Category: Healthcare System

PHM Korea statement on COVID-19 outbreak and responses in South Korea

March 19th, 2020

 

South Korea (hereafter Korea)’s COVID-19 outbreak and response are still ongoing, and assessment of it is rather hasty. But we share this conditional statement because we think it is our responsibility to share Korea’s experience with civil society around the world, which is experiencing COVID-19 outbreak one tempo later than ours. In particular, we hope that the main barriers to the government responses and the efforts of the Korean civil society to find and fill the blind spots out of reach of the government policies or existing systems will be a lesson for the civil society of each country in the responses of COVID-19.

 

  • Barrier One: Reactionary right-wing alliance makes the situation worse.

 One of the most difficult challenges the government is confronted is the political assaults by the reactionary right-wing alliances, including the opposition party, Korean Medical Association (KMA) and right-wing news media. Before the general election in April, the right-wings blame the government for almost everything. They unnecessarily politicized the problems, which hampered reasonable and timely decision making by the government. They deliberately stick to the term ‘Wuhan Pneumonia’ and still demand a total immigration ban against Chinese people, although many experts repeatedly pointed out that it was unnecessary and special immigration process has been working very well. The opposition party disturbed the formation of an ad-hoc parliamentary commission to plan the supplementary budget for dealing with the outbreak, insisting that the commission name should include the term ‘Wuhan Pneumonia’. Even the KMA denounced the national advisory committee of which members are delegates from eleven academic societies, claiming that several members of the committee are leftists and clandestine power figures dominate government policies. Such a claim was absurd, but the committee was dissolved for protecting individual scientists from political attacks.[1][2] The KMA strongly criticizes the rationing of face-mask by the government and recommends that every citizen has to wear disposable face-mask without re-use in spite of the serious shortage of supply. In this situation, people are confused and lose trust in the government. Then the government is more likely to make hasty decisions and adopt populist measures and has to pay more efforts to rebuke fake news and misleading demands.

 

  • Barrier Two: The private, market-oriented healthcare system is the main barrier to cope with the COVID-19 though the ‘public control’ over the private hospitals and diagnostic kits industry makes the system keep to work.

 The number of beds owned by public hospitals accounts for around 10% of the national total, which is the lowest one among the OECD member countries,[3] and the health care delivery system from primary care through to the tertiary-care hospitals is not well organized. So as the number of patients sharply increased, it became very difficult for the government to procure beds and allocate patients according to their severity, especially in Daegu where the entire healthcare system was overwhelmed by the acute surge of patients related to the religious event. So-called ‘Big 5’ hospitals located in the capital city Seoul including Seoul Samsung Hospital which was the hotbed for the MERS-CoV outbreak in 2015[4] are surprisingly invisible in this situation except for the Seoul National University Hospital, while they account for 35.5% of total National Health Insurance benefits reimbursed to the tertiary-care hospitals.[5] The CSOs cannot but repeat their aged but never achieved claim that the government should expand public hospitals.

Now, tentative partial ‘public control’ over the private hospitals works by utilizing a pre-existing informal public-private network, not sufficiently but in a more organized way over time. Public control works much better with regard to the diagnostic kits production and supply.[6] Without the support from the government (Ministry of Food and Drug Safety and The Korean Centers for Disease Control and Prevention, KCDC) and the Korean Society for Laboratory Medicine, the industry would have never achieved the development and production of the diagnostic kits, and extensive screening tests with high quality would not be performed.[7] The acclaimed Korean test system is not the fruits of laissez-faire innovative capitalism and deregulation but an excellent example of tight coordination of public-private partnership and publicization of innovative technology. We should demand public benefit-sharing, including affordable prices and stable supplies and the public control over private sectors in dealing with public health emergencies instead of unleashed deregulation for innovation.

 

  • Barrier Three: Long-standing structural inequality/inequity paralyzes the control measures.

 Almost 80% of COVID-19 cases in Korea are linked to cluster infections,[8] and many of cluster cases reveal the structural inequity/inequality pervasive in Korea.

Among them, closed-ward hospitals for chronic psychiatric patients,[9] nursing homes for the elderly mostly in bedridden status, and living facilities for the severely disabled[10] became the hotbed for infection because of their poor living environments and underlying health conditions.

Dualized labor market which is caused by long-standing labor market liberalization makes effective prevention measures impotent; for example, the largest cluster infection in Seoul occurred in a call-center where workers cannot exercise ‘social distancing’ in a very crowded condition without proper ventilation system nor demand paid leaves in fear of layoff.[11] The more people stay at home for ‘social distancing’, the higher the work demands become in some sectors, such as call-centers and delivery services. One delivery worker died of Karoshi while dealing with skyrocketed online orders from the dawn to midnight.[12] As school closure extends, substitute teachers and caregivers in precarious employment have to work for children who cannot be cared at home, while regular teachers stay at home with paid leaves.[13] Pre-existing inequality and discrimination against low-waged, precarious workers aggravate the situation around the public health crisis.

 

 

  • Pros and Cons in the acclaimed ‘openness and transparency’ strategy of the Korean government.

 Korean Foreign Minister KANG Kyung-wha’s interview with the BBC on March 15th is gaining popularity. The strategy of the COVID-19 response by the Korean government, “openness, transparency and fully keeping the public informed,” appears to be paying off as Minister Kang said.[14]

There is a context in the government’s commitment to open and transparent responses. The secrecy strategy adopted by the right-wing government during the early phase of MERS-CoV outbreak in 2015 led to the failure of timely control and wide distrust in the government.[15] For the current liberal MOON Jae-in government, who was elected after the impeachment of the ex-president PARK Geun-hye, open and transparent responses to COVID-19 are becoming the barometers for legitimacy.

Current obsessive tracking/tracing of COVID-19 patients and information release/disclosure is possible thanks to the passage of the so-called ‘MERS act’ at the time of the MERS-CoV outbreak in 2015.[16] Recently, the government and the National Assembly also passed the so-called ‘COVID-19 acts,’ which allow involuntary testing, quarantine and treatment of those suspected of infection and the prosecution of those who refuse to test. This enabled the current aggressive massive screening tests.[17] While the ‘openness and transparency’ strategy is desirable in principle, there is a rising concern over privacy and human rights violation at the same time.[18] Indeed, many individuals were blamed and stigmatized as they ‘spread’ out viruses, and restaurants patients had visited had to shut down in order not to being blamed. After all, the National Human Rights Commission of Korea[19] announced the recommendation not to release specific addresses or workplace names of the COVID-19 patients, nor their travel path and the places they’ve visited to protect their privacy.[20] The KCDC had recently updated the guideline for local governments with incorporating such recommendations. However, CSOs have to follow up the situation and continue discussing how to protect population health in balance with individual human rights.

