INTRODUCTION

Korea is widely regarded as having achieved near-universal health coverage (UHC) through its national health insurance system [1]. However, this achievement has been realized within a system that remains heavily privatized. As of 2023, government-owned healthcare institutions accounted for only 5.2% of all providers, and public hospitals represented just 9.5% of hospital beds [2]. The expansion of UHC through public financing of privately delivered care has resulted in a highly fragmented system with limited coordination or referral across providers [3-5]. This fragmentation has led to unclear delineation of institutional responsibilities. For instance, it remains uncertain whether procedures such as emergency cesarean sections or appendectomies should be available at local hospitals or concentrated in higher-tier facilities.

Existing regulatory frameworks, such as the Regulations on Standards of Operation by Medical Institution Classification [6] and the Designation and Evaluation of Superior General Hospitals [7], provide only broad guidance. These frameworks either categorize diseases at a general level or identify conditions deemed suitable for superior general hospitals, but they lack specificity regarding which services should be provided at which levels of care. Evaluation mechanisms conducted by the Health Insurance Review & Assessment Service (HIRA), such as quality assessments for intensive care and transfusions, offer limited insight into whether specific hospitals are delivering essential services at appropriate standards. The National Medical Center’s HealthMap system also emphasizes structural and outcome indicators, while providing little service-specific information [8]. Moreover, essential procedures such as percutaneous coronary intervention and cesarean sections have been excluded from quality assessments, often due to conflicts with professional medical societies [9]. This exclusion substantially weakens the value of these evaluations for system-wide planning. Collectively, these limitations hinder efforts to determine what services should be available at each level of the healthcare system. A clearer understanding of existing service delivery patterns is therefore critical for rational planning and equitable access to essential care.

Although the government has recently taken steps to address service inequality, such as through the Essential Healthcare Package announced in 2024 [10], local governments still face persistent uncertainty about what services hospitals should provide within their regions and what institutional investments are required to achieve minimum standards [11]. Meanwhile, initiatives to stratify hospital functions by severity and complexity have disproportionately focused on tertiary-level care [12-15], leaving the lower end of the acute care spectrum—services that should be locally accessible—systematically neglected. The Essential Surgery List (ESL) developed in Disease Control Priorities, 3rd edition (DCP3) [16,17] offers an internationally recognized benchmark for the minimum surgical services that should be available at the hospital level. This framework provides a useful means of evaluating whether Korean hospitals are functionally equipped to deliver essential surgical care. While the DCP3 list was not designed specifically for high-income settings, it nonetheless serves as a conservative yet meaningful benchmark for assessing baseline surgical functionality.

In this study, we address this gap by evaluating the capacity of Korean hospitals to provide basic surgical services, using the ESL as a proxy for baseline hospital functionality (Supplemental Material 1). By mapping these procedures to Korea’s national insurance claims data, our study aims to: (1) assess the functional capacity of Korean hospitals to deliver essential surgical services, (2) analyze trends in service provision across different levels of care, and (3) identify geographic disparities in access to essential surgical care.

METHODS

Data Source and Study Design

We conducted a retrospective observational study using health insurance claims data obtained from the HIRA (https://opendata.hira.or.kr). This dataset contains comprehensive, nationally representative records for all National Health Insurance (NHI) enrollees and Medical Aid beneficiaries in Korea, including demographic characteristics, diagnostic codes, and claims for all reimbursable medical services [18]. Its broad coverage allowed for a robust population-level analysis of surgical service utilization across the country.

To identify essential surgical services provided in Korean hospitals, we used the ESL from the DCP3 [16,17]. Because the ESL provides generic descriptions of surgical procedures, we created a systematic crosswalk table to map each ESL item to the most appropriate NHI claims codes (Supplemental Material 2). The mapping process considered the intent and scope of each ESL item and was performed by 1 of the authors in consultation with clinicians familiar with the Korean coding system.

Using this validated crosswalk, we extracted all procedure claims that matched the ESL-mapped codes between 2013 and 2022. The dataset included procedure-level details along with demographic information on individuals undergoing surgery [18]. Each procedure claim was treated as a distinct observation, regardless of whether the same patient received multiple procedures.

