In Korea, which had even been labeled as "the first country in the world that could disappear" due to the low birthrate, the sound of babies crying is growing louder again. In the first quarter (January–March) of this year, the number of births was 75,013, up 14.8% from a year earlier. But delivery rooms to receive those babies are in short supply. Mothers are facing a reservation scramble, and hospitals are struggling with staff shortages. We examined the problems in Korea's delivery infrastructure. [Editor's note]
At 12 p.m. on the 22nd, at an obstetrics and gynecology clinic in Gangnam-gu, Seoul. In the hallway by the entrance, stand signs promoted various procedures, including early breast cancer screening, a "vaginal implant" that inserts an implant inside the vagina, a "hair removal and whitening package," and "body lifting."
Even though it was a weekday lunchtime, the waiting seats were crowded. Pregnant women, however, were not noticeable. When asked whether deliveries were available, a hospital official said, "We only provide gynecological care; for delivery-related care, you need to go to a delivery hospital."
While demand for deliveries appears to be reviving as the number of births increases, the field of obstetrics and gynecology is continuing a trend of reducing or shutting down obstetric care. Deliveries require maintaining round-the-clock staff and facilities, are less profitable, and carry a high risk that medical staff will be drawn into lawsuits if an accident occurs.
◇Ob-gyn clinics shift to profitable noncovered services
According to the Health Insurance Review & Assessment Service on the 24th, Gangnam-gu, Seoul, has 54 obstetrics and gynecology clinics, the most among basic local governments nationwide. But only four of them can handle deliveries. In contrast, more than 10 clinics each offered noncovered services such as vaginal cosmetic surgery and laser procedures. Some operate mainly on gynecological care or cosmetic procedures without obstetric specialists.
This is not unique to Gangnam. According to data submitted by People Power Party lawmaker Kim Mi-ae from the Health Insurance Review & Assessment Service, about 89% of obstetrics and gynecology clinics nationwide had no delivery-related health insurance claims from January to August last year. In nearly nine out of 10 ob-gyn clinics, no deliveries took place.
During the same period, the number of deliveries performed at clinic-level institutions was 35,422, down about 60% from 89,923 in 2019. While the decline in births played a role, the drop also reflects a rapid decrease in the number of clinic-level medical institutions that handle deliveries.
The medical community says deliveries are structurally unprofitable. Because it is impossible to know when a mother will go into labor, delivery rooms and on-call staff must be maintained 24 hours a day, and equipment and personnel are needed to prepare for emergency C-sections or neonatal care.
By contrast, noncovered services can be run by appointment, with relatively lighter staffing needs and legal risks. A representative noncovered item, abortion in early pregnancy, costs from several hundred thousand won to around 1 million won. Even if the price looks similar to that of a natural delivery at first glance, deliveries have high fixed costs—such as running a neonatal unit and maintaining on-call systems—resulting in a substantial gap in actual profitability, according to the medical community.
◇High-risk deliveries are rising, and so is the litigation burden
The burden on delivery rooms is not limited to profitability. As the number of older mothers and infertility procedures increases, high-risk pregnancies are on the rise, making care more complex and raising the likelihood that accidents lead to lawsuits. Filings for delivery-related medical dispute mediation rose from 23 in 2022 to 35 in 2024. Considering cases that went straight to court without mediation, the legal burden felt by medical staff is even greater.
Lee, an obstetrician at a general hospital in Gangdong-gu, Seoul, in their 40s, said, "With more mothers aged 35 and older and more multiple births from infertility procedures, the difficulty of obstetric care has risen sharply," adding, "When a medical accident occurs, the tendency is to file a lawsuit against the obstetrician first, so medical staff are leaving the field."
High-risk mothers are flocking to tertiary general hospitals. Asan Medical Center said that of 6,999 deliveries over the past three years, 4,163 cases, or 59.5%, involved high-risk pregnancies or fetal abnormalities. Asan Medical Center handles the most deliveries among the "big five" tertiary general hospitals in Seoul.
While high-risk deliveries concentrate at large hospitals, staffing has not increased enough to handle them. In the resident selection for the first half of this year, the fill rate for obstetrics and gynecology was 69.4%. The fill rate for pediatrics, which must care for preterm infants born from high-risk deliveries, was just 21.7%. Low profitability, high responsibility, and shrinking staffing are reinforcing a vicious cycle.
An official at a university hospital in Seoul said, "Unless it leads to additional procedures after delivery or to a postpartum care linkage business, it's a field that realistically doesn't make money," adding, "If, on top of that, we are told to accept the risk of lawsuits, of course people will avoid it."
◇Government says it will adjust fees; medical community says compensation must be larger
The government plans to overhaul the national health insurance fee schedule to prevent gaps in essential care. The core plan is to adjust fees for tests such as CT, MRI, and blood tests and reinvest more than 2 trillion won a year into essential areas, including emergency care, pediatrics, and deliveries.
It will also push measures to protect medical staff. Minister Jung Eun-kyeong of the Ministry of Health and Welfare said, "We will revise the Medical Dispute Mediation Act to ease criminal liability when there is no gross negligence for high-risk essential medical procedures," adding, "We will provide coverage of up to 1.7 billion won for medical accidents to reduce the compensation burden on medical staff."
The medical community agrees with the direction but says the scale of compensation and level of legal protection must be higher. Park Jin-sik, vice president of the Korea Small and Medium Hospital Association, said at a recent public hearing, "We need to increase total national health insurance spending itself, beyond simply cutting test fees and reallocating some of the funds."