Oral Health Care Policy and Systems in Korea: Past, Present and Future
Jin-Bom Kim(ΰθNΝ), DDS, MSD, Ph D
Professor and Chairman, Dept. of Community and Preventive Dentistry,
College of Dentistry
Pusan National University, Korea
The total population of Korea was 47,008,000 in 2000. 79.7% of Korean lives in urban area. Aged population over 65-year-olds was 7.3%. In 2000, 96.3% of Korean population benefited from the health insurance program and 3.7% benefited from the medical assistance program.
Among most payable 10 diseases of Korean health insurance program in 2000, the top was diseases of pulp and periapical tissues which were caused from dental caries, the fourth; dental caries, the seventh; gingivitis and periodontal disease. In 2000, national oral health survey was implemented. DMF rate was of 12-year children was 77.1% and mean DMFT score of 12-year children was 3.3. The persons who have dental calculus among aged 15-19 were 43.2%. Among total chronic diseases in Korean population, the top was dental caries at the national survey in 1998-2000. The Ministry of Health and Welfare set the goals of oral health by the year 2010. One of the goals is to reduce mean DMFT score of 12-year children from 3.3 to 2.8.
We have three types of licensed oral health personnel; dentists, oral hygienists and dental laboratory technicians. In 2002, we had 19,589 dentists, 22,371 oral hygienists and 17,002 dental laboratory technicians. Accordingly, population dentist ratio was calculated to be 2,400, dental hygienist dentist ratio to be 1.1 and dental laboratory technician dentist ratio to be 0.9.
In Korea, there are 11 dental colleges for dentists, 28 junior colleges and 1 college for oral hygienists and 18 junior colleges and 1 college for dental laboratory technicians. The educational period is 6 years for dentists and 3 or 4 years for oral hygienists or dental laboratory technicians.
Community health centers are located at city or county level. Health sub-centers are branches of health centers which are located at town level. The population supported by a health center is about 100,000 to 500,000 in urban area and 50,000 to 100,000 in rural area. The population supported by a health sub-center is about 3,000 to 20,000 in rural area. All health centers are 242 in cities and counties. Dentists of health centers and health sub-centers are 920 in 2002. Among 920 dentists, 874 dentists are public health dentists who works for 3 years instead of military duties. Some health centers in urban areas had no dentists. Oral hygienists of health centers and health sub-centers are 1,133 in 2002. Oral hygienists of health centers and health sub-centers are more than dentists.
Adjusted water fluoridation program has been implemented in Chinhae since 1981 and in Chongju since 1982, respectively. Adjusted water fluoridation program is implemented in 31 cities this year. Benefit population of adjusted water fluoridation program is 4,854,000, which is 10.3% of total Korean population. Fluoride mouth rinsing program is implemented at 4,454 primary schools located in the non-fluoridated area. Benefit children in all Korea is 2,263,000, which is 56.3% of total Korean children in primary schools.
Pit and fissure sealant program is implemented in primary schoolchildren by health centers. The materials of pit and fissure sealant program is permanent molars. Benefit population are 269,650 and 1,078,600 teeth will be sealed by the end of this year.
Denture program for poor residents aged 65 over is implemented by the Oral Health Division of the Ministry of Health and Welfare this year. Co-operative private practitioners supply partial and complete dentures for 4,760 persons. All costs are paid from the Ministry of Health and Welfare.
The facilitation of school dental clinics has been initiated by the Ministry of Health and Welfare at primary schools since 1999. There are 98 school dental clinics. They mainly provides the preventive oral treatments such as pit and fissure sealants to school children by the dentists and oral hygienists of community health centers.
The facilitation of dental clinics has been initiated at schools for children with physical disabilities since 2001. There are 24 dental clinics at schools for disabilities. They provide the preventive and curative oral treatments to children with disabilities by the dentists and oral hygienists of community health centers or private voluntary groups.
The control tower of Korean public oral health programs is the Oral Health Division(ϋoΫΫ) of the Ministry of Health and Welfare(Ϋ). The basic laws supporting oral health program are Public Health Promotion Act( ―Nϊi@) and Oral Health Act(ϋoΫ@).
After the end of Second World War, US Armed Forces ruled over the southern part of Korean Peninsular from August 15, 1945 to August 15, 1948.
At the first government ruled by Korean People, August 15, 1948, the Dental Affair Section(κ±W) was established at the Medical Affair Division(ηΞ±Ϋ) in the Public Health Bureau(ΫΗ) of the Ministry of Social Affairs(Ππ). By the effort of Korean Dental Association(εΨκΘηΞt¦π), the Dental Affair Division(κ±Ϋ) was established in the Medical Policy Bureau(ηΞΗ) of the Ministry of Public Health(Ϋ), March 1949. However, it was reduced to Dental Affair Section, the Medical Affair Division in the Medical Policy Bureau(ηΞΗ) of the Ministry of Public Health(Ϋ), April 1950.
The Dental Affair Division was restored in the Medical Policy Bureau of the Ministry of Public Health, August 1960. However, it closed October 1961. The Dental Affair Division was restored in the Medical Policy Bureau in the Ministry of Health and Social Affairs(ΫΠπ) February 1967. However, it reduced to the Dental Affair Officer(κ±^αc―) February 1970 and it closed February 1975.