 

  • Role of civil societies.

Many NGOs and CSOs have been monitoring the situation the disadvantaged population, such as the disabled,[21] homeless,[22] and migrants[23] are faced with, and demanded government measures. Also, trade unions collected situation reports from their locals and investigated the sufferings of precarious workers who cannot access the paid leaves and proper protection from the COVID-19 infection.[24][25] On March 19th, NGOs and CSOs, including more than 40 organizations, national as well as local, announced a collective statement that the government should provide more support for vulnerable population, expand public hospitals, protect precarious workers regarding paid leaves and employment security, publicly control healthcare resources including face-masks, and organize community-based care system. Also the statement asserts that the media should stop their way of reporting obsessed with sensationalism and racism, stigmatizing special population groups.[26]

The government showed rather proper responsiveness; for example, undocumented immigrants can get the test without risk of deportation according to the decree of Ministry of Law,[27] and the Seoul Metropolitan Government began to provide ‘emergency care’ services for the disabled and the elderly who experienced the interruption of daily care services.[28] Although the government has shown unprecedented efforts and quick responses, the problems rooted in long-time under-investment in the social security system cannot be easily tackled. Many NGOs and voluntary community organizations are now trying to find and fill the blind spots in cooperation with local governments.

We hope this outbreak could facilitate social discussions for establishing a robust social protection system in Korea.

 

  • Participatory governance is needed dealing with pandemics.

 It is unrealistic to expect that all systems are perfectly in place in advance of an unprecedented public health crisis such as COVID-19 pandemic. There are many loopholes in the Korean government’s COVID-19 responses.

However, we could manage the situation better if we work together. Such loopholes could be filled through a ‘healthy’ partnership between the government and the civil society. The social power, including the CSOs, works to make the government actions more equitable and effective. The Korean civil society is closely monitoring the COVID-19 responses, as it did in the 2015 MERS-CoV outbreak,[29] with a focus on human rights and social justice.

We believe that ‘participatory governance’ would be effective for dealing with pandemic as well as defending democracy. We will keep working in solidarity.

 

pdf version of the statement:
PHM_Korea_statement_on_COVID_19_outbreak_and_responses

[1] The Hankyoreh 21, March 13, 2020, http://h21.hani.co.kr/arti/special/special_general/48375.html

[2] The SisaIN, March 17, 2020, https://www.sisain.co.kr/news/articleView.html?idxno=41519

[3] OECD Statistics https://stats.oecd.org/index.aspx?queryid=30183

[4] Ki, 2015 MERS outbreak in Korea: hospital-to-hospital transmission, Epidemiol Health. 2015; 37: e2015033. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533026/

[5] The Young Doctors, May 27 2019,  http://www.docdocdoc.co.kr/news/articleView.html?idxno=1068705

[6] http://www.hitnews.co.kr/news/articleView.html?idxno=15675

[7] The SisaIN, February 14 2020, https://www.sisain.co.kr/news/articleView.html?idxno=41277

[8] The Korea Herald, March 14 2020, 8 in 10 coronavirus cases in S. Korea linked to cluster infections http://www.koreaherald.com/view.php?ud=20200314000077

[9] The Washington Post, March 1 2020, How a South Korean psychiatric ward became a ‘medical disaster’ when coronavirus hit https://www.washingtonpost.com/world/asia_pacific/how-a-south-korean-psychiatric-ward-became-a-medical-disaster-when-coronavirus-hit/2020/02/29/fe8f6e40-5897-11ea-8efd-0f904bdd8057_story.html?fbclid=IwAR1JUUYndQisgqmM0i5M7i5AzOFGmo-aRxoHx0zdSpKr43bIWZS-8CuEFMg#comments-wrapper

[10] VOA, February 26 2020, Coronavirus Outbreak Inside 2 S. Korean Medical Facilities Highlights Vulnerability of Disabled Patients https://www.voanews.com/science-health/coronavirus-outbreak/coronavirus-outbreak-inside-2-s-korean-medical-facilities

[11] Yonhap News Agency, March 10 2020, Seoul call center emerges as city’s biggest infection cluster, numbers feared to rise https://en.yna.co.kr/view/AEN20200310002154315

[12] Korea Joongang Daily, March 17 2020, Union blames Coupang for delivery worker’s death http://koreajoongangdaily.joins.com/news/article/article.aspx?aid=3075014

[13] The Redian, March 17 2020, http://www.redian.org/archive/141581

[14] Ministry of Foreign Affairs, March 15 2020, Andrew Marr interviews Foreign Minister Kang Kyung-wha http://www.mofa.go.kr/eng/brd/m_5674/view.do?seq=320056&srchFr=&srchTo=&srchWord=&srchTp=&multi_itm_seq=0&itm_seq_1=0&itm_seq_2=0&company_cd=&company_nm=&page=1&titleNm=

[15] Minjeong Kang et al., 2018, From concerned citizens to activists: a case study of 2015 South Korean MERS outbreak and the role of dialogic government communication and citizens’ emotions on public activism, Journal of Public Relations Research, 30:5-6, 202-229, DOI: 10.1080/1062726X.2018.1536980

[16] The Korea Times, July 9 2015, Install epidemics system https://www.koreatimes.co.kr/www/opinion/2019/11/137_182505.html

[17] Korea.net (Overseas Korea Centers), March 4 1010, Cabinet passes laws to fight COVID-19 outbreak http://www.korea.net/NewsFocus/policies/view?articleId=182884

[18] Korean Federation Medical Activist Groups for Health Rights (KFHR), February 25 2020, http://kfhr.org/?p=129581

[19] National Human Rights Commission of Korea, March 9 2020, https://www.humanrights.go.kr/site/program/board/basicboard/view?boardtypeid=24&boardid=7605121&menuid=001004002001

[20] The Hankyoreh, Mar 16 2020, Government decides not to disclose personal information about novel coronavirus patients http://english.hani.co.kr/arti/english_edition/e_national/932783.html

[21] The Be Minor, March 18 2020, https://beminor.com/detail.php?number=14476&thread=04r03

