"Pediatric Healthcare in Deficit: 'Worse Than Dog Treatment... This Is the Reality in Korea'"

Choi Yongjae, President of the Pediatric Hospital Association, Warns Adult-Centered Reimbursement Standards Threaten Pediatric Care
Structural Deficits and Fear of Fee Clawbacks Accelerate Staff Exodus and Clinic Closures

"The average cost of an X-ray for a dog (companion animal) is 46,000 won, but the fee a hospital receives for performing a full-body X-ray (Infantogram) on an infant is only 13,700 won. Even that amount is often reduced during the review process."

Choi Yongjae, President of the Korean Pediatric Hospital Association and Director of Uijeongbu Tuntun Children's Hospital (pictured), on April 30 urged the government to come up with measures to address the pediatric healthcare crisis in Korea, stating that "the root cause lies in flawed institutions that evaluate pediatric care through the lens of adult standards."

President Choi pointed to the review and reimbursement system—based on adult patients—as the biggest problem currently facing pediatric and adolescent medical care. He noted that there is virtually no separate standard reflecting the unique medical characteristics of pediatric patients.

A representative example is the "urine collection patch (urine bag)" used for diagnosing urinary tract infections in infants and young children. Unlike adults, infants and young children cannot collect urine on their own, so attaching a patch is essential. However, under the current reimbursement system, unless the patient is in intensive care, this patch is classified as a "non-compensable" item, requiring hospitals to bear the entire cost. President Choi lamented, "If the patch falls off or leaks, we may have to use four to five per baby, and since the cost of consumables (800–1,000 won each) is higher than the test fee (2,010 won), the more cases we treat, the deeper the deficit becomes."

The same issue exists with pediatric arterial blood gas analysis (ABGA). For pediatric emergency patients suspected of respiratory distress or sepsis, following guidelines recognized in the United States and Europe, venous blood was drawn instead of forcibly puncturing an artery. However, the Health Insurance Review and Assessment Service questioned, "Why didn't you draw arterial blood like you would for adults?" and ordered a mass reduction and clawback of three years' worth of medical fees. President Choi remarked, "It is tragic that physicians worry about clawback notices before even picking up a stethoscope or syringe."

He also criticized reimbursement standards that are disconnected from medical best practices. In cases of suspected autoimmune encephalitis, international standards recommend immediate administration of intravenous immunoglobulin (IVIG) to prevent brain damage. However, the Korean review authorities require a "confirmed diagnosis," which can take up to three weeks. President Choi pointed out, "If doctors treat according to the textbook, their fees are cut; if they wait for confirmation as per review standards, the child's brain could be damaged."

President Choi also voiced criticism regarding the government's plan to establish new children's hospitals. He argued that simply building new hospitals is ineffective when pediatricians are already leaving the field. "The personnel to staff these new hospitals will ultimately be drawn from existing local pediatric hospitals, which will undermine the already fragile infrastructure," he said. "It would be much quicker and more effective to allocate even a portion of the construction budget to reducing hospitals' legal risks and supporting night-shift medical staff."

Accordingly, the Korean Pediatric Hospital Association is calling for the following: ▲ establishment of an "independent pediatric health insurance reimbursement standard" separate from adults, ▲ legal grounds for a "pediatric care fee surcharge" to strengthen national responsibility, and ▲ creation of a "pediatric medical care division" within the Ministry of Health and Welfare.

President Choi emphasized, "Korea has the world's lowest infant mortality rate and a childhood cancer survival rate exceeding 85%, reflecting the high quality of pediatric care. However, with the rate of applications for pediatric residency in the single digits and 662 pediatric clinics closing in the past five years, the government must now respond to the voices from the field to overcome this grim reality."

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