A policy designed to help tertiary hospitals focus on severe, emergency, and rare diseases is backfiring, orthopedic surgeons claimed. They argue that orthopedic surgeries are being uniformly classified as minor regardless of complexity, leading to reduced procedures and patient harm.
The Korean Orthopedic Association held a press conference at the National Assembly on the 13th, stating that "due to the severity classification system linked to the tertiary hospital restructuring policy, elderly patients with hip fractures are recently being forced to visit multiple hospitals without receiving timely surgery."
The tertiary hospital restructuring initiative, part of broader healthcare reform, aims to reorganize the system so that tertiary hospitals—at the top of the healthcare delivery hierarchy—can focus on severe, emergency, and rare disease care. Participating hospitals must raise their proportion of severe care to 70% and reduce general beds, while receiving higher reimbursement rates for ICU and semi-private room fees. All 47 tertiary hospitals are currently participating.
The association criticized the severity criteria as disconnected from clinical reality. Unlike cancer surgeries, which are mostly classified as severe, orthopedic procedures lack detailed disease codes, leaving many high-complexity, high-risk surgeries unrecognized as severe cases. For example, spinal surgeries are uniformly classified as simple treatment cases whether one vertebra or five are involved, treating them as minor procedures.
"Orthopedic operating rooms not included in the specialized disease category are being reduced at tertiary hospitals," said Kim Hak-sun, President of the Korean Orthopedic Association and professor at Yonsei University College of Medicine. "Institutional review is needed particularly for cases like hip fractures and malignant soft tissue tumors—actually high-risk, high-complexity surgeries that are classified as general treatment cases."
The irrational structure that fails to properly recognize orthopedic severity has become entrenched during policy implementation, leading to workforce attrition. According to the association, 133 of 873 orthopedic supervising specialists at tertiary hospitals resigned last year, representing a 15.2% resignation rate. Regional hospitals saw rates reaching 19.1%. As orthopedic departments lose ground within tertiary hospitals, physicians are increasingly leaving for private practice. Hand surgery and pediatric orthopedics—fields with high workload intensity, surgical complexity, and risk—are seeing applicants disappear.
"At some tertiary hospitals, immediate surgery is difficult due to orthopedic specialist shortages and reduced operating room allocations," Kim said. "Gaps in severe orthopedic surgery are becoming reality amid the tertiary hospital restructuring."
He called for "refining the severity classification system to reflect surgical complexity and risk, ensuring high-risk orthopedic procedures are clearly recognized within the essential healthcare framework." He also urged authorities to "establish reasonable compensation systems and institutional safeguards so tertiary hospitals can maintain high-complexity orthopedic surgery infrastructure."