have been more affected than areas that were not. (3) The thresholds for economic and public health impacts may be more sensitive for researchers evaluating medical tourism in Korea. (4) Procurement practices by the medical tourism sector are relatively strong. It was after the 2009 amendment of the Medical Care Act that the Korean government began to fully implement policies to actively promote medical tourism, opening the door to home medical care operators and other private companies (except for those in the health insurance sector) to attract foreign patients with medical services [24] (see Table 3 for the policy timeline). In conjunction with the Medical Care Act, in January 2009, the Korean government announced the New Engine for Growth: Vision and Strategy plan. According to this strategy, global healthcare was one of 17 new growth industries in the category of five high value-added industries that the government should strategically consider.

Table 3 Chronology of policy measures by the Korean government to support medical tourism

In February 2013, 140 national priority items were announced by former President Park Geu n-hye, one of which global healthcare was listed. This led to the enactment of the law in 2016, but before the establishment, the Korean government has implemented many policy mechanisms aimed at promoting medical tourism based on the individual benchmarks of the medical tourism industry in other countries. Specifically, the Korean government analyzes the policy and economic strategy of Thailand, Singapore, and India, which are major competitors in the field, and report the 2011 Economic Policy Coordination Committee's report, "Performance and Promotion Measures for the Medical. The result is reported in Tourism Industry. 39, 40, 41]. These evaluation results are reflected in the policy decision before and after the law.

For example, one of the policy mechanisms that the report encourages medical tourism is the establishment of a medical visa system to facilitate and access foreign patients in South Korea's medical system. Other policy changes include the tolerance of medical advertising in foreign languages, indicating a clear deviation from strict regulations on marketing in the national medical system. In July 2011, Korean Patients (KHIDI) were domestic and foreign patients in order for foreign patients to take potential medical mistakes and reduce the economic risks of foreign patients. The target medical error insurance policy was formulated. In December 2011, the Health and Welfare Department (MOHW) (MOHW) had a foreign doctor and a dentist, despite the strict diagnosis and administration of the public medical system through the revision of the Presidential Ordinance of the Pharmaceutical Affairs Law. He also acknowledged that drugs were administered to patients. < SPAN> In February 2013, 140 national priority items were announced by former President Park Geu n-hye, one of which global healthcare was listed. This led to the enactment of the law in 2016, but before the establishment, the Korean government has implemented many policy mechanisms aimed at promoting medical tourism based on the individual benchmarks of the medical tourism industry in other countries. Specifically, the Korean government analyzes the policy and economic strategy of Thailand, Singapore, and India, which are major competitors in the field, and report the 2011 Economic Policy Coordination Committee's report, "Performance and Promotion Measures for the Medical. The result is reported in Tourism Industry. 39, 40, 41]. These evaluation results are reflected in the policy decision before and after the law.

For example, one of the policy mechanisms that the report encourages medical tourism is the establishment of a medical visa system to facilitate and access foreign patients in South Korea's medical system. Other policy changes include the tolerance of medical advertising in foreign languages, indicating a clear deviation from strict regulations on marketing in the national medical system. In July 2011, Korean Patients (KHIDI) were domestic and foreign patients in order for foreign patients to take potential medical mistakes and reduce the economic risks of foreign patients. The target medical error insurance policy was formulated. In December 2011, the Health and Welfare Department (MOHW) (MOHW) had a foreign doctor and a dentist, despite the strict diagnosis and administration of the public medical system through the revision of the Presidential Ordinance of the Pharmaceutical Affairs Law. He also acknowledged that drugs were administered to patients. In February 2013, 140 national priority items were announced by former President Park Geu n-hye, one of which global healthcare was listed. This led to the enactment of the law in 2016, but before the establishment, the Korean government has implemented many policy mechanisms aimed at promoting medical tourism based on the individual benchmarks of the medical tourism industry in other countries. Specifically, the Korean government analyzes the policy and economic strategy of Thailand, Singapore, and India, which are major competitors in the field, and report the 2011 Economic Policy Coordination Committee's report, "Performance and Promotion Measures for the Medical. The result is reported in Tourism Industry. 39, 40, 41]. These evaluation results are reflected in the policy decision before and after the law.