Statistical Analysis

We analyzed the data along 3 primary dimensions: (1) type of medical institution, (2) geographic location, and (3) ESL procedure category. Medical institutions were classified into 5 categories based on Korean administrative definitions: superior general hospitals (SGHs), general hospitals (GHs), hospitals (Hs), long-term care hospitals/mental health hospitals (LTCH/MHHs), and clinics (Cs). SGHs generally correspond to tertiary-level institutions, while GHs and Hs provide secondary care, and Cs offer primary-level services. However, these boundaries are often blurred in Korea, as Cs frequently provide specialized procedures rather than serving solely as providers of general primary care [15]. Geographic location was grouped into 3 administrative categories. The Seoul Metropolitan Area included Seoul, Incheon, and Gyeonggi Province. The Metropolitan and Special cities category encompassed Busan, Daegu, Daejeon, Gwangju, Ulsan, and Sejong. The Provinces (do) category comprised Gangwon, Chungbuk, Chungnam, Jeonbuk, Jeonnam, Gyeongbuk, Gyeongnam, and Jeju.

Hospital participation in ESL provision was measured by calculating the annual frequency of each ESL-coded procedure. To define minimally functional service capacity, we applied 4 annual volume thresholds: 12, 24, 60, and 120 procedures. The 12-case threshold represented a baseline indicator of operational continuity, while the higher thresholds were used for sensitivity analyses of services that may require greater procedural experience or specialization.

Because there are no universally accepted minimum volume standards for ESL procedures, we reviewed the volume–outcome literature to evaluate the appropriateness of these thresholds (Supplemental Material 3). As most existing studies focus on complex interventions such as percutaneous coronary intervention and cancer surgery, we adopted more modest thresholds suitable for lower-risk procedures. To examine proportional changes over time in patient age, sex, procedure category, and institution type, we applied Cochran–Armitage tests for trend. Data extraction and preprocessing were conducted using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA) on the HIRA secure server. Statistical analyses and data visualizations were performed using R version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria). A complete list of R packages used is provided in Supplemental Material 4.

Ethics Statement

This study was approved by the Institutional Review Board of Seoul National University (IRB No. E2402/004-006), with informed consent waived due to the secondary use of de-identified data.

RESULTS

National Trends in Procedure Volume, Patient Demographics, and Institutional Distribution

Table 1 summarizes the descriptive characteristics of all procedures mapped to the ESL between 2013 and 2022. A more detailed year-by-year breakdown is provided in Supplemental Materials 5 and 6. The total number of ESL surgeries more than doubled, increasing from 2.79 million to nearly 6 million, with most categories showing significant linear trends (Cochran–Armitage test). The proportion of patients aged 65 and older rose from 31.4% to 36.9%, while those under 20 declined by nearly half (8.2 to 4.2%). Sex distribution remained stable, with females consistently representing 54-56% of surgical patients.

By procedure type, surgeries for visual impairment (primarily cataracts) exhibited the sharpest increase, both in absolute volume and proportional share (30.7 to 46.9%). Obstetric and gynecologic procedures declined proportionally (16.0 to 7.5%) but remained stable in overall volume. Injury-related surgeries decreased as a share of the total, while general surgical procedures grew steadily in both volume and proportion.

Institutional roles also shifted considerably. C-based surgeries increased from 33.4% to 41.9%, while surgeries performed at Hs declined from 20.9% to 13.5%. SGHs and GHs remained relatively stable, while LTCHs/MHHs showed modest growth, largely due to increases in minor procedures. Regionally, service delivery became more centralized: the Seoul Metropolitan Area’s share rose from 48.8% to 53.1%, while provincial regions declined from 29.1% to 24.2%.

To further contextualize these patterns, Supplemental Material 6 presents population-standardized ESL surgery rates (per 1000 population) disaggregated by sex, age group, procedure category, insurance type, admission day, institution type, and region. While overall rates more than doubled, growth varied substantially across subgroups. The steepest increases were observed among older adults (≥65), visual impairment surgeries, and clinic-based provision. Trends among female patients and across both NHI and Medical Aid beneficiaries closely mirrored national trends. By contrast, slower increases were seen among patients under 20, obstetric procedures, and weekend admissions. Regionally, provincial areas lagged behind, while the Seoul Metropolitan Area experienced the most rapid rise in population-adjusted surgical delivery.

