Structural reform project launched in October 2024 shows mixed results as ICU bed utilization continues to fall

A hospital ward [123RF]
A hospital ward [123RF]

A government initiative to restructure South Korea's top-tier hospitals around severe, emergency and rare diseases is showing some early results, with a notable decline in outpatient visits from patients with minor conditions.

Performance data from the Health Insurance Review and Assessment Service, obtained by People Power Party lawmaker Kim Mi-ae of the National Assembly's Health and Welfare Committee, showed that outpatient visits to 47 tertiary hospitals last year totaled about 7.654 million — a drop of roughly 11.8 percent from 8.676 million in 2023.

Inpatient numbers also fell over the same period, declining 17.1 percent from about 1.879 million to about 1.557 million.

The number of serious surgeries rose 9.5 percent, from 391,706 to 429,085, between 2024 and 2025, a period when tensions between the government and the medical community were ongoing.

The government launched the structural reform support project in October 2024 to reorient tertiary hospitals toward treating serious illnesses.

The initiative aims to refocus these hospitals on complex, high-difficulty cases in line with their intended role, while redirecting patients with minor conditions to local clinics and hospitals through a cooperative care model.

While some indicators — including the drop in outpatient visits — have improved, the data also revealed areas where tertiary hospitals still fall short of becoming fully established centers for serious care.

ICU bed utilization rates at tertiary hospitals have fallen steadily: 71.4 percent in 2022, 70.4 percent in 2023, 64.6 percent in 2024 and 61.8 percent in 2025 — a decline of 9.6 percentage points from the 2023 level.

Over the same period, the total number of ICU beds grew from 4,909 in 2023 to 5,363 in 2025, an increase of 454. The expansion in bed capacity has not translated into actual use.

Particularly striking was the performance of the five hospitals commonly known as the "Big Five." Their ICU bed utilization rate fell 13.3 percentage points — from 71.7 percent in 2023 to 58.4 percent in 2025 — a steeper decline than the national average.

Regional disparities also emerged from the data.

The drop in inpatient numbers between 2023 and 2025 was roughly 1.7 times larger outside the Greater Seoul area, at 22.9 percent, compared with 13.6 percent within it. ICU bed utilization in 2025 stood at 64.8 percent in the metropolitan area, while regions outside it were limited to 58.3 percent.

"We can assess that the structural transition has begun to take hold on the ground, with fewer outpatient visits for minor conditions and more serious surgeries being performed," Kim said. "But the fact that bed numbers have increased while ICU utilization rates are falling — and that the burden of declining inpatient numbers is falling more heavily on non-metropolitan regions — warrants closer examination."


thlee@heraldcorp.com