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

Introduction: This study investigates 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 affecting clinic closures and exacerbating regional disparities in healthcare resources. The research aims to analyze changes in private clinic (PC) 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: the Seoul Metropolitan Area (SMA), metropolitan cities (MCs), and small and mid-sized city/rural areas (SMRs). Permit data from local governments, publicly disclosed by the national government, were used to analyze changes in PC numbers during the pre-COVID-19 (2017-2019) and post-COVID-19 (2020-2022) periods. 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 COVID-19 in 2020, the rate of PC increase decreased across all regions. From 2021, despite ongoing pandemic measures, the SMA and MCs saw PC increase numbers recover and exceed pre-COVID-19 levels in 2022. However, in SMRs, PC 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 SMA and MCs in 2021. In contrast, SMRs saw a continuous decrease in IGOP clinic supply during the pandemic period. Disparities between the SMA/MCs and SMRs in PC increase intensified in 2021-2022. The overall number of primary healthcare facilities per population continued to increase across regions during the COVID-19 period. The increase was more pronounced in the SMA and MCs compared to SMRs. Notably, after the onset of COVID-19, there was a reversal in the disparity between MCs and SMRs in terms of primary healthcare per population.
Conclusion: The COVID-19 pandemic has deepened regional disparities in primary healthcare resources in South Korea. Particularly, the supply of essential medical services in SMRs significantly decreased compared to MCs 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 healthcare, regional disparity.