"Operating at a Loss, Yet Government Subsidies Are Being Reduced"…Why Dalbit Children's Hospital Is Giving Up

[Interview] Lee Hong-jun, Chief Director of Gimpo Ijeil Hospital
Pediatric Night Care Increases Medical Staff Fatigue While Costs Balloon
Emergency Patients Surge Amid Medical Crisis... "Considering Returning Designation"

At 6 p.m. on the 18th at Gimpo Ijeil Hospital in Gimpo-si, Gyeonggi Province. Normally, this would be the time to close outpatient registration, but in the waiting room, more than forty children patients and their guardians were waiting for their turn. It was a typical pediatric hospital scene, with children whining in pain and sounds of crying and coughing coming from the examination rooms.

Around 6 p.m. on the 18th, the waiting room at Gimpo Ijeil Hospital in Gimpo-si, Gyeonggi-do, which operates Dalbit Children's Hospital, was crowded with about 40 patients and guardians./Photo by Tae-won Choi peaceful1@

This place is one of the 95 Dalbit Children’s Hospitals nationwide designated and operated by the government. It is a public late-night pediatric hospital where mild pediatric patients under 18 years old can receive medical services on weekday nights, weekends, and holidays. It was introduced to prevent relatively mild symptom patients, such as those with sudden fever or vomiting, from crowding the pediatric emergency rooms of general hospitals when regular clinics are closed, thereby avoiding disruption in the treatment of critically ill patients. When Dalbit Children’s Hospitals first started in 2014, there were eight locations; by 2022, there were 31, last year 57, and this year 95.

Although the number has increased significantly, Dalbit Children’s Hospitals are complaining of financial difficulties. The government promised to provide national subsidies twice this year, in the first and second halves, but has not properly fulfilled this. Among eight Dalbit Children’s Hospitals recently checked by the Korean Pediatric and Adolescent Hospital Association, only two received national subsidies. Three hospitals did not receive any subsidies at all, and three received only partial payments.

Lee Hong-jun, the chief director of Gimpo Ijeil Hospital, said, “From the beginning, operating at a deficit and management difficulties were expected, so we had repeatedly refused the government’s request to operate a Dalbit Children’s Hospital. We eventually started operations earlier this year, but the promised support funds were unilaterally reduced and have not been received on time.” He added, “At this point, I am considering returning the designation as a Dalbit Children’s Hospital.”

An official from the Ministry of Health and Welfare’s Emergency Medical Service Department explained, “Subsidies have already been allocated to local governments, but some payments have been delayed due to lengthy internal verification procedures and will be completed within this month. The number of designated Dalbit Children’s Hospitals increased more than expected, causing budget shortages.” The official added, “Hospitals that do not meet the standard of operating the Dalbit Children’s Hospital for more than 43 hours per week cannot receive support.”

Below is a Q&A with Director Lee.

Lee Hong-jun, Chief Director of Gimpo Ijeil Hospital

- What was the background for deciding to operate a Dalbit Children’s Hospital?

▲ The government had been persistently requesting for several years, but the situation was unfavorable. Although the circumstances did not change this year, I had no choice but to step in due to the treatment gaps in tertiary hospitals caused by the mass resignation of residents. After opening the Dalbit Children’s Hospital, many severe pediatric patients came, mistaking this place for an emergency room. Although we transferred them to tertiary hospitals, we often have to see critically ill patients returning at night or patients having seizures. When a severe patient comes to a hospital that accepts mild patients, almost all hospital staff must attend to that one patient. This leads to longer waiting times for other patients and complaints from guardians of mild patients.

- What is the current operating staff and patient volume?

▲ About 10 staff members work, including at least 1-2 doctors, 3 nurses, 2 injection room staff, 1 laboratory technician, 1 X-ray technician, and 3 administrative staff. During peak seasons such as transitional periods when respiratory diseases are prevalent, about 40-50 patients visit daily; during off-peak seasons, about 20-30 patients.

- Why does operating at a deficit occur?

▲ Operating a Dalbit Children’s Hospital receives an annual subsidy of 160 million KRW and an additional 16,679 KRW per patient. However, a pediatric hospital in Gyeonggi Province spends about 64 million KRW monthly on personnel costs alone for the Dalbit Children’s Hospital (according to the Pediatric and Adolescent Hospital Association). This hospital treats about 40 patients on weekday nights and 100 on weekends, with total Dalbit fees amounting to 28.5 million KRW. The total patient treatment fees outside of Dalbit fees are about 24 million KRW, resulting in a monthly loss of 12 million KRW. Our hospital is in a similar situation, though on a different scale.

Besides deficits, management difficulties and increased staff fatigue are issues. No one wants to work late at night or on weekends. Since many hospital staff are female, most avoid shifts ending at 11 p.m. or midnight. We conduct individual interviews with staff to accommodate their preferences as much as possible.

- Have you not received the promised national subsidies?

▲ Last month, Gimpo City suddenly sent a notice reducing the promised subsidy amount, citing “changes in the operation type of some medical institutions.” However, none of the three Dalbit Children’s Hospitals in Gimpo City have changed their operation type even once since January 1. There was no discussion or explanation with the hospitals or the Pediatric and Adolescent Hospital Association during the notification process. Payments are also delayed. Although it was initially promised to be paid twice, in the first and second halves of the year, as of today (the 18th), only a quarter has been received. Operating Dalbit Children’s Hospitals requires hiring more staff first, meaning money must be spent upfront, but subsidies are paid retrospectively, which shows a lack of understanding of the field by the administration.

- Will you return the designation as a Dalbit Children’s Hospital?

▲ I am considering it seriously. It is not easy to recruit hospital staff, and the current medical staff’s fatigue has reached its peak. On the other hand, there is little merit in operating a Dalbit Children’s Hospital. Therefore, I think it might be better to stop for the sake of staff working conditions and the hospital’s sustainable management.

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