[22] CSOs network, March 9 2020, http://www.konkang21.or.kr/bbs/board.php?bo_table=sotong_statement&wr_id=200

[23] Workers’ Solidarity, March 9 2020, https://wspaper.org/article/23620

[24] Korean Public Service and Transport Workers’ Union (KPTU), February 28 2020, KPTU Healthcare Workers Solidarity Division Statement on COVID-19 https://www.kptu.net/english/detail.aspx?mid=&page=1&idx=27605&bid=KPTU_PDSENG

[25] Korean Public Service and Transport Workers’ Union (KPTU), March 16 2020, COVID-19 and South Korean Workers, KCTU Demands https://www.kptu.net/english/detail.aspx?mid=&page=1&idx=27604&bid=KPTU_PDSENG

[26] CSOs network, March 19 2020, http://health.re.kr/?p=6357

[27] Yonhap News Agency, March 5 2020, https://www.yna.co.kr/view/AKR20200305142400064

[28] Seoul Metropolitan Government, March 16 2020, http://mediahub.seoul.go.kr/archives/1273495

[29] People’s Health Institute (PHI), 2016, http://health.re.kr/?p=2751

South Korea COVID-19 Outbreak Archive (update Mar/17/2020)

PHI column series 1

——— community infection started in a city of Daegu ———

 

PHI column series 2

——— community infection started in a city of Daegu ———

 

Other columns or interviews by PHI

 

——— community infection started in a city of Daegu ———

 

 

 

 

[call for petition]Abortion should be decriminalized in South Korea, now!

PHM Korea supports the campaign of Joint Action for Reproductive Justice in South Korea which demands people’s action for the decriminalization of abortion and expansion of access to safe abortion in South Korea.

Please Join for the petition.

Petition for Safe Abortion in South Korea

#Reproductice_justice #safe_abortion #medical_abortion #South_Korea

 


 

abortion
In South Korea, abortion is the only medical procedure included in the Criminal Code (Article 269 and 270) since 1953. Abortion is only legal if the pregnancy causes the woman serious physical health issues, if the pregnancy is a result of an incest/rape, or if one of the parents has ‘eugenic’ disease. Also, this law requires the consent of (male) spouses even in these grounds. Women can be sentenced to a year in prison or ordered to pay fines of two million won (about $2,000) for having abortions. Doctors, midwives and any healthcare workers who provide abortions can face up to two years imprisonment.

Korean women and doctors for sexual, reproductive health and right(SRHR) have been fighting for decriminalizing of abortion since 2010. This year is a very critical moment to decriminalize abortion under the circumstances that the Constitutional Court is currently reviewing a case that challenges the abortion law’s constitutionality. Meanwhile, the Ministry of Health and Welfare issued revised regulations toughening punishment for doctors who perform abortions. The ministry also labeled providing abortion services as an ‘immoral medical practice’.

Abortion has been a widespread experience for many Korean women. According to a government estimate, based on a survey of women of childbearing age, 169,000 abortions(16 abortions per 1,000 people) were conducted in 2010, the latest year for which data is available. While the government has neglected it, abortion practice was not adequately monitored nor officially educated.

Sign the petition to decriminalize abortion and to expand access to safe abortion in South Korea. We’ll collect our voices directly to the Constitutional Court, and push to draw the stalled verdict. By signing you will be a great support to women’s movement in South Korea and stunning wake-up call for our policymakers and judges.

[Our demands]
-Article 269, 270 of the Criminal Code is unconstitutional. Repeal the 269, 270!”
-Provide safe abortion!
-Officially register the abortion pills!
-Guarantee sexual rights and comprehensive sexual education!
-Guarantee safe and legal abortion for everyone!
-End stigma!

Alternative Astana Statement

일차보건의료에 대한 시민사회의 대안 아스타나 성명

 

2018.10.24. People’s Health Movement

(http://phmovement.org/alternative-civil-society-astana-declaration-on-primary-health-care/?fbclid=IwAR1Oyjp9WEcPiBzLVLnH399z-2pk5YwL3KJN4N7iSCulmwUXq14OCn_xuH4)

 

 

공익을 추구하는 시민사회와 사회운동의 회원이며 일차보건의료에 대한 국제 컨퍼런스에 참여하고 있는 일원으로 우리는 모두의 건강과 안녕을 추구함으로써 건강 형평성을 달성하고자 하는 일차보건의료에 대한 우리의 헌신을 다시 확인한다. 우리는 다음과 같은 세상을 상상한다.

 

  • 사람들의 건강을 중요하게 여기고 이를 보호하며 증진하는 사회와 환경
  • 모든 곳에서 모두가 접근 가능하고 지불 가능하며 수용할 수 있는 보건의료서비스
  • 사람들의 존엄을 지키고 존중하는 양질의 보건의료서비스
  • 지역사회가 통제력을 행사할 수 있는 보건의료체계

 

아나스타 선언은 이런 목적들을 공유하지만 여기서 일차보건의료는 보편적 건강보장(Universal Health Coverage, UHC)의 주춧돌, 혹은 기반으로 도구화 되어 있다. 일차보건의료는 보다 넓은 의미를 포괄한다. 많은 나라에서 보편적 건강보장은 민간의료보험회사에 의해 시행되고 있으며 이는 건강형평성을 악화하고 있다. 아스타나 선언은 “건강 결과에서 격차와 건강 불평등이 지속된다는 사실이 윤리적, 정치적, 사회적, 경제적으로 수용 불가능하다”고 공식적으로 인식하지만 일부 지역에서 건강 수준이 오히려 나빠지고 있음을 의식하지 않는다. 선언은 만성질환의 위험 요인뿐만 아니라 “전쟁, 폭력, 유행병, 자연 재해, 기후 변화, 극단적 기후, 다른 환경적 요인”들로 인한 조기사망에 대해 인정하고 있지만 이들의 원인이 되는 근본적인 경제적 정치적 원인과 전세계적으로 확대되고 있는 불평등에 대해 명시하지 않는다. 이러한 이유로 민중건강운동을 비롯한 진보적 시민사회조직과 사회운동단체인 우리들은 아나스타 선언에 대한 대안 성명을 제안해야 할 필요가 있음을 표명한다.

