The discussion on public healthcare systems has been submerged amid the protracted government-doctor conflict. During that time, management difficulties of regional public hospitals in the “blind spot” have gotten worse.

Many barely survive with government support, but their deficits run into hundreds of billions of won. Some are even facing wage arrears. “We are barely keeping our heads above water,” heads of regional public hospitals say in unison.

The deficit in regional public hospitals has grown sharply since the Covid-19 pandemic. According to data Rep. Kim Yoon of the Democratic Party of Korea received from the Ministry of Health and Welfare, as of June last year, 34 regional public hospitals (excluding Seongnam Citizens Medical Center) had a net loss of 111.2 billion won ($76.98 million). Thirty-three of the 34 regional public hospitals were in the red.

As the deficit has increased, some regional public hospitals have borrowed from commercial banks or issued municipal bonds to cover the shortfall. As of August last year, the borrowing volume of 21 regional public hospitals amounted to 122.14 billion won. Financial recovery has been slow. Regional public hospitals' average bed utilization rate has stagnated after a sharp drop from 78.4 percent in 2019 to 49.5 percent in 2020.

This means some relatively small regional public hospitals are still owed wages, and others struggle to pay bonuses properly.

“On payday, directors of regional public hospitals sigh,” said Kim Young-wan, director of Seosan Medical Center in South Chungcheong Province. “Patients who left during Covid-19 are not coming back. To make matters worse, it has become difficult for regional public hospitals to find doctors amid the protracted medical turmoil caused by the medical school enrollment quota increase.”

Kim lamented that several bad things have overlapped, noting that the government can't afford to pay attention to regional public hospitals (because of its conflict with the medical community. They are living day by day, he said.

“At the time of Covid-19, the government said it would be different from MERS. The government promised to support us even if it took three to four years to normalize our management after we finished our role as dedicated Covid-19 hospitals, but the situation has changed,” Kim said. “I don't know how long we can hold on like this.”

Kim emphasized that the government should give them full support as initially promised.

“As things stand now, regional public hospitals, which serve as public medical institutions, are bound to collapse. At the same time, however, it must consider a systematic and continuous policy, not a temporary one. It is also necessary to consider introducing a regional medical fee system to protect regional medical care,” he said.

Kim also pointed out that the government's healthcare reform policy lacks a plan for public healthcare. He criticized the government's subsidies as “pouring water into a bottomless jar” in a situation that is difficult to manage independently.

“There is no way for regional public hospitals to stand independently. Even a few successful medical centers can only operate with substantial government subsidies, said Cho Seung-yeon, former head of the Korea Association of Regional Public Hospitals. “To solve the chronic deficit, the government must solve the fundamental problem. In other words, it must move toward the global budgeting system. The public policy medical fee system is also a good example. It must use the system to give us some breathing room.”