Distribution of Procedures by Volume Thresholds

Figure 1 illustrates the distribution of 4 representative ESL procedures—cataract surgery, appendectomy, fracture reduction, and cesarean birth—across institution types in 2022. These procedures were selected to capture diverse clinical domains (visual, general, injury-related, and obstetric) and to represent both elective and emergency care. Each tile shows the proportion of institutions within a facility type meeting or exceeding 4 minimum annual volume thresholds (12, 24, 60, and 120 cases), while the adjacent grayscale bars represent total procedural volume on a log₁₀ scale.

The results reveal a clear stratification of surgical capacity. SGHs and GHs dominate high-volume provision: over 80% of SGHs exceeded the 120-case threshold across all 4 procedures, and GHs also performed strongly, particularly for appendectomy and fracture reduction. By contrast, Hs demonstrated substantially lower volume attainment—especially for cesarean births and cataract surgeries—indicating reduced functional capacity. Cs and LTCH/MHHs contributed a meaningful share of total procedure volume in some categories, but only a small proportion of institutions reached even the lowest thresholds, indicating highly concentrated service delivery.

Supplemental Materials 7-9 (2022, 2018, and 2013) highlight temporal shifts in institutional roles. SGHs maintained consistently high coverage, while GHs expanded their role, particularly in emergency and obstetric surgery. Hs, however, experienced a decline in the proportion of institutions performing ESL procedures, despite moderate aggregate volumes, suggesting reduced readiness or evolving institutional roles. Cataract surgeries and cesarean births showed the most pronounced shifts, becoming increasingly concentrated in higher-tier hospitals over time, likely reflecting difficulties in sustaining these services at lower levels. Emergency procedures such as perforation repair and fracture reduction remained centralized in SGHs throughout, reinforcing the persistent hierarchy in managing high-acuity cases. Collectively, these trends underscore a widening divide in surgical delivery capacity across hospital tiers in Korea.

Longitudinal Changes in Institutional Participation

Figure 2 illustrates longitudinal trends (2013-2022) in both service volume and institutional participation for 4 representative ESL procedures, disaggregated by facility type. The x-axis depicts total procedure volume (log₁₀ scale), and the y-axis shows the proportion of institutions performing ≥120 case/yr.

The findings highlight persistent stratification across the healthcare system. SGHs and GHs consistently maintained high and stable provision rates over the decade, reliably delivering above-threshold volumes for all procedures. By contrast, Hs demonstrated limited expansion in institutional participation, particularly for cesarean births and cataract surgeries. Although overall volumes modestly increased, these gains were concentrated in a small subset of facilities rather than reflecting broader functional growth. Cs showed a steep rise in cataract procedure volumes, but this was again concentrated among a limited number of providers, with overall participation rates remaining low. Collectively, these patterns indicate that rising national surgical volumes have not translated into a wider diffusion of functional capacity across lower-tier institutions.

Regional Variation in High-volume Institutions

Figure 3 provides a regional perspective on institutional participation in 4 essential surgeries in 2022, showing the share of facilities performing ≥120 annual cases among those performing at least 1 case, stratified by region and institution type. SGHs exhibited the highest participation rates across all regions, with particularly strong representation in provincial areas. GHs also made a substantial contribution, especially for cesarean births and fracture reductions. Hs played a notable role in cataract surgery, particularly outside Greater Seoul, while Cs contributed minimally, except for cataract provision in the capital region.

Regional comparisons from 2018 and 2013 (Supplemental Materials 10 and 11) indicate a gradual centralization of high-acuity procedures toward SGHs, especially in rural provinces. GHs recorded moderate gains but continue to play a more limited role relative to SGHs. Cs have steadily reduced their participation in procedures such as appendectomy and cesarean birth, although some retained a role in cataract care. Hs have maintained, or in some provinces modestly expanded, their cataract surgery provision outside the capital area. Overall, these findings point to increasing regional differentiation, with higher-tier institutions consolidating capacity while lower-tier facilities retain selective roles in lower-risk procedures.

