Differences among Ophthalmology Patients Referred to Tertiary Medical Centers according to Referral Hospital

Kim, Heesuk; Kim, Hong Kyu; Rim, Tyler Hyungtaek; Kim, Ji Won; Kim, Jin Hyung; Kim, Sung Soo

Healthcare delivery systems are implemented to provide efficient use and distribution of medical resources via differentiated care and complementary roles through hospi- A B C tals of various classifications. Currently, medical laws in Korea require that hospitals be classified according to their number of beds. This classification system may be easy to use but it is not a practical way to organize a healthcare delivery system for a country where approximately 90% of the physicians are specialists [7] , because the bed-number classification system does not apply to specialties, such as ophthalmology. For this reason, we investigated the shortcomings of the current referral system by analyzing patients who were referred to ophthalmology departments of higher-level hospitals and our findings suggest a need for a new complementary healthcare delivery system. The Korean Ophthalmological Society selects the training hospitals for ophthalmology residencies based on whether the hospital has at least four physicians with ophthalmology sub-specialties in such as cornea, retina, glaucoma, or others. Therefore, eye specialists in trainee hospital are considered as more professional than eye specialist in non-trainee hospital. When we categorized referral hospitals by their specialty function, we found that patients being referred to the eye specialists in trainee hospital tended to have more severe disease. On the other hand, 81.8% of all patients referred from non-eye specialists did not require treatment, and 93.4% of the patients under the age of 20 in this group did not require any treatments as well. Many patients could not be diagnosed because most visited the hospitals for a health examination despite being well; thus, herein, such cases are classified as "healthcare". The problems of the current healthcare delivery system appear to arise from non-ophthalmologic practitioners, such as pediatricians or family physicians, who too easily give referral letters for tertiary hospitals to patients complaining of ophthalmologic discomfort [6] [7] [8] .