세계보건기구 헌장에 명시된 바와 같이, 가능한 최고의 건강을 달성하는 것은 모든 인간의 기본 권리이다. 40년 전, 1978년 세계의 지도자들은 알마아타 선언에서 일차보건의료를 통해 모든 사람들의 건강을 위해 헌신할 것을 약속했다. 우리 서명자들은 전 세계 모든 사람들의 건강을 보호하고 증진하기 위해 모든 국제 기구와 정부, 모든 보건의료와 개발 종사자들, 그리고 세계 공동체가 긴급한 행동에 나설 필요가 있음을 밝히고, 다음과 같이 선언한다.

 

  1. 우리는 단지 질병이 부재한 상태가 아닌 완전한 신체적, 정신적, 사회적, 문화적, 생태적으로 온존한 상태를 의미하는 건강이 인간의 근본적 권리이며, 달성할 수 있는 최상의 건강 수준을 달성하는 것이 세계적으로 가장 중요한 사회적 목표 중 하나임을 강력하게 재확인한다. 각국 정부는 이 목표를 실현해야 할 책임을 지며, 이를 위해서는 건강 영역 외에도 다수의 사회적 경제적 부문의 조치가 필요하다. 사람들의 건강은 번영하는 삶과 건강하고 보호받는 자연 환경을 촉진하는 사회와 일하고 살아가는 조건에 달려있다.
  2. 국가 간, 국가 내에서뿐만 아니라 전세계적으로 존재하고, 점차 벌어지고 있는 극단적 경제적 불평등과 건강 불평등은 정치적, 사회적, 경제적, 윤리적으로 받아들일 수 없으며 이는 환경 파괴와 분쟁의 근원이기에 모든 국가에게 공통의 문제이다.
  3. 공정한 경제적, 사회적 발전을 위해서는 현재 지배적인 신자유주의 패러다임을 거부하고 국제적, 국가적으로 지속가능하고 평등한 경제 질서를 수립해야 한다. 달성가능한 모두의 건강을 성취하고 국가 간, 국가 내 건강 격차를 줄이기 위해 무엇보다도 국제적 금융 흐름과 조세피난처와 조세회피를 규제하는 것이 시급하며, 이와 더불어 젠더, 신분, 인종, 장애, 성적 지향으로 인한 불평등을 해소하기 위한 인식과 실천이 중요하다. 모든 사람의 건강과 안녕을 증진, 보호하는 것은 세계 평화와 환경 보호에 기여하는 지속가능하고 평등한 사회적 경제적 개발을 가능하게 할 것이다.
  4. 사람들은 각자의 건강을 돌보기 위한 계획과 집행에 개별적으로 그리고 집합적으로 참여할 수 있는 기회를 제공받아야 한다. 이 참여는 연령, 젠더, 민족, 사회경제적 지위를 고려해야 하며, 적절한 경우 디지털 기술을 활용해야 한다.
  5. 정부는 유엔인권선언에 명시된 다른 권리들과 함께 국민의 건강권을 실현할 책임이 있다. 앞으로 수십년 간 정부, 국제기구, 전세계 공동체는 전 세계 모든 사람들이 사회적, 경제적으로 번성하는 삶을 살 수 있도록 적정한 수준의 건강을 달성하는 것을 중요한 사회적 목표로 삼아야 한다. 유엔의 지속가능한 발전목표(Sustainable Developmental Goals, SDGs)는 국제적, 국가적으로 평등하고 지속가능한 경제 질서를 확립하는 데에 기여함으로써 이런 목표를 달성하는 데에 중요한 역할을 할 수 있다. 일차보건의료는 사회정의를 추구하는 개발의 한 부분으로 모두의 건강을 성취하기 위한 열쇠이며, 현재의 지식, 기술, 자원을 고려한다면 이는 충분히 가능하다.
  6. 일차보건의료를 실현하기 위해서는 효과적이고 책무성 있는 국제적 거버넌스가 필요하다. 여기에는 건강과 건강에 이로운 여러 서비스들의 재원 조달을 위해 모든 개인과 기업이 공평하게 세금을 납부하게 하기 위한 효과적인 과세 수단이 포함된다.
  7. 2018년 현재, 지구 상의 생명체들은 가속되는 기후변화로 인해 위협받고 있다. 따라서 일차보건의료 접근은 우리 모두가 국민 국가의 시민일 뿐만 아니라 이 행성의 시민임을 제안하는 지구 헌장(Earth Charter, 2000)을 지지해야 한다. 이는 자연환경과 지구 상의 다른 종들과 조화롭게 살아가며 이를 보호하는 것과, 인간 사회 안에서 형평과 사회 정의의 상호연관을 인식하는 것이다. 지구 헌장의 모든 핵심적 원칙들은 일차보건의료 운동과 공유된다.
  8. 일차보건의료는 과학적으로 건전하며 사회적으로 받아들일 수 있는 방법과 기술을 토대로 하는 필수 보건의료이며, 지역사회의 모든 개인과 가족들이 자기결정의 원리에 따라 이에 충분히 참여하고 보편적으로 접근가능해야 한다. 일차보건의료는 국가의 보건의료체계의 중심 기능이자 주요 초점인 동시에 전반적인 사회적 경제적 발전의 핵심적인 부분이다. 일차보건의료는 가구와 지역사회 수준에서 첫 번째 단계의 돌봄을 강조하고, 사람들이 살고 일하는 장소와 최대한 가까운 곳에서 포괄적 보건의료서비스를 지향하며, 다른 수준의 보건의료서비스 및 돌봄과 통합되어야 한다.
  9. 일차보건의료는;
    • 한 국가와 국가 내 공동체들의 경제적 조건과 사회문화적, 정치적 속성을 반영하며 관련된 사회적, 생의학적, 보건의료체계 연구와 공중보건에 대한 경험들을 적용하는 데에 기초한다.
    • 공동체의 주요 건강 문제를 다루며 이를 위한 건강증진, 예방, 치료, 재활, 완화 서비스를 제공한다
