'Expansion of Dalbit Children's Hospital' Government Operation Guidelines Revised... Medical Community Questions "Effectiveness"

Photo of Dalbit Children's Hospital.

As part of the essential pediatric and adolescent medical support measures, the government has announced plans to expand 'Dalbit Children’s Hospitals,' which provide pediatric outpatient care during nights and holidays. It has been confirmed that the related operational guidelines have also been revised. The revisions allow for the additional designation of Dalbit Children’s Hospitals based on population size and include some relaxation of operational standards. However, the medical community has raised doubts about the actual operation of Dalbit Children’s Hospitals, criticizing the measures as ineffective.

According to the Ministry of Health and Welfare’s '2023 Operational Guidelines for Pediatric Night and Holiday Medical Institutions (Dalbit Children’s Hospitals)' released on the 7th, the guidelines have been changed to expand participating institutions. First, the designation and review of Dalbit Children’s Hospitals, which were previously conducted by metropolitan local governments (cities and provinces), will now be reviewed by basic local governments (cities, counties, and districts) and then designated by the metropolitan governments. This change is expected to enable each basic local government to promptly review and designate Dalbit Children’s Hospitals according to local circumstances.

The designation intervals have also been adjusted. Under the previous guidelines, one institution per city, county, or district was designated, with up to two institutions allowed if the population exceeded 300,000. Now, if the population aged 18 or younger in a city, county, or district exceeds 50,000, one additional institution can be designated, and one more institution can be added for every additional 50,000 people. Moreover, regardless of these principles, each city or province can conduct additional designations within the region through a review committee considering the population aged 18 or younger and the distribution of medical institutions. This effectively opens the door for local governments to expand Dalbit Children’s Hospital designations whenever necessary.

The criteria for medical staff required for operation have been somewhat relaxed while strengthening management and supervision. The requirement for at least three attending physicians at a single hospital or clinic has been lowered to two, and operation seven days a week is now specified. Even in a joint operation model where adjacent hospitals or clinics take turns providing night and holiday care, each individual hospital or clinic must operate at least two days a week. Additional points are awarded when participating institutions have agreements with nearby general hospitals for pediatric patient care, and there is a provision for unannounced inspections by city, county, or district authorities once a year, with reports submitted to the Ministry of Health and Welfare. The government expects that expanding Dalbit Children’s Hospitals will strengthen the medical care foundation for pediatric patients.

However, criticism about the effectiveness of these measures has emerged from the medical community. This is because most pediatric emergency treatments for high fever patients are handled not by Dalbit Children’s Hospitals but by most children’s hospitals and primary care institutions nationwide. According to the Korean Association of Children’s Hospitals, among the 37 Dalbit Children’s Hospitals nationwide, only 5 (13.5%) provide night care on public holidays, 9 (24.3%) provide night care on Saturdays, and 7 (18.9%) provide night care on Sundays. The association criticized the system as "Dalbit Children’s Hospitals in name only" and questioned whether there has ever been a single project evaluation since the system was introduced in 2014.

In response, the medical community is calling for a redefinition of hospital roles based on patient severity. For example, tertiary general hospitals would handle severe patients, children’s hospitals would manage moderate severity cases as Dalbit Children’s Hospitals, and clinics would treat mild cases (Dalbit Clinics), thereby systematizing the target patient groups. Park Yang-dong, president of the Korean Association of Children’s Hospitals, emphasized, "During the past three years of the COVID-19 pandemic, 120 children’s hospitals nationwide treated over one million outpatients with subacute illnesses such as fever, and more than 150,000 of these patients received inpatient treatment and services. To address the current collapse of the pediatric emergency medical system, it is essential to clearly recognize the importance of children’s hospitals and establish policies accordingly."

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