Comparison of medical tourism policies of other top Asian destination countries

For example, one of the policy mechanisms that the report encourages medical tourism is the establishment of a medical visa system to make foreign patients entering and access to South Korea's medical system. Other policy changes include the tolerance of medical advertising in foreign languages, indicating a clear deviation from strict regulations on marketing in the national medical system. In July 2011, Korean Patients (KHIDI) were domestic and foreign patients in order for foreign patients to take potential medical mistakes and reduce the economic risks of foreign patients. The target medical error insurance policy was formulated. In December 2011, the Health and Welfare Department (MOHW) (MOHW) has a foreign doctor and a dentist, despite the strict diagnosis and administration of the public medical system through the revision of the Presidential Ordinance of the Pharmaceutical Affairs Law. He also acknowledged that drugs were administered to patients.

In addition, in November 2013, a new type of business called the “Medical Tourism Hotel Business” was founded in November 2013 by the Presidential Order to enable medical tourists to provide better medical services. The Ordinance has established a medical hotel as an entity that provides the same services and products (different types of room accommodation, eating and drinking services, etc.) as provided by the hotel. Furthermore, this policy requires Korean medical tourist hotels to be registered only by medical services or medical tourism business services, and to further promote these services in public health systems. Developed a tour coordinator (IMC). Medical tourism promoters also focused on improving the satisfaction of people working in the medical tourism industry to improve service performance and appeal.

Following these early minor policy actions to promote medical tourism, in 2016, there was no sufficient legal and institutional support for the development of the medical tourism industry. [46] The law was signed. The main legislation elements of this law are designed to deal with those that have been recognized as continuous policy defects that inhibit this field in the context of growth experienced by the destination nations in other regions. (See Table 4 for summary). Overall, these provisions have established a certain standard and formal evaluation of South Korea's medical tourist providers, restricted those who can provide medical tourist services, and created mechanisms for rights and pr e-approval. 。

Table 4 Mainly legislative elements (2016)

Discussion

Public views in Korea through a governmen t-sponsored website called "Visit Medical Korea" (http: // English. com/english/pt/index. do) operated by KHIDI Officially the optical industry Reflecting the movement of the Korean government trying to promote, promoting the whole medical tourism industry was held. This website is specially designed to introduce and advertise services of Korean hospitals and medical facilities to foreign patients, and in English, Japanese, Chinese, Russian, and Arabic. Translated. There is no Korean version on this website.

Based on the legislative goal set by the law in 2016, the comprehensive plan has increased the number of foreign patients using Korean medical services from 0. 3 million to 0. 8 million in 2021. [47] Related revenue would increase from 666. 4 billion won ($ 0. 5 billion) to 170 billion won ($ 1. 4 billion). It is estimated that from 2017 to 2021, 400 billion won ($ 330 billion) added value will be added through other economic incentives associated with 80. 000 employment creation and medical tourism. ]. Before the law was enacted, the number of foreign patients visiting South Korea increased from 60. 201 in 2009 to 296. 889 in 2015, and the annual growth rate was 30. 5 %. In 2015, ethnic distribution of foreign patients was Chinese (34 %), US nationals (14 %), Russian (7 %), and Japanese (6 %). Medical care distributions used by medical tourists include internal medicine (21, 3 %), plastic surgery (11 %), medical examination center (9 %), dermatology (9 %), orthopedic surgery (6 %). ) It was. The total of 2. 813 medical institutions in South Korea that gathered foreign patients in Korea was 2. 813. < SPAN> South Korea, a dedicated website hosted by the Korean Tourism Corporation and KHIDI (http: // English. Medical and sightseeing industry inside Reflecting the movement of the Korean government to formally promote, promoting the whole medical tourism industry. This website is specially designed to introduce and advertise services of Korean hospitals and medical facilities to foreign patients, and in English, Japanese, Chinese, Russian, and Arabic. Translated. There is no Korean version on this website.

Based on the legislative goal set by the law in 2016, the comprehensive plan has increased the number of foreign patients using Korean medical services from 0. 3 million to 0. 8 million in 2021. [47] Related revenue would increase from 666. 4 billion won ($ 0. 5 billion) to 170 billion won ($ 1. 4 billion). It is estimated that from 2017 to 2021, 400 billion won ($ 330 billion) added value will be added through other economic incentives associated with 80. 000 employment creation and medical tourism. ]. Before the law was enacted, the number of foreign patients visiting South Korea increased from 60. 201 in 2009 to 296. 889 in 2015, and the annual growth rate was 30. 5 %. In 2015, ethnic distribution of foreign patients was Chinese (34 %), US nationals (14 %), Russian (7 %), and Japanese (6 %). Medical care distributions used by medical tourists include internal medicine (21, 3 %), plastic surgery (11 %), medical examination center (9 %), dermatology (9 %), orthopedic surgery (6 %). ) It was. The total of 2. 813 medical institutions in South Korea that gathered foreign patients in Korea was 2. 813. Public views in Korea through a governmen t-sponsored website called "Visit Medical Korea" (http: // English. com/english/pt/index. do) operated by KHIDI Officially the optical industry Reflecting the movement of the Korean government trying to promote, promoting the whole medical tourism industry was held. This website is specially designed to introduce and advertise services of Korean hospitals and medical facilities to foreign patients, and in English, Japanese, Chinese, Russian, and Arabic. Translated. There is no Korean version on this website.

