Living in Gangnam Makes Managing Diabetes and Hypertension More Difficult?

From October, Increased Out-of-Pocket Costs for Mild Illness Treatment at Large Hospitals
Encouraging Primary Care Visits for Mild and Chronic Diseases within Local Areas
Gangnam Has Many Medical Institutions but Limited Access to Comprehensive Care

Photo by Asia Economy DB

[Asia Economy Reporter Choi Dae-yeol] Since the concept of treatment rights, which restricted patients to receive medical care only in the region specified on their 'health insurance card,' was abolished in 1998, patients have been able to visit any hospital easily. Although the threshold for medical institutions has lowered, the phenomenon of concentration in tertiary general hospitals, so-called large hospitals, has continued for over a decade. There is also criticism that the concentration of large hospitals in the Seoul metropolitan area has widened the medical gap between regions.

Having many large hospitals in one's residential area is not always beneficial. The larger the hospital, the higher the medical fees, which increases the patient's out-of-pocket expenses. For mild illnesses like the common cold or chronic diseases such as diabetes and hypertension, it is better to visit local clinics near home, i.e., neighborhood hospitals, which have lower costs and are more accessible.

The health authorities' efforts to reform the medical delivery system largely aim to encourage patients to use appropriate medical institutions based on the characteristics of the patient and the severity of the disease. However, these measures contradict the trend of strengthening health insurance coverage. Strengthening coverage means increasing the burden of health insurance on medical expenses to reduce the hospital cost burden on individuals or households. This could incentivize patients with mild illnesses to visit tertiary general hospitals.

Considering these factors comprehensively, an improvement plan that lowers the fees for mild diseases at tertiary general hospitals while increasing the patient's co-payment rate will be applied from October. This measure is designed so that large hospitals treat severe or rare diseases, while smaller hospitals focus on mild and chronic diseases. As a result, if a patient with a mild illness receives treatment at a tertiary general hospital, they will not receive any health insurance coverage and must bear the full cost of treatment themselves.

Gangnam-gu, Seoul: Among the Top Nationwide in Medical Institutions, Beds, and Clinics, but Functional Primary Care Clinics Account for Only Half of Seoul and One-Third Nationwide

Gangnam-gu in Seoul, considered a wealthy district nationwide, had 2,559 medical institutions as of 2017 (Statistics Korea), ranking first among all basic local governments in Seoul and nationwide. The second highest is Seongnam-si, Gyeonggi Province, with 1,561 institutions. Gangnam-gu also ranks third nationwide in the number of hospital beds, with 8,368 as of 2018. While there are many large hospitals, there are also many small-scale medical institutions and clinics. The number of clinic-level medical institutions is 1,543, more than twice that of Seongnam-si (729), which ranks second.

This means hospitals are abundant. However, when classified by the function of medical institutions, i.e., the type of treatment provided, very different indicators emerge. Professor Park Sang-min's team at Seoul National University College of Medicine classified clinics by function and found that only about 11% of clinics in Gangnam-gu are 'functional primary care clinics.' This is significantly lower compared to the Seoul average of 21% and the national average of about 31%. In Gangnam-gu, specialist clinics account for about 70%, making up the majority.

This classification was made by Professor Park's team using actual claims data submitted to the National Health Insurance Service in 2017. Functional primary care institutions are defined as medical institutions that claim all 10 essential high-frequency community care areas. If a specific area accounts for more than 60% of claims, the institution is classified as a specialist clinic; if it falls between functional primary care and specialist clinics, it is classified as a borderline clinic.

Professor Park explained, "The low number of functional primary care clinics in Gangnam is interpreted as large hospitals within the area playing the role of primary care institutions, and relatively profitable non-reimbursed medical institutions clustering due to high rental costs."

Samsung Seoul Hospital, Gangnam-gu, Seoul. Photo by Mun Honam munonam@

Diabetes Patients’ Burden at Functional Primary Care Institutions Less Than Half That at Large Hospitals
Consistent Visits to Hospitals Lower Risk of Cardiovascular and Coronary Artery Diseases

Primary care institutions are the first point of contact for patients when health problems arise, maintaining continuous relationships and providing medical services. They also guide patients to larger hospitals when necessary. Comprehensive evaluation and management of various health issues are core attributes of primary care. Especially for chronic diseases like diabetes and hypertension, continuous management is crucial, making functional primary care institutions with high patient accessibility play a significant role.

According to an analysis of 205,867 newly diagnosed diabetes patients in 2011, those whose regular doctor was at a functional primary care institution were able to visit more consistently and had lower medical costs. The average out-of-pocket medical cost related to diabetes was about 40,000 KRW, which is half and one-third of the costs at general hospitals (81,000 KRW) and tertiary general hospitals (123,000 KRW), respectively.

Furthermore, a six-year follow-up of these diabetes patients showed that those who frequently visited functional primary care institutions had a lower probability of developing cardiovascular or coronary artery diseases compared to those visiting specialist clinics or general hospitals. Similar trends were observed in patients with hyperlipidemia, where increased continuity of medical use improved medication adherence.

As the number of patients with complex chronic diseases is expected to increase due to aging, Professor Park emphasized the need for institutional support to enable comprehensive and continuous care within the community through a functional primary care system. He stated, "Chronic disease patients living in Gangnam do not necessarily have to bear high medical costs. There is a need for institutional support to establish a care cooperation system that allows referrals or returns between specialist clinics and functional primary care institutions within the region."

This content was produced with the assistance of AI translation services.