    • 최소한 다음의 내용들을 포함한다
      • 주요 건강 문제에 대한 건강 교육과 이를 예방, 통제하는 방법
      • 적절한 영양과 건강한 식품 공급 촉진
      • 기본 위생과 안전한 물의 적절한 공급
      • 모성 건강과 피임, 임신중절을 포함하는 성과 재생산 건강 서비스
      • 젠더기반폭력에 대한 보건의료서비스와 예방
      • 아동 건강 돌봄
      • 주요 감염 질환에 대한 백신접종
      • 지역 내 풍토성 질환 예방 통제
      • 정신질환을 포함한 비전염성 질환 예방 통제
      • 흔한 질병과 손상에 대한 적절한 치료
      • 장애인의 필요를 충족하기 위한 보건의료서비스
      • 필수 의약품 공급
    • 보건 부문 외에도 국가 및 지역사회 개발의 모든 관련 부문, 특히 농업, 무역, 식품, 산업, 교육, 주택, 공공 인프라, 통신과 정보 기술 등과 관련이 있으며 이런 모든 부문의 협력을 필요로 한다.
    • 일차보건의료의 계획, 조직, 운영, 관리에 대한 개인과 공동체의 최대한의 자율성과 참여를 요구, 촉진하고 지역, 국가, 및 기타 가용 자원을 최대한 활용하며 이를 위해 적절한 교육을 통해 지역사회의 참여 능력을 개발한다.
    • 통합되고 기능적이며 상호보완적인 의뢰체계를 통해 지속되어야 하며 이는 모두를 위한 포괄적 보건의료서비스의 점진적 개선을 이끌어 내고 가장 필요한 이들에게 우선순위를 두어야 한다.
    • 지역과 상위 의뢰 수준에서 의사, 간호사, 조산사, 중간의료인력, 마을건강요원 등 보건의료인력, 필요한 경우 적절하게 사회적으로 기술적으로 훈련받은 전통의료인력에 의해 실행되지며 팀으로 일하면서 지역사회의 건강 필요에 대응한다. 모든 정부는 다른 부문과 협력 하에 포괄적 국가 보건의료체계의 일부로 일차보건의료를 강화하고 지속하기 위한 국가 정책, 전략, 실행 계획을 수립해야 한다. 이를 위해서는 정치적 의지를 발휘하고 국가의 자원을 동원하며 외부 자원을 합리적으로 사용할 필요가 있다.
  10. 기술은 건강을 향상하는 데에 기여하지만 새로운 기술들이 지혜롭게 사용될 수 있도록 주의가 필요하다;
    • 새로운 바이오기술과 인공지능을 전체 인구집단의 건강과 형평에 기여할 수 있을 가능성 외에도 잠재적으로 해를 끼칠 가능성의 측면에서 검토하고 필요에 따라 규제해야 한다.
    • 특히 민간 부문에서 과도한 기술 적용에 대한 규제가 필요하다. 의료와 산업 농업 부문에서 항생제의 비합리적 남용에서 기인한 항생제 내성 위기가 대표적인 사례이다.
    • 디지털 기술을 활용함으로써 접근성과 서비스 질을 향상할 가능성이 있으나 사회경제적 불평등을 반영하는 디지털 서비스 접근의 기울기를 인식하고 이에 대응하기 위한 전략이 필요하다. 이 기울기를 줄이기 위한 특별한 조치들이 필요하다.
  11. 보편주의적인 것이 당연한 보편적의료보장은 일차보건의료의 핵심 요소이며 이는 사회 연대와 대부분의 서비스를 공공기관을 통해 공급하는 통합된 공공자금지원체계에 기반하여 구축되어야 한다.
  12. 한 국가 사람들의 건강을 보호, 성취하는 것이 모든 다른 나라에 직접적으로 영향을 미치고 혜택을 주게 되므로 원조 프로그램을 포함해 모든 개발 원조는 국가 공중보건의료체계를 강화하고 건강의 사회적, 환경적, 생태학적 요인들을 다루어야 한다.
  13. 보건의료인력 훈련을 일차보건의료 중심으로 재편하고 보건의료인력들에게 안전하고 공정한 근무 환경을 보장해야 한다. 의료인력의 분배는 대단히 불평등하며 더 많은 의료 인력이 필요한 곳에 더 적은 의료 인력이 배치되고 있다(의료 제공 반비례 법칙, Inverse care law). 자국의 보건의료인력 양성을 늘리고 인력유출국의 훈련 비용 손실을 보상하는 등 국제적, 국가적 정책을 통해 중저소득 국가에서 고소득 국가로 두뇌 유출 문제를 해결해야 한다.
  14. 효과적인 일차보건의료체계 시행으로 인한 건강 향상은 건강에 해로운 상품의 거래와 홍보(예. 초가공식품, 알코올, 담배)나 환경적으로 해로운 채굴 산업 등 건강의 상업적 결정요인에 의해 쉽게 저해될 수 있다. 효과적인 규제를 포함해 세계적, 국가적 정책을 통해 건강의 상업적 결정요인의 해로운 영향을 방지해야 한다.
  15. 세계 모든 사람들이 받아들일 수 있는 건강 수준은 세계의 자원을 더 충분히 잘 사용함으로써 성취할 수 있으며, 현재 이 자원 중 상당 부분이 군비와 군사적 충돌에 사용되고 있다. 독립, 평화, 군비 축소에 대한 진정한 정책은 보다 평화적인 목적을 추구하는 데에 추가적 자원을 투입할 수 있고 자원을 투입하도록 해야 한다. 특히 일차보건의료가 핵심적인 부분을 구성하는 사회적 경제적 개발을 가속하고 이에 필요한 적절한 몫의 자원이 할당되어야 한다.