Geographic Availability of Essential Procedures

Figure 4 maps the provincial distribution of institutions performing ≥120 annual cases for each ESL procedure in 2022. High-volume procedures such as appendectomy, fracture reduction, cesarean birth, and cataract extraction showed broad geographic availability, reflecting their integration into routine surgical care packages and consistent reimbursement under the national insurance system.

In contrast, several procedures—particularly those involving congenital anomalies (e.g., cleft lip and palate repair), trauma management (e.g., thoracotomy, amputations), or family planning (e.g., vasectomy, tubal ligation)—were performed above the threshold in only a limited number of provinces. These patterns likely result from a combination of factors: clinical rarity, the concentration of expertise in specialized centers, and limited financial incentives under current reimbursement structures. For instance, many sterilization and contraception procedures are excluded from standard insurance benefits and may instead be delivered in outpatient or non-claim-based settings, contributing to their underrepresentation in claims data.

DISCUSSION

Summary of Key Findings

This study presents the first national-level assessment of surgical delivery patterns in Korea using the DCP3-ESL framework. Between 2013 and 2022, the volume of ESL procedures more than doubled, with particularly notable growth among older populations. Visual impairment, general, and injury-related surgeries accounted for the largest shares (Table 1), reflecting both demographic transitions and the integration of these services into the routine benefits of the NHI system.

SGHs consistently performed the majority of ESL surgeries, underscoring their central role in surgical delivery. GHs expanded their scope over time, particularly for appendectomy and cesarean birth, suggesting functional upgrading in mid-tier institutions. By contrast, smaller Hs experienced a decline in ESL activity, pointing to possible erosion of readiness or staffing capacity. Clinics demonstrated substantial growth in cataract extraction and childbirth, particularly during the coronavirus disease 2019 (COVID-19) period, likely reflecting decentralized care preferences and infection control considerations.

Interpretation of Institutional and Regional Patterns

Regionally, the capital area continued to dominate in obstetrics and gynecology services. Provincial variation was moderate overall, with no broad decline in service availability in rural areas; however, sub-regional accessibility remained unclear due to the absence of catchment definitions. The presence of SGHs in a province does not necessarily guarantee access across sub-regions, particularly in mountainous or remote areas [19,20]. Obstetrics and gynecology procedures showed greater regional disparity, underscoring the fragility of reproductive health service delivery in decentralized areas.

Encouragingly, the number of Cs and Hs-level facilities offering obstetric care in provincial regions modestly increased over the study period (Figure 3) [21-23] (Supplemental Materials 10 and 11) Cataract surgeries and childbirth also rose at the clinic level during COVID-19, likely driven by both policy measures and patient preferences favoring smaller facilities [24-26]. Broader demographic shifts, including population aging and evolving care preferences, further contributed to rising demand for community-based services, especially cataract extraction [27], and childbirth in maternity-friendly clinics [28].

Our findings imply 3 key considerations: (1) the dominance of SGHs reflects a widening functional divide across hospital tiers; (2) selective decentralization of procedures such as cataract surgery and childbirth may be viable but requires effective regulation and quality assurance; and (3) while the ESL provides a valuable benchmarking tool, planning must also account for local demographics, infrastructure, and workforce constraints.

Study Contributions and Limitations

Unlike prior studies, this study evaluated hospital functionality using procedure-specific delivery thresholds. By integrating volume indicators with the ESL, we provide a more granular assessment of surgical service readiness at the institutional level.

Several limitations should be acknowledged. First, the ESL was developed primarily for global comparability and not specifically tailored to the Korean health system. Our mapping to Korean claims codes—though guided by expert consultation—remains operational and may not fully capture the scope or granularity of each procedure. Nonetheless, this effort represents a foundational step toward validation, and our procedure code mapping is made available in Supplemental Material 2.

