Korea has five largest hospitals, called the “Big Five,” which dominate patient care services. They are Samsung Medical Center, Asan Medical Center, Seoul National University Hospital, Severance Hospital, and Seoul St. Mary’s Hospital. The five hospitals overwhelm others in all aspects, including the number of beds, number of patients, and medical workforce. The medical community often calls them, “the black hole” of the Korean healthcare because they suck in every medical service.

Established by Samsung Life Public Welfare Foundation in Gangnam-gu, the affluent southern area of Seoul, Samsung Medical Center opened in 1994 with 1,100 sickbeds and advanced facilities. At the time, there were few hospitals large enough to accommodate more than 1,000 beds. As of 2016, the hospital had 1,979 beds and 7,776 employees, including 1,297 physicians and 2,602 nurses.

Located in Songpa-gu, Seoul, Asan Medical Center started operation with 1,043 beds in 1989. People often call the hospital, “chaebol hospital,” because Hyundai Group-affiliated Asan Foundation established it. Asan Medical Center’s founding chairman was Chung Ju-yung, the late founder and chairman of Hyundai Group. As of 2017, Asan Medical Center had 2,704 beds and 7,921 employees, including 1,676 doctors and 3,605 nurses.

Among the Big Five, SNUH is the only national hospital. Medical staffs at SNUH are proud that they are working at “Korea’s top hospital,” as the hospital is affiliated with the nation’s most prestigious university.

SNUH claims that it took root in Chejungwon, the first Western-style, national hospital in Korea established in 1885. However, Severance Hospital, one of the Big Five hospitals, also argues that it was originated from Chejungwon, too. The two hospitals still fight over which one was the right successor of Chejungwon. As of 2017, SNUH was equipped with 1,778 beds, with 6,200 employees, including 1,390 physicians and 2,147 nurses.

Severance Hospital was established as Korea’s first modern hospital with the sponsorship of an American businessman L.H. Severance. It is also a Christian hospital. In 1894, Chejungwon got to belong to the Missionary of the Presbyterian Church of the USA In 1904, the hospital changed its name to Severance Hospital. Based on this, Severance Hospital claims it is the successor of Chejungwon. According to data from the Health Insurance Review & Assessment Service (HIRA), Severance Hospital had 866 physicians working on 2,625 beds in 2017.

Catholic University Seoul St. Mary's Hospital started as “Kangnam St. Mary' s Hospital,” the first general hospital in the Gangnam area in 1980. In March 2009, it changed its name to Seoul St. Mary's Hospital and built a new building with a total floor space of 190,000 square meters, which had 22 floors above ground and six floors underground, with 1,200 beds. It was the largest single hospital in Korea at that time. As of 2017, Seoul St. Mary's Hospital had 1,369 beds, with 4,208 staffs, including 843 doctors and 1,999 nurses.

Patient care concentrated in Big Five hospitals

The Big Five hospitals have 10,455 hospital beds or 12.1 percent of 86,630 beds in Seoul. Physicians tend to seek jobs at the Big Five. In annual recruitments for residents and interns, the five hospitals remain at the top in competition rate. As most talented people rush to enter the Big Five, even local academic conferences are following the schedules of the Big Five hospitals.

Equipped with state-of-the-art facilities and competent medical staffs, the five largest hospitals are heavily overcrowded with patients. More than 90 percent of the beds are full at the Big Five. There is rarely an empty bed. In 2016, a whopping 2.22 million patients visited the five hospitals.

Although the Big Five are all located in Seoul, 61 percent of the patients visiting them do not come from Seoul. Due to such popularity, the Big Five’s emergency rooms are overcrowded, too. According to the Ministry of Health and Welfare’s “2016 Evaluation on Emergency Service of Medical Institutions,” the five largest hospitals ranked low in the patient density and stay time at the emergency room by severely ill patients. Inpatients at hospitals with more than 100 percent of the emergency room overcrowding index, or the total stay time of inpatients, should be on the waiting list because of insufficient beds at emergency rooms.

The Big Five hospitals also receive a considerable amount of medical expenses (reimbursements) paid by the National Health Insurance Service. As of 2016, 3.73 trillion won, or 8 percent of the total reimbursements of 64.75 trillion won, went to the Big Five. This is equal to 34.2 percent of the reimbursements paid to 43 general hospitals. The medical treatment costs at the Big Five increased to 3.7 trillion won in 2016 from 2.7 trillion won in 2012, a 37 percent rise over the five years.