Based on the legislative goal set by the law in 2016, the comprehensive plan has increased the number of foreign patients using Korean medical services from 0. 3 million to 0. 8 million in 2021. [47] Related revenue would increase from 666. 4 billion won ($ 0. 5 billion) to 170 billion won ($ 1. 4 billion). It is estimated that from 2017 to 2021, 400 billion won ($ 330 billion) added value will be added through other economic incentives associated with 80. 000 employment creation and medical tourism. ]. Before the law was enacted, the number of foreign patients visiting South Korea increased from 60. 201 in 2009 to 296. 889 in 2015, and the annual growth rate was 30. 5 %. In 2015, ethnic distribution of foreign patients was Chinese (34 %), US nationals (14 %), Russian (7 %), and Japanese (6 %). Medical care distributions used by medical tourists include internal medicine (21, 3 %), plastic surgery (11 %), medical examination center (9 %), dermatology (9 %), orthopedic surgery (6 %). ) It was. The total of 2. 813 medical institutions in South Korea that gathered foreign patients in Korea was 2. 813.

However, just two years after the law came into force, the adjusted plan (i. e., the implementation plan) restated forecast targets and significantly reduced the initial estimates predicting the influx of new foreign patients. This revision reflected the recognition that optimistic forecasts of a rapid growth in the medical tourism industry needed to be revised based on the impact of the law and related medical tourism promotion policies (see summary in Table 5). Even after such adjustments, the number of new foreign patients entering the Korean healthcare system continued to fluctuate. For example, according to data from the Korea Mohw, after the law was passed in 2016, the number of foreign patient intakes increased to 364, 189 and total revenues from foreign patient care increased to 860, 6 billion revenues, representing an average annual increase of 48, 2%[48]. However, in 2017, reported medical tourists decreased to 321, 574, representing a 26% decrease in revenues from 2016[49]. In 2018, the number of medical tourists increased again, reaching 378, 967 people, a 17% increase from 2017.

Table 5 Comparison of data from the Comprehensive Plan (2016) and the Implementation Plan (2018) - Targets for the number of foreign patients

While the data generally point to economic growth in Korea's medical tourism industry, the 2016 Comprehensive Plan highlights several major challenges for the medical tourism industry going forward, including low recognition of Korean medical care from overseas [33], a lack of specialized staff and expertise to attract foreign patients, cultural differences with foreign patients that affect the use of services [21, 25], and a shortage of qualified personnel. Thus, based on available data prior to the passage of the Medical Care Act, the medical industry is experiencing growth, but stakeholders continue to point out barriers that impede further growth in the sector and call for increased investment. Uncertainty also remains regarding the availability of the education system needed to develop a new pool of medical workers to support the growing workforce needs of the medical tourism industry [27]. Moreover, the potential negative impacts of investments in medical tourism do not appear to have been taken into account in the government's analysis.

Despite the challenges of growth, the government continued to invest in the domestic medical tourism industry. The basis of this continuation is reflected in the official briefs entitled "Globalization of medical care, benefits to the people", and Movu claims:

What lies ahead for the future of the Korean medical tourism industry?

"The benefits of globalization of medical care are returned to all people. Since 2009, 630. 000 foreign patients have visited South Korea in five years. As a result, $ 1 trillion (about 83 billion yen) medical income. This is equivalent to exporting 950, 000 small cars by 2017, with $ 3. 6 trillion ($ 2. 97 trillion) medical revenue. It is brought in and increased by 28. 000 (by 2017).