Second, we were unable to distinguish between emergency and elective surgeries, nor could we classify hospitals by size or ownership status. Given ongoing policy concerns about limited 24-hour and emergency surgical capacity, our volume-based metrics may underestimate functional gaps. While richer datasets such as the National Health Information Database could provide additional institutional detail, identifying emergency status remains difficult in claims data, apart from a limited set of diagnosis-related group-coded procedures such as cesarean sections.

Third, the ≥120 case threshold used to define functional provision is necessarily arbitrary. Although it provides a practical operational definition, it may have resulted in misclassification in some settings, either overstating or understating service readiness, especially for procedures requiring different minimum volumes. Procedure-specific thresholds based on volume–outcome relationships may ultimately prove more appropriate [29,30], although such relationships tend to be highly context-dependent, particularly for the relatively low-risk procedures included in the ESL [31-36].

Fourth, our analysis did not incorporate regional variation in population characteristics such as age distribution and sex ratios, both of which strongly influence service demand. Addressing demand-side determinants would require a separate modeling framework and represents an important avenue for future research.

Finally, we were unable to assess functional catchment areas or intra-provincial accessibility. The mere presence of a surgical facility in a province does not guarantee equitable access for all sub-regions, especially in remote or mountainous areas. This limitation may lead to an underestimation of within-province disparities in surgical access.

Study Implications

Despite these limitations, the findings have several important implications for health system planning. First, instead of imposing rigid national thresholds for service provision, policy initiatives should prioritize strengthening rural surgical capacity through continuing medical education, certification, retraining, and structured personnel rotation programs tailored to local resource environments [37-39]. For example, readiness criteria could include maintaining staff trained to perform essential procedures (e.g., appendectomy, cesarean section), supported by structured rotation between urban and rural facilities. Regional governments might also consider performance-based funding or targeted incentives for facilities that meet, or are working toward meeting, these criteria. Given the higher comorbidity burden often seen in rural populations, dedicated clinical support will be essential to ensure safe and timely care [40].

Second, future service models must move away from uniform redistribution and toward region-specific planning that reflects population health needs, workforce availability, and infrastructure constraints. Such planning cannot rely solely on managerial efficiency or financial incentives, which tend to prioritize high-volume, revenue-generating services. Instead, a needs-based approach is required—one that identifies and addresses local service gaps directly.

Third, public hospitals should serve as equity-focused anchors that are deeply embedded in local contexts. With appropriate policy support and clearly defined mandates, they are uniquely positioned to deliver essential services in low-volume settings, respond to region-specific needs, and assume equity-oriented roles that private institutions may not prioritize. Beyond their clinical functions—particularly outside metropolitan areas—the role of public hospitals should be defined by their locality, rooted in community health needs, and aligned with their functional capacity to address essential problems at the regional level. Supporting this role will require adapting evaluation frameworks, which currently mirror those applied to acute care hospitals. Redefining “publicness” in healthcare should extend beyond ownership structures to encompass measurable practices such as accountability, responsiveness to local needs, and integration with community governance.

Strengthening surgical delivery in underserved areas will require not only targeted public investment but also a bottom-up approach that empowers local systems to define, adapt, and sustain essential services based on real-world needs.

Supplemental Materials

Notes

Data Availability

Data were obtained through the Health Insurance Review & Assessment Service and are not publicly available.

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant No. RS-2023-00271195).

Acknowledgements

The NRF had no role in study design, data collection, analysis, interpretation of results, or manuscript preparation.

We utilized Claude 3.7 Sonnet for English language editing and graphical refinements.

Author Contributions

Conceptualization: Bai H, Kim JH. Data curation: Bai H, Kim JH. Formal analysis: Bai H. Funding acquisition: Kim JH. Methodology: Bai H. Writing – original draft: Bai H, Kim JH, Park Y. Writing – review & editing: Bai H, Kim JH, Park Y.

Figure. 1.

Institutional distribution of 4 representative essential surgeries by annual volume thresholds in 2022. Red tiles indicate the proportion of institutions performing each surgery at or above minimum volume thresholds (12, 24, 60, 120 case/yr); grayscale bars indicate log-transformed total procedure volume. SGH, superior general hospital; GH, general hospital; H, hospital; LTCH/MHH, long-term care hospital / mental health hospital; C, clinic.

