In the N. Korean model, patients play an important role in the “pre-certification process” which is tied to a per admission “deductible” intended to speed up access to needed healthcare……………………
The realities of N. Korea’s “free medical system” laid bare
The tragic story of a family in Pyongyang that tried to get eye surgery for their eight-year-old son
This article is part of a series written by Daily NK journalist Kim Jeong Hun entitled “North Korea’s Secret Stories.”
It was the evening of Nov. 1, 2021, the fifth anniversary of the opening of Ryugyong General Ophthalmic Hospital in Pyongyang’s Munsu area. A shabbily dressed couple in their 40s shouted at the entrance of the hospital, imploring to “meet the hospital director or the party secretary.” They were Mr. Chu and his wife Mrs. Kim of Kallimgil-dong in Mangyongdae District, who had visited the hospital the previous year so their eight-year old son could receive an operation to correct his strabismus.
There was a reason why they were shouting at the entrance of the hospital on the anniversary of its founding, demanding to meet with hospital cadres. Even though they sold their home to pay for their son’s operation, the operation turned out badly, and they wanted to meet with cadres to protest.
In 2020, the couple — worried about their only son’s worsening strabismus — visited Ryugyong General Ophthalmic Hospital, which had grown famous on the back of widespread propaganda. The hospital told them that their son should receive an operation as soon as possible.
The couple said they would select the earliest date and go through the hospital procedures. The hospital responded with weighty words, telling the couple to hospitalize their son after a “prudent” and “determined” decision since there were many necessary steps to receiving individual treatment with a dedicated medical team.
Believing that their son urgently needed surgery, the couple unhesitatingly said they would put their son in the hospital at the earliest date, with Kim staying at his side as guardian.
However, the doctors — who had been saying the son needed surgery as soon as possible — did nothing but make rounds for the first three days of the son’s hospitalization, simply asking questions. Thinking something was amiss, Kim went to the medical staff with her husband, who had come to the hospital to bring his son’s clothes.
When the couple asked when their son could receive surgery, the medical team responded, “We will let you know when we are ready. We are trying to put a talented team on the case, but there are very few people and they have no time. If you wait your turn, it seems you’ll have to wait. We will try to make sure that action is quickly taken.”
Yet even a week later, their son still had no date for his operation.
Then one day, as Kim was waiting vacantly to learn when her son might get surgery, the guardian of another patient in the same hospital room quietly approached her. Cluing her in, she said if you pay the hospital off, you can receive operations “at the front of the line with the best doctors.” She said bringing “15 bills” — i.e., USD 1,500 — to the doctor in charge was usually enough to put the “real” doctor on the case. “That’s the etiquette and how things are done here,” she said.
It was just then that Kim realized that the people who got their surgery before her son despite being hospitalized later either had connections with cadres or had moved quickly to bribe hospital staff.
Ryugyong General Ophthalmic Hospital was promoted as a “product of the Kim Jong Un era’s philosophy of putting the people first,” but the Chu family discovered that the hospital had quietly created this “rule” because it, too, was forced to pay money up the line every year, or rely on its own resources to acquire facilities or equipment.
The couple immediately sold their three room apartment in Mangyongdae District and moved to an old, one room apartment to pay for their son’s surgery. He received the surgery fully two months after being hospitalized.
However, their son needed another operation because the first one did not go well, so the couple was forced to move to a single room in a basement to pay for the second surgery. At this point, the couple complained, “The free healthcare system, which they promote as the superiority of the socialist system, is a lie. No matter which hospital you go to, they all demand money.”
When the surgery yielded poor results even after the couple sold everything they owned, the Chu family went to the hospital on the anniversary of its founding and demanded to see hospital cadres, protesting that the hospital should “fix their son’s eyes or return their money.”
However, the hospital requested that the police in Mangyongdae District handle the matter, accusing the couple of ruining the joyous atmosphere of the fifth year anniversary event and criticizing socialist public healthcare policy. Ultimately, the police dragged the couple in and warned them that if they showed up at Ryugyong General Ophthalmic Hospital again, the police would consider stripping them of their right to reside in Pyongyang.
Kim Jong Un visited the completed Ryugyong General Ophthalmic Hospital on Oct. 18, 2016, calling it a world-class “people’s hospital” of which to be proud; he said everything about it pleased him. Expressing his satisfaction, he said he had “wanted to do something for the people, and one of his wishes had again come true.”
Afterwards, Ryugyong General Ophthalmic Hospital grew and grew, receiving state investment as a “people’s hospital” and a “base of socialist medical services.” However, with state investment and provisions shrinking every year as the nation’s economy continued to struggle, even Ryugyong General Ophthalmic Hospital was forced to put together its own cash.
The Chu family became an innocent victim to the hospital’s predicament, forced as it is to use all means and methods to put together money to achieve the party’s policy of “self-reliance” and “hard struggle.”
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