Telemedicine in Korea has been a pilot programme for twenty years
One of the world's most digitally equipped health systems still treats remote consultation as an experiment, and the temporary permission granted during the pandemic left the apps built on it in a legal half-life.
Korea is an awkward candidate for a country that cannot do telemedicine. Effectively the entire population is covered by a single public insurer, medical records have been digitised for years, smartphone penetration is near universal, and the health system already processes claims electronically at a scale few countries match. What it has not had is legal permission. The Medical Service Act requires, in its conventional reading, that a doctor examine a patient in person, and every attempt to amend that requirement since the first government pilots in the late 1980s and the more serious trials of the 2000s has stalled.
The pattern repeats with unusual fidelity. A government announces a demonstration project, typically for patients on islands, in remote mountain districts, in the military or in correctional facilities — populations for whom the alternative is not an in-person visit but no visit. The project produces satisfactory results in a small sample. A bill to generalise it is drafted. The Korean Medical Association, which represents practising physicians and has repeatedly demonstrated its capacity to withdraw labour, opposes it. The bill lapses at the end of the parliamentary term. The next government announces a demonstration project. By the time the pandemic arrived, Korea had been running pilots for roughly two decades without ever moving beyond them.
The pandemic broke the deadlock temporarily and by an unusual instrument. In February 2020, invoking emergency provisions of the infectious disease control law, the government allowed telephone consultation and remote prescription for the duration of the elevated alert. The permission was framed as an infection-control measure rather than a health-policy reform, and it was used heavily: by the time the emergency wound down, authorities had counted well over ten million remote consultations, and a set of venture-funded platforms, of which Doctornow was the best known, had built businesses on the assumption that the change would be made permanent.
It was not. When the alert level was lowered in mid-2023, the emergency authority lapsed and the government replaced it with a pilot scheme of considerably narrower scope. In its initial form the pilot restricted remote consultation largely to follow-up visits with a doctor the patient had already seen in person, with first-visit access confined to island and remote-area residents, night and holiday hours, and certain vulnerable groups. Guidance was subsequently loosened, notably to allow after-hours first consultations more broadly, but the architecture remained a supervised exception rather than a right. Crucially, the pilot did not permit remote delivery of medicines: prescriptions issued in a video consultation must in general be collected from a pharmacy, which limits the convenience that made the service attractive in the first place.
The platforms have absorbed the consequences. Several of the companies that scaled during the emergency shut down or pivoted after the rules tightened; those that survived operate inside a scheme that can be revised by administrative guidance rather than statute, which makes ordinary business planning difficult. The pharmacists’ association has been at least as firm as the doctors’ on the dispensing question, and both objections have a defensible core alongside the obvious interest: fragmentation of care, over-prescription of controlled substances, and the risk that remote consultation becomes a channel for cosmetic and lifestyle medicine rather than for the patients who cannot easily travel.
The wider context is that the constraint is not evenly felt. Korea has one of the highest rates of outpatient visits per person in the OECD — the average resident sees a doctor far more often than an American or a Briton — because access in dense urban areas is genuinely easy and cheap. For the metropolitan majority, telemedicine solves a problem of mild inconvenience. For a resident of a county without an obstetrician or a night-time clinic, it solves a problem of distance. That the debate has been conducted mostly in terms of the first group, and settled by the professional bodies representing them, is the most durable feature of a twenty-year argument that has yet to produce a law.