 

우리는 광범위한 공공 시민사회조직과 사회운동을 대표하여 일차보건의료에 대한 국제 컨퍼런스가 일차보건의료를 발전시키고 시행하기 위한 긴급하고 효과적인 국가적, 국제적 실천에 나설 것을 요구한다. 이는 전 세계적인 요구인 동시에 중저소득 국가에서 특히 중요하며, 이를 위한 기술 협력과 지속가능하고 공정한 경제 질서의 확립을 지향해야 한다. 이를 위해서는 정부, 세계보건기구, 다른 국제 기구들, 다자기구와 양자기구, 비정부기구, 재정 지원 기관, 모든 보건의료인력, 전세계 공동체가 일차보건의료에 대한 국가적, 국제적 약속을 지지하고 특히 중저소득 국가에 대한 기술적 재정적 자원을 늘려나가야 한다. 우리는 이 선언의 내용과 정신에 따라 일차보건의료에 기초한 공공보건의료체계를 강화, 발전, 조달, 유지하기 위해 협력할 것을 촉구한다.

 

 

 

South Korea scores symbolic victories in negotiations over KORUS FTA(Hankyoreh)

What does US’s victory about pharmaceutical pricing system mean to Korean people and healthcare system?

Does idea of “free-trade” more important than efficient purchasing of single-payer system to assure medicine access to all?

 

“Another major victory for the US is the agreement to hold additional negotiations to revise South Korea’s pharmaceutical pricing system for innovative medicine from around the world. American pharmaceutical firms have repeatedly complained that the price of medicine is set too low by South Korea’s national health insurance.”

 

#KORUS-FTA #pharmaceutical_pricing #newdrug #medicine #Free_Trade

 

Original Article from: https://goo.gl/BsPBKU

 


 

US receives concessions on automobile import restrictions and prescription drug pricing

South Korean Trade Minister Kim Hyun-chong takes a drink of water during a briefing to discuss the results of the KORUS FTA revision agreements at the Central Government Complex in Seoul on Mar. 26. (by Baek So-ah, staff photographer)

While presenting results of the negotiations to revise the South Korea-US Free Trade Agreement (KORUS FTA) at the Central Government Complex in Seoul on Mar. 26, South Korean Trade Minister Kim Hyun-chong said that South Korean negotiators had protected the nation’s interests. “We participated in the negotiations more with the aim of defending the national interest than of protecting the KORUS FTA. We gave ground where appropriate while securing our interests [in the agreement],” Kim told reporters.

 

South Korea had found itself at a disadvantage in the negotiations because of the major divide between the two countries from the outset of the negotiations, which was compounded by American tariffs on steel. Despite these circumstances, Kim said, the negotiators managed to protect the South Korean market as best they could.

 

As Kim said, balancing the two sides’ interests was not an easy proposition in the negotiations, which were launched because of the US’s unilateral demand for and objective of “resolving the trade imbalance.” But a close look at the final tally of the negotiations also suggests that South Korea won the symbolic victories, while the US pocketed the practical benefits. South Korea received assurances about securing import quotas for steel and institutional and procedural improvements for investor-state dispute settlements (ISDS) and trade remedies. The US, on the other hand, received concessions that will have an immediate effect, such as easing import restrictions on automobiles and improving the pricing system for new drugs.

 

South Korea is the first country exporting steel to the US to secure a steel import quota (70%, or 2.68 million tons, of average yearly exports between 2015 and 2017). While accepting some of the US’s demands about American automobiles and pharmaceuticals, South Korea basically managed to arrange the first deal on steel. But a senior official from the Ministry of Trade, Industry and Energy said, “We initially wanted to secure a tariff-rate quota that would give us a steel quota and allow us to export the volume above that the quota to the American market with a tariff of 25%, but that didn’t work out.” The volume of steel exports will fall to 70% of the volume of previous years, and no more exports will be allowed after the quota has been reached. “This resolved the instability and the unpredictability faced by exporting companies,” Kim said when asked about the swift settlement of the steel issue.

 

One view is that the pros and cons of the steel import quota, which is limited to 70% of the average imports over the past three years, must be compared with the alternative scenario in which the tariffs take effect.“The South Korean steel industry preferred the quotas to the tariffs. If the countries exempted from the tariffs and the exempted categories increase in the future, President Trump is likely to raise the tariffs higher than 25% in order to achieve his import reduction goals. In that situation, we would have been forced to quickly get off the list of countries facing thethe tariffs. We can only export 70% of the previous volume, but if the price of steel in the US rises because of the imposition of tariffs, the value of South Korean steel makers’ exports might actually increase,” a spokesperson for the Ministry said.

 

The decision to relax environmental and safety standards for automobiles that the US has repeatedly described as non-tariff barriers to trade came as no surprise. South Korea agreed to increase the number of American automobiles that can be imported even if they do not satisfy South Korean safety standards (about the color of turn signals, for example) as long as they satisfy American standards from the current level of 25,000 vehicles per company to 50,000 vehicles.“While we increased the number to 50,000, the actual number of vehicles imported each year by the US’s three big automakers is below 10,000, so [50,000] has no effect on the actual import volume,” Kim said. But others argue that South Korea gave major concessions on automobiles in order to reach an agreement on steel. When calculating South Korea’s costs, it is also necessary to include the government’s and various industries’ sharp increase in imports of American products and their expansion of investment in the US, which were aimed at highlighting the FTA’s benefits.

 

20 year extension on tariffs for Korean pickup trucks

 

Furthermore, the timeframe for repealing the 25% tariff on Korean pickup trucks was extended by 20 years, from 10 years after the KORUS FTA took effect (that is, 2021) until 2041. “At the moment, basically no pickup trucks are being exported to the US,” Kim noted.But in Kim’s book Talking about the KORUS-FTA, when he played up the importance of ending the tariff on pickups. “We aren’t currently manufacturing pickup trucks, but we will be in the future. The important thing is that [the US’s] high tariff of 25% on pickup trucks must be lowered so that we can attract investment,” he wrote. In effect, the extension of the timeframe greatly reduces the likelihood of South Korean companies breaking into the growing US pickup truck market.

 

Another major victory for the US is the agreement to hold additional negotiations to revise South Korea’s pharmaceutical pricing system for innovative medicine from around the world. American pharmaceutical firms have repeatedly complained that the price of medicine is set too low by South Korea’s national health insurance.

 

Among South Korea’s gains, one of the more notable is the improvement of the system for settling investor-state disputes. The two sides agreed to include in the revised agreement a provision to prevent investors who have invested capital in the other country from filing frivolous disputes and to ensure that the two governments’ due sovereignty over policy is not infringed.

 

There will also be the addition of a section to ensure procedural transparency, such as releasing documents from local anti-dumping investigations, when either side initiates trade remedies (that is, import restrictions). This measure is designed to provide a way of dodging or blunting trade pressure from the US. But Kim said, “The results of the negotiations do not allow us to say categorically that the US trade risk has markedly decreased, and trade pressure is likely to continue for the rest of Trump’s time in office.”

 

The specifics of the revisions of the ISDS and trade remedy systems will be made public when the revised agreement is officially signed, following additional deliberations with the US.

By Cho Kye-wan, staff reporter

Widow sues National Pension Service, Suwon City over husband’s death (Hankyoreh)

#conditional_beneficiary’s_death #unrealistic_working_capacity_assessment #basic_livelihood_benefit #Korea

 

“It was the country that killed him.”

“A conditional beneficiary cannot receive part or any of livelihood benefits unless he or she fulfills certain conditions for rehabilitation, such as obtaining employment.”

“It is the first lawsuit holding the state accountable for the death of a social welfare beneficiary.”

