In Korea, which had even been called a "country that could disappear first in the world" due to 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 the same period last year. But delivery rooms to receive babies are in short supply. Pregnant women are facing a reservation crush, 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 District, Seoul. In the hallway in front of the entrance, stand-up signs advertised a variety of procedures, including early diagnosis of breast cancer, "vaginal implant" inserting 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. But pregnant women were not noticeable. When asked whether delivery care was available, a hospital staffer said, "We only offer gynecology care; for delivery-related care, you need to go to a delivery hospital."
As the number of births increases, demand for deliveries appears to be reviving, but in the field of obstetrics and gynecology, the trend of scaling back or dropping obstetric care continues. Deliveries require maintaining 24-hour staffing and facilities, yet profitability is low, and if an incident occurs, medical staff face a high risk of getting entangled in lawsuits.
◇ Obstetrics and gynecology ramping up lucrative noncovered services
According to the Health Insurance Review & Assessment Service (HIRA) on the 24th, Gangnam District in Seoul has 54 obstetrics and gynecology clinics, the most among basic local governments nationwide. But only four of them can handle deliveries. By contrast, there were 10 or more clinics each offering noncovered services such as vaginal plastic surgery and laser procedures. Some operate mainly on gynecology care or cosmetic procedures without an obstetrician.
This is not unique to Gangnam. According to data that People Power Party lawmaker Kim Mi-ae received from the Health Insurance Review & Assessment Service (HIRA), about 89% of obstetrics and gynecology clinics nationwide filed 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 clinic-level deliveries was 35,422, down about 60% from 89,923 in 2019. While the decline in births played a role, it is seen as a result of a rapid decrease in the number of clinic-level medical institutions handling deliveries.
The medical community says deliveries are structurally unprofitable. Because no one can know when a pregnant woman will go into labor, delivery rooms and on-call staff must be maintained 24 hours a day, and equipment and personnel are also needed in case of emergency cesarean sections or neonatal care.
By contrast, noncovered care can be run by appointment, with relatively less staffing burden and legal risk. A representative noncovered item, abortion in early pregnancy, costs from several hundred thousand won to around 1 million won. Even if a simple comparison with the cost of a vaginal delivery makes them look similar, deliveries have large fixed costs for operating a nursery and maintaining on-call systems, creating a substantial profitability gap, according to the medical community.
◇ High-risk deliveries are rising, along with lawsuit burdens
The burden in delivery settings goes beyond profitability. With more older pregnant women and more infertility procedures, high-risk pregnancies have increased, making care more complex and raising the likelihood that incidents lead to lawsuits. Delivery-related applications for medical dispute mediation rose from 23 in 2022 to 35 in 2024. Considering cases that went straight to lawsuits without going through mediation, the legal burden felt by medical staff is even greater.
A 40-something obstetrics specialist at a general hospital in Gangdong District, Seoul, surnamed Lee, said, "With more pregnant women age 35 and older and more multiple births conceived through infertility procedures, the difficulty of obstetric care has increased greatly," and "when a medical accident occurs, there is a tendency to first sue the obstetrician, driving medical staff away from the field."
High-risk pregnant women are flocking to tertiary hospitals. Asan Medical Center said that of 6,999 deliveries over the past three years, 4,163 involved high-risk pregnancies or fetal anomalies, accounting for 59.5%. Asan Medical Center has the most deliveries among Seoul's "big five" tertiary hospitals.
While high-risk deliveries are concentrating in large hospitals, staffing to handle them has not increased sufficiently. In the first half of this year's resident recruitment, the fill rate for obstetrics and gynecology was only 69.4%. The fill rate for pediatrics, which must care for preterm infants born from high-risk deliveries, was just 21.7%. Low profitability, heavy responsibility, and shrinking staffing are feeding a vicious cycle.
An official at a university hospital in Seoul said, "Unless it's additional procedures after delivery or a program linked to postpartum care, it's realistically a money-losing field," and "if, on top of that, we are told to bear the risk of lawsuits, it is only natural that people avoid it."
◇ Government: "We will adjust fees"… medical community: "Compensation must be larger"
The government has decided to revise the health insurance fee system to prevent gaps in essential care. The core is to adjust fees for specimen tests such as CT, MRI, and blood tests and reinvest more than 2 trillion won a year into essential fields such as emergency, 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 amend the Medical Dispute Mediation Act to ease criminal liability for high-risk essential medical acts when there is no gross negligence," and "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 the level of legal protection should be higher. Park Jin-sik, vice chair of the Korea Small and Medium Hospital Association, said at a recent public hearing, "We need to increase overall health insurance spending itself, not just shave some testing fees and shift a portion."