Expansion of Hub Hospitals and Balanced Development
Overview
Expanding hub hospitals is a policy that designates and nurtures large hospitals capable of stably providing severe and essential medical care in each region, thereby seeking to disperse healthcare infrastructure and personnel concentrated in the Seoul metropolitan area to the provinces. It is evaluated as a core axis of balanced national development that goes beyond a simple health and medical measure to alleviate the structure in which jobs, population, and industry are concentrated in Seoul. As the departure of resident doctors and the medical crisis in 2024 made the gap in regional severe care a reality, expanding hub hospitals emerged as a representative balanced development agenda combined with responding to regional extinction.
Background: The Seoul Metropolitan Area-Centered Structure of Healthcare
Korea’s healthcare resources are structurally concentrated in Seoul and the metropolitan area. About half of the 47 tertiary general hospitals are clustered in Seoul and the metropolitan area, and it is estimated that 55–60% of key medical personnel, including specialists and residents, work in the metropolitan area. For severe diseases such as cancer, cardiovascular and cerebrovascular diseases, and rare diseases, a higher proportion of provincial patients travel to Seoul for treatment, which leads to time and cost burdens and loss of the golden time for treatment. Conversely, provincial hospitals are trapped in a vicious cycle of declining patients → worsening revenues → outflow of personnel → reduced services. Ultimately, healthcare is not merely a service but a key element of living conditions that enables population to remain in a region, and healthcare disparities directly translate into regional disparities.
Concept and Promotion Structure of Hub Hospitals
A hub hospital (regional hub hospital) refers to a hospital designated by the government and local governments at the regional level and nurtured to perform functions such as responding to severe diseases, providing essential healthcare including emergency, trauma, childbirth, and pediatrics, and responding to infectious diseases. National university hospitals and large regional general hospitals are the main targets, and policy tools include raising fees for essential healthcare and regional add-ons, investment in facilities and equipment, allocation of personnel quotas, and forming regional cooperative networks. The goal is a “regionally self-sufficient healthcare system” that allows residents to resolve most severe care within their region.
Link to Balanced Development
First is the population retention effect. Regions with hospitals capable of childbirth, pediatric, and emergency care slow the departure of young people and family units. Second is job creation. Medical institutions are anchor institutions that employ large numbers of high-skilled professionals, and a single hospital has significant ripple effects on the regional economy. Third is industrial linkage. If bio, healthcare, and medical device clusters and clinical research functions are combined around hub hospitals, it can lead to upgrading the regional industrial structure. Fourth is fiscal and administrative decentralization. Discussions are underway to transfer authority to establish regional healthcare plans and allocate resources to local governments, and this is evaluated as a case of substantive decentralization in the healthcare sector.
Issues and Limitations
Expanding hub hospitals entails several debates. Representative issues include the sustainability of funding, gaps in hospital capacity by region, the competitive structure with Seoul’s Big 5 hospitals, medical personnel’s avoidance of working in provincial areas, and the accuracy of regional demand estimates. There is also a risk that if only beds and equipment are increased while personnel and clinical capacity fail to keep up, they may become “hospitals that are large only on the outside.” Some raise concerns that nurturing hub hospitals may rather accelerate patient outflow from small and medium-sized hospitals and clinics, simplifying the regional healthcare ecosystem.
Latest Trends
After the government’s announcement in February 2024 of increasing medical school admissions, a significant portion of the increased quota was allocated to provincial national universities and regional hospitals, directly linking the hub hospital discussion with workforce supply policy. In the same year, the essential healthcare policy package and regional healthcare innovation measures were announced in succession, and as the departure of resident doctors was prolonged and the gap in regional severe care deepened, the need to nurture hub hospitals was reconfirmed. In 2025, the trend continues toward expanding the budget for strengthening regional and essential healthcare and concretizing projects to designate and support regional hub hospitals. Discussions on nurturing regional essential healthcare physicians (regional doctor system), the “regional healthcare-care integration” model linked to responding to regional extinction, and building regional-level healthcare networks have become key terms. However, disagreements remain over role-sharing between the medical community and local governments, who bears the fiscal burden, and the setting of performance indicators, so whether the expansion of hub hospitals will lead to actual balanced development outcomes depends on future institutional design and implementation capacity.
Related Topics
- [[Balanced National Development]]
- [[Essential Healthcare]]
- [[Regional Healthcare]]
- [[Healthcare Disparities]]
- [[Regional Extinction]]