Figure. 2.

Institutional trajectories in the provision of selected essential surgeries by hospital type, 2013-2022. Longitudinal relationship between institutional volume (x-axis, log scale) and the proportion of institutions performing ≥120 surgeries annually (y-axis) for 4 selected procedures, stratified by facility type. Bold dots indicate 2013 values; arrowheads denote 2022 values. SGH, superior general hospital; GH, general hospital; H, hospital; C, clinic.

Figure. 3.

Proportion of institutions performing ≥120 surgeries annually by institution type and region group for 4 essential procedures in 2022. Share of institutions performing ≥120 annual cases of (A) appendectomy, (B) cesarean birth, (C) cataract surgery, and (D) fracture reduction in 2022, stratified by institution type and region group. Denominators include only institutions that performed at least 1 case of the respective procedure. Regions are grouped as follows: Seoul Metropolitan Area (Seoul, Incheon, Gyeonggi); Metropolitan/Special cities (Busan, Daegu, Daejeon, Gwangju, Ulsan, Sejong); Provinces (do): Gangwon, Chungbuk, Chungnam, Jeonbuk, Jeonnam, Gyeongbuk, Gyeongnam, Jeju). SGH, superior general hospital; GH, general hospital; H, hospital; C, clinic.

Figure. 4.

Geographic distribution of institutions performing ≥120 annual procedures by Essential Surgery List (ESL) category and surgery type, 2022. Provincial distribution of institutions performing ≥120 annual cases for each procedure included in the ESL of the Disease Control Priorities, 3rd edition in 2022. Each tile represents a single procedure; shading indicates the number of institutions meeting the threshold per province (white=0, dark red=4 or more). Procedures are grouped by ESL major category. Province borders are outlined in black.

