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<p>Congenital heart disease (CHD) requires highly specialized surgical care. In South Korea, despite policies for balanced regional development, resources are increasingly concentrated in the Seoul Metropolitan Area (SMA), requiring non-SMA residents to undertake “medical travel” for surgery. We aimed to examine regional disparity and the determinants of medical travel. We analyzed nationwide claims data from the Health Insurance Review and Assessment Service (HIRA) (2009–2022), including patients aged 0–19 years who had undergone CHD surgery. Residence was defined using a proxy based on the most frequent outpatient visits. Factors associated with medical travel were evaluated using multivariable logistic regression. Of 12,101 non-SMA residents, 52.6% traveled to the SMA for surgery. By 2022, the proportion of surgeries performed in the SMA exceeded 70% overall and reached nearly 90% for high-risk procedures. Medical travel was driven by lack of local infrastructure; compared to Area 1 (baseline infrastructure), residents in Area 5 (virtually no infrastructure) were 29.9 times more likely to travel. High surgical risk increased the likelihood of travel. Conversely, vulnerable groups were less likely to travel, despite their greater clinical need for specialized care. Neonates, patients with emergency admissions, and Medical Aid recipients were all significantly less likely to travel than their respective comparators. This study confirmed the “<i>de facto</i> centralization” of pediatric CHD surgery in South Korea, driven by infrastructure insufficiency and expertise polarization. Although medical travel has become a common pathway for accessing specialized surgical care, access is restricted for the most vulnerable populations: neonates, emergency patients, and the socioeconomically disadvantaged. Policy interventions should shift from simple decentralization to structured regionalization to ensure equity and safety.</p>

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Medical Travel and Geographic Inequities in Access to Pediatric Congenital Heart Surgery: Evidence from a Nationwide Cohort in South Korea

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Hogyeong Jo,
  • Eunhwa Lee,
  • Nam Kyung Je

摘要

Congenital heart disease (CHD) requires highly specialized surgical care. In South Korea, despite policies for balanced regional development, resources are increasingly concentrated in the Seoul Metropolitan Area (SMA), requiring non-SMA residents to undertake “medical travel” for surgery. We aimed to examine regional disparity and the determinants of medical travel. We analyzed nationwide claims data from the Health Insurance Review and Assessment Service (HIRA) (2009–2022), including patients aged 0–19 years who had undergone CHD surgery. Residence was defined using a proxy based on the most frequent outpatient visits. Factors associated with medical travel were evaluated using multivariable logistic regression. Of 12,101 non-SMA residents, 52.6% traveled to the SMA for surgery. By 2022, the proportion of surgeries performed in the SMA exceeded 70% overall and reached nearly 90% for high-risk procedures. Medical travel was driven by lack of local infrastructure; compared to Area 1 (baseline infrastructure), residents in Area 5 (virtually no infrastructure) were 29.9 times more likely to travel. High surgical risk increased the likelihood of travel. Conversely, vulnerable groups were less likely to travel, despite their greater clinical need for specialized care. Neonates, patients with emergency admissions, and Medical Aid recipients were all significantly less likely to travel than their respective comparators. This study confirmed the “de facto centralization” of pediatric CHD surgery in South Korea, driven by infrastructure insufficiency and expertise polarization. Although medical travel has become a common pathway for accessing specialized surgical care, access is restricted for the most vulnerable populations: neonates, emergency patients, and the socioeconomically disadvantaged. Policy interventions should shift from simple decentralization to structured regionalization to ensure equity and safety.