Although the medical tourism industry continues to receive national support, the Korean Medical Tourism Industry's potential adverse effects (such as internal outflows of medical workers and privatization of public medical departments) are specific. Policys to deal with have not attracted much attention in literature and government official documents. For example, in the analysis under the comprehensive plan, the ratio of foreign patients (1 % in 2014 and 3 % in 2020) are relatively low, so Korean medical infrastructure is in Japan. It was concluded that it could accept more foreign patients without adversely affecting medical abilities. However, this calculation did not affect more optimistic predictions, as the number of foreign patients rapidly increased at the same ratio. Despite the issues of growth, the government continued to invest positively in the domestic medical tourism industry. The basis of this continuation is reflected in the official briefs entitled "Globalization of medical care, benefits to the people", and Movu claims:

"The benefits of globalization of medical care are returned to all people. Since 2009, 630. 000 foreign patients have visited South Korea in five years. As a result, $ 1 trillion (about 83 billion yen) medical income. This is equivalent to exporting 950, 000 small cars by 2017, with $ 3. 6 trillion ($ 2. 97 trillion) medical revenue. It is brought in and increased by 28. 000 (by 2017).

Although the medical tourism industry continues to receive national support, the Korean Medical Tourism Industry's potential adverse effects (such as internal outflows of medical workers and privatization of public medical departments) are specific. Policys to deal with have not attracted much attention in literature and government official documents. For example, in the analysis under the comprehensive plan, the ratio of foreign patients (1 % in 2014 and 3 % in 2020) are relatively low, so Korean medical infrastructure is in Japan. It was concluded that it could accept more foreign patients without adversely affecting medical abilities. However, this calculation did not affect more optimistic predictions, as the number of foreign patients rapidly increased at the same ratio. Despite the challenges of growth, the government continued to invest in the domestic medical tourism industry. The basis of this continuation is reflected in the official briefs entitled "Globalization of medical care, benefits to the people", and Movu claims:

"The benefits of globalization of medical care are returned to all people. Since 2009, 630. 000 foreign patients have visited South Korea in 5 years. As a result, $ 1 trillion (about 83 billion yen) medical income. This is equivalent to exporting 950, 000 small cars by 2017, with $ 3. 6 trillion ($ 2. 97 trillion) medical revenue. It is brought in and increased by 28. 000 (by 2017).

Limitations

Although the medical tourism industry continues to receive national support, the Korean Medical Tourism Industry's potential adverse effects (such as internal outflows of medical workers and privatization of public medical departments) are specific. Policys to deal with have not attracted much attention in literature and government official documents. For example, in the analysis under the comprehensive plan, the ratio of foreign patients (1 % in 2014 and 3 % in 2020) are relatively low, so Korean medical infrastructure is in Japan. It was concluded that it could accept more foreign patients without adversely affecting medical abilities. However, this calculation did not affect more optimistic predictions, as the number of foreign patients rapidly increased at the same ratio.

Conclusion

In this way, the analysis of the comprehensive plan is almost positive for the economic benefits of medical tourism, but the number of foreign patients has increased to the number needed to generate serious national economic benefits. In some cases, there is a lack of detailed evaluation of how this field affects public medical abilities. Furthermore, it is comprehensive to see how the deregulation causes the profits generated by hospitals and groups to support the public medical department in the event of a negative effect on growth and it is necessary to offset it. It is not shown in plans and laws [51]. It is also unknown whether South Korea can achieve desirable results in the face of a strong competition with existing local medical tourism rivals, and the Korean government is more liberalized and government incentive to maintain competitiveness. There is a possibility that we will go on a policy that likes the increase.

In order to better understand South Korea's policy basis for continuing to promote domestic medical tourism, it is important to evaluate other major medical tourism description policies in Asia. The top 10 lists of the world's top medical tourism destinations include India, Brazil, Malaysia, Thailand, Turkey, Mexico, Costa Rica, Taiwan, South Korea, and Singapore. Among these countries, some of the "important destinations" are Asian countries that have established an active policy initiative to promote medical tourism as an important part of the National Economic Development Strategy. See Table 6). In particular, the governments in Thailand, India, and Singapore participate in major international trade meetings and actively advertise the appeal of each medical tourism service, and have wider economic development and tourism through various policy initiatives. As part of the expansion agenda, it is officially supporting the medical tourism industry as a government [24, 29, 32].

Availability of data and materials

Table 6 Top Destination Comparison of Asian Medical Tourism Industry < SPAN> In this way, the analysis of comprehensive planning has almost positive for medical tourism, but it is a serious national economy. If the number of foreign patients increases to the number required to generate benefits, a detailed evaluation of how this field will affect public medical abilities. Furthermore, it is comprehensive to see how the deregulation causes the profits generated by hospitals and groups to support the public medical department in the event of a negative effect on growth and it is necessary to offset it. It is not shown in plans and laws [51]. It is also unknown whether South Korea can achieve desirable results in the face of a strong competition with existing regional medical tourism rivals, and the Korean government is more liberalized and government incentive to maintain competitiveness. There is a possibility that we will go on a policy that likes the increase.