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Korean J Fam Med > Volume 45(2); 2024 > Article
Cho: Supply of Primary Care Physicians: A Key Strategy to Reduce Population Mortality
Primary care is a key component of an effective and efficient national healthcare system. Primary care contributes to the health of the population by ensuring accessibility to necessary services, promoting preventive care, early management of chronic diseases, and reducing unnecessary specialty care. To provide primary care to the entire population, it is crucial to have a sufficient number of primary care physicians. It is well documented that the greater supply of primary care physicians improves health outcomes including total and causespecific mortality rate, lowers costs of healthcare services, and reduces health inequities [1]. Basu et al. [2] showed that in the United States, an increase of 10 primary care physicians per 100,000 population was associated with a 51.5-day increase in life expectancy, while an increase of 10 specialists per 100,000 population was associated with a 19.2-day increase.
Compared with other developed countries, Korea has a less robust primary care system and a lower ratio of primary care physicians to specialists. Korean patients can generally access any healthcare provider, including primary care clinics and specialty clinics in communities and hospitals, without a referral letter [3]. They are more likely to perceive the quality of hospital-based care to be better than that of clinic-based care and favor specialty care over primary care, even for mild to moderate illnesses [4]. The preference for specialty care among Korean patients can lead even primary care physicians, such as family medicine doctors or general internists, to focus more on specialized areas such as weight management or skincare. In Korea, where specialty care is dominant, the relationship between the primary care physician supply and health outcomes may be weaker compared to countries with stronger primary care systems. However, there is limited evidence regarding the impact of the supply of primary care physicians on health outcomes in South Korea.
In the present issue, Koh et al. [5] presented that a higher density of primary care physicians was associated with lower allcause mortality rates and lower mortality rates due to cardiovascular diseases, respiratory tract diseases, and traffic accidents. In their study, an increase of a primary care physicians per 100,000 people was associated with a 0.11% decrease in all-cause mortality, whereas the density of specialists in primary care facilities was not significantly associated with allcause mortality. Specialists working in primary care settings contribute to improving access to specialized care, which may be beneficial. However, because specialists typically focus on specific areas of medicine, they may have limitations in improving long-term health outcomes. In another article published in the present issue, Kang and Sung [6] showed that having a regular doctor as usual source of care was associated with better medication adherence among Korean patients with hypertension. This finding supports the contribution of primary care physicians in providing comprehensive and longitudinal care for managing chronic diseases and improving health outcomes.
Recently, the Korean government announced a package of essential healthcare policies, including expanding the admission quota for medical schools by 2,000, from 3,058 to 5,058 [7]. However, Korean doctors strongly opposed the government’s healthcare reform policies. In particular, most trainee doctors have resigned in protest. A detailed plan to strengthen primary care and increase the supply of primary care physicians is not included in the Korean government’s policies. Although the Korean government frequently uses the term “essential healthcare,” the concept of essential healthcare is obscure [8]. Presumably, essential healthcare in the Korean government’s policies focuses on emergency medical care and critical care needed in life-threatening situations, rather than primary care proven to improve long-term health outcomes. The lack of strong primary care is a widely acknowledged weakness of the Korean healthcare system, and the number of primary care physicians is significantly insufficient, particularly in deprived areas. It is crucial to note that the supply of primary care physicians is a key strategy for reducing mortality. If the Korean government wishes to reform its healthcare system, it should also focus on strengthening primary care and increasing the number of primary care physicians. Finally, I would like to point out that simply increasing the overall number of doctors cannot be a sufficient solution to the shortage of primary care physicians.

Notes

CONFLICT OF INTEREST

Young Gyu Cho has been an associate editor of the Korean Journal of Family Medicine but had no role in the decision to publish this review. Except for that, no other potential conflict of interest relevant to this article was reported.

REFERENCES

1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83:457-502.
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2. Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of primary care physician supply with population mortality in the United States, 2005-2015. JAMA Intern Med 2019;179:506-14.
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3. Organization for Economic Cooperation and Development. OECD reviews of public health: Korea: a healthier tomorrow [Internet]. Paris: OECD Publishing; 2020 [cited 2024 Mar 10]. Available from: https://doi.org/10.1787/be2b7063-en
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4. Ock M, Kim JE, Jo MW, Lee HJ, Kim HJ, Lee JY. Perceptions of primary care in Korea: a comparison of patient and physician focus group discussions. BMC Fam Pract 2014;15:178.
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5. Koh H, Kwon S, Cho B. Association of primary care physician supply with population mortality in South Korea: a pooled cross-sectional analysis. Korean J Fam Med 2024;45:105-15.
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6. Kang HK, Sung NJ. Correlation between usual source of care and medication adherence in patients with hypertension. Korean J Fam Med 2024;45:82-8.
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7. Ministry of Health and Welfare. A policy package to bring essential healthcare back from the brink of collapse [Internet]. Sejong: Ministry of Health and Welfare; 2024 [cited 2024 Mar 10]. Available from: https://www.mohw.go.kr/board.es?mid=a20401000000&bid=0032&list_no=1480151&act=view

8. Kim M. A crisis caused by confusion in the concept of essential healthcare. Korean J Med Ethics 2023;26:257-63.
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