 


Kwak Hye-sook, the widow of Choi In-ki, holds a photo of her deceased husband while speaking at the MINBYUN office in the Seocho neighborhood of Seoul on Aug. 30. (Ko Han-sol, staff reporter)

Choi In-ki had lost his government assistance despite having a serious heart condition, in real-life Korean version of “I, Daniel Blake”

Kwak Hye-sook held up a picture of her husband. Choi In-gi, who died three years ago at the age of 60, was shown lying in critical care with several different hoses attached to him. Kwak let out a deep sigh as her tears began to flow.

“I photographed everything. Is someone in this state a human? He wasn’t a human. It was the country that killed him.”

Choi In-ki was an express city bus driver. After an aortic aneurysm diagnosis in 2005, he underwent two major operations in 2008 to have the blood vessels around his heart replaced with artificial ones. An aortic aneurysm is a serious condition in which blood vessels could fatally swell and burst at any moment. Left unable to work, Choi was selected as a basic livelihood benefit recipient and received support for living and hospital expenses.

 

But in 2013, the National Pension Service (NPS), which conducts assessments on the ability to work, concluded that Choi was capable of working. That October, Bundang Seoul National University Hospital diagnosed him as corresponding to stages 3–4 in a four-stage assessment of working capabilities – but NPS re-rated him as a 1, indicating the most favorable state. The city of Suwon, where Choi lived, accepted the conclusion and declared him a “conditional beneficiary.”

A conditional beneficiary cannot receive part or any of livelihood benefits unless he or she fulfills certain conditions for rehabilitation, such as obtaining employment. In June 2014, Choi was finally forced to find work as part of the cleanup crew at an apartment complex. Three months later, he collapsed in an underground parking garage; two months after that, he passed away.

On Aug. 28, the third anniversary of Choi’s death, his widow Kwak joined the MINBYUN-Lawyers for a Democratic Society Public Interest Human Rights Legal Defense Center in filing suit against NPS and the city of Suwon.

Kwak Hye-sook (second from right) holds a press conference with MINBYUN representatives at a press conference in the group’s office on Aug. 30 to discuss her husband’s death. The case has drawn parallels to the film, “I, Daniel Blake.” (Ko Han-sol, staff reporter)

During an Aug. 30 press conference at MINBYUN’s office in Seoul’s Seocho neighborhood, the group referred to Choi’s death as “the result of unrealistic working capability assessments.” MINBYUN said it was the first lawsuit holding the state accountable for the death of a social welfare beneficiary.

Kwak and the group described Choi’s death as a Korean version of I, Daniel Blake, a film by director Ken Loach about a man who is forced to find work to meet conditions for benefit payment like Choi. In the film, the character dies while his case is being reheard by a public institution.

 

By Ko Han-sol, staff reporter

Original article from: http://english.hani.co.kr/arti/english_edition/e_national/809123.html

“Miracle Cancer Drug” Gleevec Sales Threatened Following Novartis Rebate Scandal (the Korea Bizwire)

Health Right Network Korea, asserted that MoH immediately suspend reimbursement of the drug, condemning Novartis’ continued illegal kickback to the doctors. Patent on Gleevec expired on 2013, and various generic form are available with much lower price. We, in solidarity with Health Right Network Korea, believe that strict and fir punitive measure for pharmaceutical company’s illegality is necessary, to secure people’s health right in Korea.

(Look at the Statement on http://bit.ly/2p7lZa6)

#Gleevec #Novartis #Rebate_Scandal #reimbursement_suspension #Health_Right_Network


Imposing the measure would discourage the prescription and use of Novartis drugs, and greatly reduce the company’s sales in South Korea. (image: Wikimedia)

Imposing the measure would discourage the prescription and use of Novartis drugs, and greatly reduce the company’s sales in South Korea. (image: Wikimedia)

SEOUL, April 10 (Korea Bizwire) – South Korea’s health authorities are considering a suspension of health insurance reimbursement for imatinib, a highly effective leukemia drug sold under the brand name of Gleevec (or Glivec), after its maker Novartis was found to have provided illegal kickbacks to doctors.

The Swiss multinational pharmaceutical company was investigated by prosecutors in February of last year for allegedly providing unlawful rebates to local doctors amounting to 2.59 billion won ($2.62 million). In August, six incumbent and former executives of the company were indicted.

South Korea operates on a two-strike policy for companies providing illicit rebates as a punitive measure. Under the terms of the policy, offending drug companies have insurance reimbursements suspended for their products for a year for first-time violation, and indefinitely if another violation occurs within five years.

Imposing the measure would discourage the prescription and use of Novartis drugs, and greatly reduce the company’s sales in South Korea. But at the same time, it could add a bigger burden to patients willing to continue with the medication, as it would have a high price tag, leaving health authorities in a dilemma.

(image: Novartis)

(image: Novartis)

In fact, representatives from the Korean Leukemia Association petitioned the Ministry of Health and Welfare recently, requesting that it impose a fine on the pharmaceutical company instead of a reimbursement suspension, reported Yonhap News Agency Sunday.

“If the allowances are suspended, patients (using Gleevec) will have to spend an additional 2 million won ($1,749) each month on their medication,” said Ahn Ghi Jong, the head of the KLA. “It is unfair for thousands of patients to suffer from the wrongdoings of Novartis.”

However, those with an opposing view demand that government should stick to its punitive measure, especially since there are other substitute drugs and generic imatinibs for leukemia.

“There are some 30 biosimilar imatinib generics in the market in addition to other new drugs for leukemia treatment. Making exceptions would leave the laws vulnerable to future debate,” said an industry official on condition of anonymity.

Health authorities are leaning towards the latter argument, but they’re still deliberating and gathering more feedback from outside experts. An official from the health ministry said, “The ground rule is to suspend reimbursement, but we are considering whether doing so would have a significant impact on patients.”

By Kevin Lee (kevinlee@koreabizwire.com)

 

Original article from: http://koreabizwire.com/miracle-cancer-drug-gleevec-sales-threatened-following-novartis-rebate-scandal/80054

South Korea shows improved welfare, declining happiness [hankyoreh]

Country with unhappy, insecure people unsatisfied with their quality of life and social security?
Survey finds South Korean youth among the unhappiest in the world
+ A quarter of elderly people suffer from shame at being in care facilities
+ Survey finds that to be happy, South Koreans need to have work

#welfare_need_unsatisfied #declining_happiness #OECD #South_Korea

 

Change of welfare levels in South Korea. Data: OECD

OECD data put South Korea at or near the bottom in rankings measuring suicide and fertility rates

South Korea’s overall level of welfare improved slightly over the past five years – which included Park Geun-hye’s four years as president – but perceived happiness among South Koreans fell sharply, a research study shows.

