[Exclusive] Tertiary Hospitals Say, "Get Treated at Small Hospitals"... Patient Transfers Surge 69% in Q3

46% Increase in Referred Patients in Q2 and Q3 Compared to Last Year
HIRA, "Improving Medical Referral System"
Medical Community, "Sending Patients Back Due to Lack of Capacity"
Referral Fees in Q3 Rise 158% Following Fee Increase

Since the second quarter, when medical disruptions due to the healthcare crisis began in earnest, the number of patients transferred from tertiary hospitals to secondary hospitals has significantly increased. This involves referring existing patients who regularly received treatment for chronic diseases or follow-up observations to other hospitals, or sending newly diagnosed cancer patients with long surgery wait times directly to secondary hospitals for surgery. The transfer fees claimed by tertiary hospitals to the Health Insurance Review and Assessment Service (HIRA) for sending patients to cooperating hospitals have also surged.

According to HIRA data on the 3rd, the number of outpatients transferred from 47 tertiary hospitals nationwide to secondary hospitals in the second and third quarters of this year was 378,249, a 46.3% increase compared to the same period last year. Transfers in the second quarter increased by 26.1% year-on-year, and in the third quarter, they surged by 68.5%, showing a growing trend of patients being redirected from tertiary hospitals to smaller hospitals over time.

Transfers refer to sending patients who have completed treatment or whose condition has stabilized at tertiary hospitals back to general hospitals or primary and secondary medical institutions. Since 2016, the government has been conducting a pilot project for referrals and transfers to allow tertiary hospitals to focus on treating severe and complex patients. Until last year, this was virtually ineffective, but as the medical gap worsened due to the collective resignation of residents in February this year, the government has actively encouraged transfers by increasing the transfer fees for tertiary hospitals to disperse patients.

Accordingly, transfer fees have increased more sharply. In the second quarter of this year, tertiary hospitals claimed 12.41606 billion KRW in outpatient transfer fees from HIRA, a 69.3% increase from 7.33382 billion KRW in the second quarter of last year, and in the third quarter, the amount surged to 17.241 billion KRW, more than 2.5 times (158.4%) compared to 6.67258 billion KRW in the same period last year.

A HIRA official explained, "The increase in the number of transfers and transferred patients means that tertiary hospitals are effectively sending mild cases to secondary medical institutions," adding, "It is understood that the medical delivery system is improving in a desirable direction, where severe patients are treated at tertiary hospitals, and mild diseases are managed at appropriate medical institutions through transfers."

However, the medical community believes that many of these transfer cases include situations where tertiary hospitals, regardless of the government's ongoing specialized referral and transfer program, have sent patients back because they lack the capacity to continue treating existing patients or accept new ones. A professor at a tertiary hospital in Seoul said, "Due to the shortage of medical personnel such as residents after the medical dispute, not only mild patients but also new general patients and early-stage cancer patients cannot be admitted," adding, "There are cases where only examinations and diagnoses are done, and surgeries or chemotherapy are referred to other general hospitals or regional hospitals."

Another issue raised is the inability to confirm whether transferred patients are receiving appropriate care at secondary hospitals. Professor Ha Eun-jin of the Department of Neurosurgery at Seoul National University Hospital said, "Previous studies have shown that patients transferred from the Big 5 hospitals often visit other tertiary hospitals or university hospitals again," and added, "It seems necessary to track whether patients transferred after the healthcare crisis are receiving treatment at the respective hospitals."

Professor Ha also pointed out, "The government is currently increasing transfer fees to restructure tertiary hospitals and has promised additional support to hospitals that increase the proportion of severe patients, but it is necessary to consider whether this policy is financially sustainable," adding, "If patients' conditions worsen at secondary hospitals and they return to tertiary hospitals, treatment delays and increased medical expenses will occur."