The government is launching health care reforms to reorganize the national medical system into three tiers of service areas by severity. The plan is to build a "regional, self-sufficient medical system" that allows most treatment to be completed locally by changing the structure in which patients flock to large hospitals in the Seoul metropolitan area and essential local care collapses.
The Ministry of Health and Welfare on the 22nd announced a "strategy to strengthen regional, essential and public health care" reflecting these plans. It is the first comprehensive strategy since the launch of the Regional Essential Public Health Care Office, the unit in charge of regional, essential and public care.
According to the ministry, last year the number of doctors per 1,000 people was 3.69 in Seoul, compared with 1.43 in North Gyeongsang and 1.56 in South Chungcheong. In 2024, avoidable deaths per 100,000 people were 39.7 in Seoul, but 51.6 in North Chungcheong and 50.2 in North Gyeongsang, showing clear regional disparities in health care.
The shortage of essential medical personnel is also severe. This year, the resident fill rate was 21.7% in pediatrics and 69.2% in obstetrics and gynecology, while it was 98.2% in dermatology and 100% in ophthalmology. Of 35 local medical centers, 30 are in the red, and public hospital bed share is 9.4%, far below the Organization for Economic Cooperation and Development (OECD) average of 71.5%.
However, the government said it is not considering offering financial incentives to patients to prevent the concentration of patients in the Seoul metropolitan area. Son Young-rae, head of the Regional Essential Public Health Care Office, said, "Survey results show that if regional medical institutions have sufficient capacity and trust, 70% to 80% of residents would seek care locally," and noted, "We will first focus policy capacity on boosting the competitiveness of regional medical institutions."
◇Nurture national university hospitals to the level of the "big five"… overhaul the national medical system into three tiers
The core of the strategy is to reorganize the national medical system into large, medium and small service areas. High-acuity, complex diseases will be handled in large service areas; moderate-severity conditions requiring hospitalization and surgery in medium service areas; and minor illnesses and preventive care in small service areas. Service areas will be readjusted every five years after analyzing medical demand and supply.
Large service areas (five mega-regions and three special self-governing provinces) will focus on raising regional national university hospitals to the level of the Seoul metropolitan area's "big five." The number of full-time faculty will be increased by at least 30%, and resident slots will be expanded by at least 20%. The government will channel the new 120 billion won regional essential health care special accounts to be created next year and establish a separate National Health Insurance assessment and compensation system.
Medium service areas (70 locations) will handle moderate-severity hospitalizations and surgeries. Local medical centers and regional public anchor hospitals such as Red Cross hospitals will be developed to the level of comprehensive secondary hospitals, and for medically underserved medium service areas without public hospitals, expansion plans will be drawn up in consultation with local governments. The number of comprehensive secondary hospitals will also be increased from 175 to 195.
Small service areas will be responsible for primary care at the city, county and district level. To fill rural and fishing village care gaps, the government will introduce integrated health subcenters and public primary care clinics, and allow medication delivery after telemedicine in islands and remote areas. A "Korean-style primary care physician model," in which doctors, nurses and physical therapists jointly manage patients, will also be introduced.
◇Focused support for emergency, childbirth and pediatrics… revamp compensation for public hospitals
Support for essential care such as emergency, trauma, childbirth and pediatrics will also be expanded.
Regional emergency medical centers will be reorganized into severe emergency medical centers, increasing from 44 this year to 53, and to around 60 by 2030. The number of doctor helicopters will be expanded from eight to 12, and the number of severe maternal and child medical centers will grow from the current two to six. The government plans to strengthen support to prevent operating losses at maternal and child centers and introduce performance-based rewards reflecting patient intake results.
In population-declining areas, a pediatric primary care physician program will be piloted, and in regions without outpatient obstetrics and gynecology, outreach clinics and a maternal registration system will be introduced to build a management system from prenatal to postpartum care.
The public health care foundation will also be strengthened. The National Medical Center (NMC) will be relocated and newly built with more than 1,000 beds, and through the national graduate school of medicine scheduled to open in 2030, 100 public health care workers will be trained annually. Starting in 2027, the regional doctor system will select 2,942 people over five years to enforce mandatory regional service.
To fix the chronic deficit structure of public hospitals, the government also plans to pilot a new payment system from next year that compensates at the institution level instead of the current fee-for-service model.
◇Ease the burden of medical accidents… inject an additional 3.6 trillion won a year into essential care
The criminal burden of medical accidents, cited as a deterrent to essential care, will also be eased. For high-risk essential care accidents that are not due to gross negligence, sentence reductions and limits on indictment will be allowed, and a medical accident review committee will be established. Conversely, when serious medical accidents such as deaths occur, patient protections will be strengthened by introducing a new duty for medical staff to explain and by raising the state compensation cap to up to 300 million won.
The National Health Insurance compensation system will also be revamped. To strengthen compensation for essential care such as severe and emergency cases, pediatrics and childbirth, the government will inject an additional 3.6 trillion won annually and create "regional fees" that add up to 100% for surgeries and high-risk childbirths outside the Seoul metropolitan area.
In addition, in the short term, the plan is to ease workforce regulations for regional medical institutions, such as part-time work and dispatching medical personnel, and expand support for retired doctors to work in the regions to alleviate local staffing shortages.