REFERENCES

• 1. Preker AS, Cotlear D, Kwon S, Atun R, Avila C. Universal health care in middle-income countries: lessons from four countries. J Glob Health 2021;11: 16004. https://doi.org/10.7189/jogh.11.16004ArticlePubMedPMC
• 2. Ministry of Health and Welfare. Status of public medical institutions nationwide (as of the end of December 2023). 2024 [cited 2024 Dec 11]. Available from: https://www.mohw.go.kr/board.es?mid=a10107010100&bid=0043&act=view&list_no=1483015 (Korean)
• 3. World Health Organization Regional Office for the Western Pacific. Republic of Korea health system review; 2015 [cited 2024 Dec 11]. Available from: https://wkc.who.int/resources/publications/i/item/9789290617105
• 4. Jeon B, Kwon S. Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea. Health Policy 2013;113(1-2):69-76. https://doi.org/10.1016/j.healthpol.2013.05.007
• 5. Jeon B, Kwon S. Health and long-term care systems for older people in the Republic of Korea: policy challenges and lessons. Health Syst Reform 2017;3(3):214-223. https://doi.org/10.1080/23288604.2017.1345052ArticlePubMed
• 6. Ministry of Health and Welfare. Regulations on Standard Work by Type of Medical Institution. 2020 [cited 2024 Dec 11]. Available from: https://www.mohw.go.kr/board.es?mid=a10107010000&bid=0042&act=view&list_no=357023&tag=&cg_code=&list_depth=1(Korean)
• 7. Ministry of Health and Welfare. Regulations on the Designation and Evaluation of Superior General Hospitals. 2023 [cited 2024 Dec 11]. Available from: https://www.mohw.go.kr/board.es?mid=a10409020000&bid=0026&act=view&list_no=1479563&tag=&nPage=1 (Korean)
• 8. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966;44(3):166-206. https://doi.org/10.2307/3348969Article
• 9. Park EC. Problems and future directions for quality evaluation of the Health Insurance Review and Assessment Service. J Korean Med Assoc 2015;58(3):176-178. (Korean). http://doi.org/10.5124/jkma.2015.58.3.176Article
• 10. Ministry of Health and Welfare. The four challenges of healthcare reform. 2024 [cited 2024 Dec 11]. Available from: https://www.mohw.go.kr/menu.es?mid=a10715020000 (Korean)
• 11. Kim JH, Kim CY. The meaning of essential in health: critical analysis in South Korea. J Crit Soc Welf 2022;76: 155-187. (Korean). https://doi.org/10.47042/ACSW.2022.08.76.154Article
• 12. Kang HC, Hong JS, Park HJ. Development of peer-group-classification criteria for the comparison of cost efficiency among general hospitals under the Korean NHI program. Health Serv Res 2012;47(4):1719-1738. https://doi.org/10.1111/j.1475-6773.2012.01379.xArticlePubMedPMC
• 13. Choi ID. A study on re-structuring role of LTC care facilities and Geriatric hospital by user’s need and region. J Community Welf 2014;50: 139-176. (Korean). https://doi.org/10.15300/jcw.2014.50.3.139Article
• 14. Park SK, Lee YJ. Categorization of long term care hospital in Korea using cluster analysis. Public Health Aff 2019;3(1):71-81. (Korean). https://doi.org/10.29339/pha.3.1.71Article
• 15. Yun JM, Choi S, Cho Y, Park SM, Kim Y. Definition and status of funtional primary clinic in Korea. Korean J Fam Pract 2021;11(1):3-9. (Korean). https://doi.org/10.21215/kjfp.2021.11.1.3Article
• 16. Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, et al. Disease control priorities, third edition: essential surgery (English). Washington, DC: World Bank; 2015. https://doi.org/10.1596/978-1-4648-0346-8
• 17. Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT, et al. Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet 2015;385(9983):2209-2219. https://doi.org/10.1016/S0140-6736(15)60091-5ArticlePubMedPMC
• 18. Kim L, Kim JA, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiol Health 2014;36: e2014008. https://doi.org/10.4178/epih/e2014008ArticlePubMedPMC
• 19. Kwak MY, Lee TH, Hong HS, Na BJ, Kim Y. Development and adjustment of indicators for underserved area. Health Policy Manag 2016;26(4):315-324. (Korean). https://doi.org/10.4332/KJHPA.2016.26.4.315Article
• 20. Jeon J, Park M, Jang D, Lim C, Kim E. Vulnerable analysis of emergency medical facilities based on accessibility to emergency room and 119 emergency center. J Korean Soc Rural Plan 2018;24(4):147-155. (Korean). https://doi.org/10.7851/Ksrp.2018.24.4.147Article
• 21. Kim JW, Kim YH. Measures to address obstetrically underserved areas: limitations and future directions. J Korean Med Assoc 2016;59(6):429-435. (Korean). https://doi.org/10.5124/jkma.2016.59.6.429Article
• 22. Bae JY, Hong SY. Program for obstetric care supporting underserved areas in Korea: outcome and evaluation standards. J Korean Med Assoc 2016;59(6):424-428. (Korean). http://doi.org/10.5124/jkma.2016.59.6.424Article
