Hospital hopping and fund shuffling: South Korea's rural healthcare crisis

Hospitals in medically underserved rural areas of South Korea are struggling to provide essential services, forcing patients to endure lengthy journeys for care and leading to the closure of emergency rooms. One hospital in a rural county, which is the only facility offering internal medicine, surgery, obstetrics, and pediatrics, had to close its emergency room due to a lack of doctors. It reopened only after offering a multi-million dollar annual salary to a specialist, yet still operates with reduced hours at night.

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The emergency room is closed because there is no doctor, and then reopened after recruiting a specialist for hundreds of millions of won a year. However, it operates partially at night.

To cut costs, the hospital sometimes skips blood tests, with doctors prescribing medication without proper diagnostics. This situation is common across regional hospitals. The high cost of running an emergency room, often requiring at least two to three doctors, makes them unattractive. One regional public hospital's emergency room alone incurs $700,000 to $800,000 annually in physician salaries. This financial strain forces many regional hospitals to avoid operating emergency services, leaving patients to travel for hours in search of care, a phenomenon known as "hospital hopping" or "뺑뺑이" (ppyaengppyaeng-i).

President Lee Jae-myung recently chaired a meeting on regional, essential, and public healthcare, promising to ensure equitable medical treatment for all citizens regardless of their location. The Ministry of Health and Welfare announced the creation of a new large organization, "Regional Essential Public Healthcare," to coordinate policies aimed at closing the healthcare gap, expanding national responsibility for essential medical services, and strengthening public healthcare. This initiative, represented by the acronym "Ji-Pil-Gong" (Regional-Essential-Public), aims to tackle the collapse of regional and essential medical services, which is closely linked to the weakening of public healthcare as private medical services gravitate towards more profitable areas, mirroring the concentration of doctors and hospitals in the Seoul metropolitan area.

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Regional hospitals are reluctant to operate emergency rooms, and patients in the region wander for hours searching for an emergency room.

While the Lee administration inherits the "essential medical services" focus from the previous Yoon Suk-yeol government, it intends to strengthen national responsibility. The "Regional Essential Medical Services Act," set to take effect in March, is a compromise combining different layers of healthcare issues. However, the plan's initial steps are shaky, as national responsibility ultimately depends on budget allocation. The act earmarks a special account funded by 55% of tobacco excise taxes, totaling 1.2 trillion won for the upcoming year. The concern is that this 1.2 trillion won might be achieved through "shuffling funds" – relabeling existing Ministry of Health and Welfare budget items rather than securing new funding. This approach could jeopardize the plan's goals of prioritizing support for areas farther from the capital and public hospitals.

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We promise to guarantee that everyone can receive proper medical treatment, regardless of where they live.

For regions lacking doctors and hospitals, simply increasing health insurance fees offers little help. The article argues that supporting medical personnel and building state-funded hospitals should come first. Both President Lee and Minister of Health and Welfare Chung Eun-kyung understand the importance of public hospitals, with Lee having been motivated to enter politics by the establishment of Seongnam Citizens' Hospital and Chung having successfully managed the COVID-19 pandemic as head of the Korea Disease Control and Prevention Agency, partly due to public hospitals and medical staff. If "life is more important than money," then sufficient funds must be allocated to protect lives.

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The problem is that they are trying to 'shuffle funds.'