De facto marketization of North Korean health care

Eun Jeong Soh, post-doctoral fellow at the ANU College of Asia and the Pacific, has written an interesting article in the East Asia Forum on the innovative practices that have developed in the DPRK’s health care system. According to the article:

In contrast to a number of incremental changes toward marketisation — which the government inevitably adopted — Pyongyang has emphasised its intention to maintain completely free and socialised health and education sectors. As a result, despite lacking the resources to provide for the country’s over 700 hospitals and over 6000 clinics, privatisation and decentralisation in the health care sector has been minimal. There have been reports of privately owned and financed pharmacies in the streets of major cities and in a number of hospitals. Nevertheless, health workers are generally reluctant to seek outside resources directly and autonomously for fear of getting into trouble.

Under this peculiar context, informal health care practices — such as informal payments, a black market for medicines and home-practicing doctors — have developed. In a study conducted by the United States Institute of Peace, 90 per cent of respondents admitted to having made informal payments to doctors and that purchasing medications on the black market was common. Interviews with defectors resettling in Seoul confirm this trend. People have learned to treat themselves at home using antibiotics, glass syringes bought from the black market and herbal or traditional medicines. Doctors and pharmacists have created informal referral networks based on a sense of mutual trust in each other’s expertise and competence.

Another noticeable phenomenon is the emergence of home-practicing doctors. Patients have come to prefer private house doctors — out of both convenience and trust — over hospitals where one has to bring everything from medicines to meals. Such practices are illegal but not uncommon. Even in the old days, given the close doctor-patient relationship fostered by the North Korean-style free health care system, people in emergency situations visited doctors’ homes.

Read the full story here:
Behind North Korea’s hospital curtain
East Asia Forum
Eun Jeong Soh, ANU
2014-7-18

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