• 23. Kwak MY, Lee SM, Lee TH, Eun SJ, Lee JY, Kim Y. Accessibility of prenatal care can affect inequitable health outcomes of pregnant women living in obstetric care underserved areas: a nationwide population-based study. J Korean Med Sci 2018;34(1):e8. https://doi.org/10.3346/jkms.2019.34.e8ArticlePubMedPMC
• 24. Kim KH, Tandi TE, Choi JW, Moon JM, Kim MS. Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea, 2015: epidemiology, characteristics and public health implications. J Hosp Infect 2017;95(2):207-213. https://doi.org/10.1016/j.jhin.2016.10.008ArticlePubMed
• 25. Kim YJ, Jeong YJ, Kim SH, Kim YJ, Lee SY, Kim TY, et al. Preparedness for COVID-19 infection prevention in Korea: a single-centre experience. J Hosp Infect 2020;105(2):370-372. https://doi.org/10.1016/j.jhin.2020.04.018ArticlePubMedPMC
• 26. Jang W, Kim B, Kim ES, Song KH, Moon SM, Lee MJ, et al. Differences in strategies for prevention of COVID-19 transmission in hospitals: nationwide survey results from the Republic of Korea. J Hosp Infect 2022;129: 22-30. https://doi.org/10.1016/j.jhin.2022.07.032ArticlePubMedPMC
• 27. Rho CR, Kim JH, Chung IK, Kim EC, Han YK, Han SY, et al. Cataract surgery practice in the Republic of Korea: a survey of the Korean Society of Cataract and Refractive Surgery 2020. Korean J Ophthalmol 2021;35(4):272-279. https://doi.org/10.3341/kjo.2020.0001ArticlePubMedPMC
• 28. Yeo JH, Sagong H. Korean women’s perceptions of traumatic childbirth: a qualitative descriptive study. BMC Pregnancy Childbirth 2023;23(1):687. https://doi.org/10.1186/s12884-023-05986-8ArticlePubMedPMC
• 29. Luft HS, Hunt SS, Maerki SC. The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? Health Serv Res 1987;22(2):157-182PubMedPMC
• 30. Hentschker C, Mennicken R. The volume-outcome relationship revisited: practice indeed makes perfect. Health Serv Res 2018;53(1):15-34. https://doi.org/10.1111/1475-6773.12696ArticlePubMed
• 31. Hannan EL, Wu C, Walford G, King SB 3rd, Holmes DR Jr, Ambrose JA, et al. Volume-outcome relationships for percutaneous coronary interventions in the stent era. Circulation 2005;112(8):1171-1179. https://doi.org/10.1161/CIRCULATIONAHA.104.528455ArticlePubMed
• 32. Spaulding C, Morice MC, Lancelin B, El Haddad S, Lepage E, Bataille S, et al. Is the volume-outcome relation still an issue in the era of PCI with systematic stenting? Results of the greater Paris area PCI registry. Eur Heart J 2006;27(9):1054-1060. https://doi.org/10.1093/eurheartj/ehi843ArticlePubMed
• 33. Schlenker RE, Hittle DF, Hrincevich CA, Kaehny MM. Volume/outcome relationships in small rural hospitals. J Rural Health 1996;12(5):395-409. https://doi.org/10.1111/j.1748-0361.1996.tb00807.xArticlePubMed
• 34. Mesman R, Westert GP, Berden BJ, Faber MJ. Why do high-volume hospitals achieve better outcomes? A systematic review about intermediate factors in volume-outcome relationships. Health Policy 2015;119(8):1055-1067. https://doi.org/10.1016/j.healthpol.2015.04.005ArticlePubMed
• 35. Itamoto K, Kumamaru H, Aikou S, Yagi K, Yamashita H, Nomura S, et al. No association between hospital volume and short-term outcomes of some common surgeries: a retrospective cohort study based on a Japanese nationwide database. Surg Today 2022;52(6):941-952. https://doi.org/10.1007/s00595-022-02467-xArticlePubMed
• 36. Stanak M, Strohmaier C. Minimum volume standards in day surgery: a systematic review. BMC Health Serv Res 2020;20(1):886. https://doi.org/10.1186/s12913-020-05724-2ArticlePubMedPMC
• 37. Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, et al. Emergency general surgery in geriatric patients: a statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg 2018;84(6):864-875. https://doi.org/10.1097/TA.0000000000001829ArticlePubMed
• 38. Curran VR, Keegan D, Parsons W, Rideout G, Tannenbaum D, Dumoulin N, et al. A comparative analysis of the perceived continuing medical education needs of a cohort of rural and urban Canadian family physicians. Can J Rural Med 2007;12(3):161-166PubMed
• 39. Curran V, Rourke L, Snow P. A framework for enhancing continuing medical education for rural physicians: a summary of the literature. Med Teach 2010;32(11):e501-e508. https://doi.org/10.3109/0142159X.2010.519065ArticlePubMed
• 40. Lee KS, Kwak JM. Effect of patient risk on the volume-outcome relationship in obstetric delivery services. Health Policy 2014;118(3):407-412. https://doi.org/10.1016/j.healthpol.2014.05.007ArticlePubMed

Figure & Data

References

Citations

Citations to this article as recorded by