By the effort of Korean Dental Association, Dentists' Association for Healthy Society(κΘηΞtπΰ¨NΠπ) and lots of professors majoring public oral health, the Oral Health Division(ϋoΫΫ) was newly established by the modification of the Enforcement Decree for the Organization of the Ministry of Health and Welfare(ΫE§ί) on November 29, 1997 and the Oral Health Division(ϋoΫΫ) formally opened on December 8, 1997.
The establishment of Oral Health Division in the Ministry of Health and Welfare and Oral Health Act by National Assembly( π) were contributed by various activities. I think that the development of many oral health programs, the effort of Korean Dental Association and Dentists' Association for Healthy Society were the keys to open the Oral Health Division and to establish Oral Health Act.
First, lots of oral health personnel were supplemented at the 1970's and 1980's. Until 1978, there were very few dentists as government officials in public health field. Since 1979 Public Health Dentists(φOΫκΘηΞt) has been distributed at Community Health Centers and Health Sub-centers. Public Health Dentists works for 3 years instead of military duty. This year they are 874. Since 1986 oral hygienists has been distributed at Health Centers and Health Sub-centers for the assistance of Public Health Dentists. This year they are 1,133. By the many oral health personnel at public health field, we could develop various oral health programs such as fluoride mouth rinsing and oral health education.
Second, the prevalence of dental caries rapidly increased due to the increase of sugar consumption resulted from rapid economic growth in 1970's. The new policy was required for the prevention of dental caries to the government. Owing to the successive requirement by dentists and professors majoring oral health, the government initiated the adjusted water fluoridation program in 1981 and fluoride mouth rinsing program in 1983. Korean Dental Health Association(εΨϋoΫ¦π) had studied fluoride mouth rinsing and oral health education as the model programs since 1970's. By the introduction of various oral health programs, the headquarters was necessary to command the related personnel and manage the programs.
Third, the birth of Dentists' Association for Healthy Society became one of the key factors. Since 1961 Presidents from the military general or ex-military general ruled over Korea. Lots of citizens resisted the military dictatorships. Many dental students also joined the democratic movement. By the citizens' resistance, democratically elected government was established in 1988. The first real democratic government, which is headed by the President not from military generals or ex-generals was established in 1993. After graduation of dental colleges, these students created a nationwide organization in 1988 called as Dentists' Association for Healthy Society. At first, their efforts were focused on restoring democracy. After the establishment of the real democratic government in 1993, the association turned its focus toward the own profession. As a link to seek for the People's Right of Health, they actively joined in the development of oral health programs, the establishment of Oral Health Division and a law to enhance oral health programs.
Fourth, the strengthening of political power of dentists became a basis to establish Oral Health Division and to establish Oral health Act. At the late of 1990's, 3 dentists were elected as members of National Assembly. They assisted actively to establish Oral Health Division and Oral Health Act.
In 1995, Public Health Promotion Act was established and several articles related to oral health programs were involved in the act. However, the articles were not strong enough to develop oral health programs. The Dentists' Association for Healthy Society campaigned to establish the Oral Health Act. In 1997, Dr. Kyu-Son Hwang(黃\ι), a dentist and a member of National Assembly formally proposed Oral Health Act at National Assembly and National Assembly passed it December 3, 1999. President declared the Oral Health Act on January 12, 2000 and it was enforced on September 1, 2000.
The main contents related to oral health programs at the Public Health Promotion Act and Oral Health Act follows as:
1. Public Health Promotion Act
Article 18 (Oral Health program) @ National and local self-governments should implement the following items in order to prevent oral diseases and promote oral health:
1. Oral health education program.
2. Adjusted water fluoridation program.
3. Research and survey program on oral health.
4. Further programs prescribed by Presidential decree for the promotion of oral health.
A The contents, the guidelines and methods of each sub-paragraph of paragraph 1 are prescribed by decree of the Minister of Health and Welfare.
* Enforcement Decree of Health Promotion Act (Presidential decree)
Article 23 (Oral Health Program) The further programs for the promotion of oral health referred to in article 18 paragraph 1 sub-paragraph 4 are as follows:
1. Pit and fissure sealing program.
2. Fluoride mouth rinsing program.
3. Programs prescribed by the decree of the Ministry of Health and Welfare for the promotion of oral health.
2. Oral Health Act
Article 6 (Contents of Oral Health Program) The basic oral health program plan referred to in article 5 should include following items:
1. Oral health survey, research and education program.
2. Adjusted water fluoridation.
3. School oral health program.
4. Industrial oral health program.
5. Oral health program for aged and disability people.
6. Oral health program for expected women, babies and preschool children.
7. Further programs prescribed by the Enforcement Decree of Public Health Promotion Act.
Article 7 (Implementation of Oral Health Program)
@ The Minister of Health and Welfare, the Mayor of Special Metropolitan City, the Mayors of the Metropolitan Cities and Provincial Governors, the heads of the cities, counties and districts and the President of Korea Water Resources Corporation should implement programs prescribed by this act.