Deepening regional disparities in primary health care during COVID-19 in South Korea

Abstract

Introduction: This study investigated the impact of the COVID-19 pandemic on primary healthcare accessibility in South Korea, beyond infectious disease control. The pandemic led to financial challenges for primary healthcare providers, potentially causing clinic closures and exacerbating regional disparities in healthcare resources. The research aimed to analyze changes in private clinic numbers in different regions and assess the resulting shifts in regional disparities in primary healthcare access during the pandemic. Methods: The study classified regions into three categories based on administrative districts: capital area, regional cities, and rural/small cities. Permit data from local governments, publicly disclosed by the national government, were used to analyze changes in private clinic numbers before the COVID-19 pandemic (2017-2019) and after the COVID-19 pandemic onset (2020-2022). Essential medical subjects (internal medicine, general surgery, obstetrics/gynecology, pediatrics (IGOP)) were also analyzed to understand the changes in specific healthcare services. Results: During the onset of the COVID-19 pandemic in 2020, the rate of increase of private clinics decreased across all regions. From 2021, despite ongoing pandemic measures, the capital area and regional cities showed that private clinic increase numbers recovered and exceeded pre-COVID-19 levels in 2022. However, in rural/small cities, private clinic supply per million people in 2022 remained lower than in 2017-2018. Similarly, the supply of IGOP clinics experienced a decrease in 2020 but started to recover in the capital area and regional cities in 2021. In contrast, rural/small cities showed a continuous decrease in IGOP clinic supply during the pandemic period. Disparities between private clinic increases in the capital area/regional cities and rural/small cities intensified in 2021-2022. The overall number of primary healthcare facilities per population continued to increase across regions during the COVID-19 pandemic period. The increase was more pronounced in the capital area and regional cities compared to rural/small cities. Notably, after the onset of the pandemic, there was a reversal in the disparity between regional cities and rural/small cities in terms of primary health care per population. Conclusion: The COVID-19 pandemic has deepened regional disparities in primary healthcare resources in South Korea. In particular, the supply of essential medical services in rural/small cities significantly decreased compared to regional cities during the pandemic. This exacerbates existing health disparities and may hinder equitable healthcare utilization in remote areas. To address this issue, proactive policies are needed, such as expanding public hospitals and increasing the public healthcare workforce in underserved regions. Future research should focus on exploring the underlying causes of healthcare disparities and implementing targeted policy responses to ensure universal and equitable access to healthcare services.

Keywords

• access
• COVID-19
• primary health care
• regional disparity
• South Korea.