Impact of Medical Crisis on the Competency of Surgical Conduct Regarding Departmental, Institutional and Regional Distribution in Korea: A National Insurance Claim Data Analysis.

内容摘要

In February 2024, a nationwide medical crisis erupted in South Korea following the mass resignation of over 90% of trainee physicians in protest against the government's healthcare reform policy. Amid the ongoing crisis, the government initiated a series of restructuring activities aimed at concentrating high-complexity surgeries and critical care at tertiary hospitals, while redistributing low-complexity procedures to hospitals and clinics. However, the nationwide impact of the reform policy on high-complexity surgical practices, particularly in terms of institutional type, departmental specialty, and regional distribution, has not yet been assessed. Using national insurance claims data from the Korean Health Insurance Review and Assessment Service, we analyzed 914 high-complexity surgical procedures across tertiary hospitals (n = 47), general hospitals (n = 331), and hospitals/clinics (n = 37,888). Claims data from February to July 2023 (pre-crisis) were compared with those from February to July 2024 (post-crisis), stratified by institutional type, medical specialty, and geographic region. After the medical crisis, overall high-complexity surgical claims decreased by 10% (P < 0.001), with a 19% decrease in tertiary hospitals (P < 0.001), 6% increase in general hospitals (P = 0.115), and 27% increase in hospitals/clinics (P < 0.001). The decreased capacity for oncological surgery in tertiary hospitals by 16% (P < 0.001) was partly compensated by increased volume in general hospitals by 23% (P = 0.001). In terms of medical specialty, shifts from tertiary to general hospital in cardiothoracic surgery (1%, P = 0.636), neurosurgery (1%, P = 0.765), and interventional radiology (0%, P = 0.186) were negligible. Oncological surgery in the capital region, which is home to a higher concentration of tertiary hospitals, decreased by 17%, while oncological surgery in around-capital and non-capital regions increased by 11% and 5%, respectively. During the Korean medical crisis in 2024, nationwide surgical capacity and systems for maintaining competency were significantly compromised. Although some procedures were offset by redistribution to lower-tier institutions or regional hospitals, most high-complexity surgeries-particularly those requiring critical care-did not recover.