The findings of a comparative study of welfare levels in OECD member countries published on Apr. 5 by the Korea Institute for Health and Social Affairs (KIHASA) showed South Korea‘s overall ranking rising two spots from 23 out of 34 countries in 2011 to 21 last year. But in the category of the population’s happiness, it slid from 30 to 33.

For its comparison of welfare levels in OECD countries, KIHASA devised indicators for the five areas of economic vitality, welfare demand, financial sustainability, meeting welfare needs, and people’s happiness. Between 2011 and 2016, South Korea’s scores rose from 0.750 to 0.834 for economic vitality, 0.781 to 0.786 for welfare demand, and 0.775 to 0.879 for financial sustainability. The score for meeting welfare needs remained constant at 0.407. The only one of the five indicators to fall was people‘s happiness, which tumbled from 0.348 to 0.133.

The people’s happiness level is a reflection of factors such as satisfaction with quality of life, transparency of the state, the suicide rate, the total fertility rate, leisure time, and anticipated lifespan from birth. It may be described as showing correspondence between the public’s basic desires and the government response to them.

Among the components of the people’s happiness level, South Korea’s quality of life satisfaction score was 5.8, tying it with Italy in 27. The state transparency level was 26, tying with the Czech Republic at 27. South Korea’s suicide rate of 28.7 per 100,000 people was the highest, while the total fertility rate of 1.21 ranked the lowest. South Korea‘s average of 14.7 hours of leisure time per day ranked it 25, while the anticipated lifespan from birth was 82.2 years, tying for 10 with Israel and Norway.

“While South Korea’s welfare level has risen in terms of its overall ranking, it is failing to keep up with the top-ranking countries in scores that take relative position into account,” KIHASA said. “In particular, there was a serious decline in the people’s happiness rating, which may be seen as a more suitable assessment indicator when defining welfare level through discussions.”

“Future welfare policy will need to focus on improving the individual indicators in the people’s happiness index to increase the public‘s perceptions that they are being served by welfare,” the institute said.

The top five countries examined in terms of overall ranking were all northern European countries: Norway, Denmark, Luxembourg, the Netherlands, and Iceland. The bottom-ranking group ranking 30 to 34 included Estonia, Chile, Turkey, Greece, and Mexico.By

 

Park Ki-yong, staff reporter

Original Article from : http://english.hani.co.kr/arti/english_edition/e_national/789612.html

Experts say measures to prevent smoking can also boost the economy(hankyoreh)

#cigarette_regulation #health_inequality #tabacco_tax_for_healthier_society

“…policies designed to regulate tobacco would help redress the health inequality among low income earners.”

“while various South Korean anti-tobacco policies were having an effect, the most effective of these was increasing the price of tobacco.”

Posted on : Mar.28,2017 17:19 KSTModified on : Mar.28,2017 17:19 KST

At the end of last year, cigarette packs sold in South Korea started to feature imaging warning of the dangers of smoking

Symposium participants argue that increased regulation of tobacco benefits public health of smokers and non-smokers

Experts from South Korea and other countries argue that government intervention is needed in the tobacco industry because there is insufficient information about the risks of smoking and because secondhand smoke is harmful.

An international symposium designed to assess smoking prevention policies and to seek directions for development is scheduled to take place at the InterContinental Seoul COEX in Seoul on Mar. 28. Domestic and foreign experts in the areas of tobacco and smoking prevention held a press conference at the same location on Mar. 27 at which they argued that the government needs to regulate tobacco and that such regulation would promote economic development.

“There is inadequate information, since people don’t know much about the risks of smoking, and tobacco consumption has externalities that harm the health not only of smokers but also of others through secondhand smoke. Since this leads to a market failure and cannot be left to the discretion of the market, from an economic standpoint, government intervention is appropriate,” argued Frank Chaloupka, a professor of economics and health policy at the University of Illinois who was the first speaker at the press conference.

“Regulation of tobacco does not have a negative effect on the economy, but it in fact has a positive effect by reducing medical costs, improving productivity and promoting economic development,” Chaloupka added. He also argued that policies designed to regulate tobacco would help redress the health inequality among low income earners.

“Poor and vulnerable members of the population smoke more cigarettes, which worsens the health gap and health inequality. Regulation of tobacco also helps mitigate this,” Chaloupka said. His proposals for South Korea were to keep strengthening tobacco regulations by increasing the price of tobacco and to invest more of the proceeds of the tobacco tax into the areas of preventing smoking and promoting health.

One of the South Korean experts present was Cho Seong-il, chair of the Korean Society for Research on Nicotine and Tobacco, who argued that while various South Korean anti-tobacco policies were having an effect, the most effective of these was increasing the price of tobacco.

“The biggest effect between 2015 and 2016 came from raising tobacco prices, and this accounted for 89% of the whole,” Cho said, referring to the policy’s effect on reducing the smoking rate. “As time goes by, the influence of raising tobacco prices will be seen in other policies.”

During the symposium on Mar. 28, Katia Campos, a technical officer at the World Health Organization’s Regional Office for the Western Pacific Region, will use a presentation to highlight the six globally proven methods for regulating tobacco: monitoring the use of tobacco, protecting nonsmokers from tobacco smoke, giving smokers assistance, offering warnings about the risk of smoking, banning tobacco advertising and raising taxes on tobacco.

By Kim Yang-joong, medical correspondent

Article from http://english.hani.co.kr/arti/english_edition/e_national/788348.html

Cigarette sales drop for 3 straight months (Korea herald)

#tobacco_control_policy #pictorial_health_warnings 
Sales of cigarettes in South Korea fell for three straight months in February, following the government’s push to imprint health warning graphics on packages, government data showed Monday.

Some 240 million packs of cigarettes were sold last month, down 14 percent from a year earlier, according to the data compiled by the Ministry of Strategy and Finance.

The monthly sales have been on a decline since November last year, when 290 million packs were sold.

The ministry attributed the sales drop to a government-led anti-smoking campaign.

 

Article from : http://www.koreaherald.com/view.php?ud=20170313001028