Regional Healthcare Gap Widens as OB-GYN Clinics Grow 11% in Capital Area While Declining 8% Elsewhere

"I had my first child at a well-known local OB-GYN clinic, but when I got pregnant with my second and went back, there was a notice saying they had stopped delivery services."

Lee, a 44-year-old woman living in Seo-gu, Daejeon, sighed, "I feel lost, wondering if I should travel to Sejong or Seoul." As her age classifies her as a high-risk mother, she is also considering commuting to a university hospital an hour away by car.

The concentration of population in the capital region, combined with accelerating low birth rates and aging demographics, is hastening the collapse of essential regional healthcare even in major metropolitan cities. As physicians increasingly avoid essential medical specialties—internal medicine, surgery, obstetrics-gynecology, and pediatrics—neighborhood clinics on the front lines of healthcare are showing severe concentration in the Seoul metropolitan area.

According to data on "Regional Changes in Clinics Across Four Medical Specialties Over the Past 10 Years" from the National Health Insurance Service, exclusively obtained by Seoul Economic Daily on June 2, the number of OB-GYN clinics in the capital region increased from 703 in 2016 to 779 in 2025, a gain of 76 clinics (10.8%). In contrast, non-capital regions saw a decrease of 47 clinics (7.8%) over the decade, from 601 to 554. The figures are based on clinics with registered specialty data among institutions open at the end of each year.

Nationally, OB-GYN clinics increased slightly from 1,304 in 2016 to 1,333 in 2025 (29 clinics, 2.2%), but the gap between capital and non-capital regions widened significantly. Daejeon recorded the highest decline rate among non-capital metropolitan cities, dropping from 46 clinics in 2016 to 36 in 2025, a reduction of 10 clinics (21.7%). In fact, the southwestern part of Daejeon was shaken when an OB-GYN hospital that had served local mothers since 2007 announced in mid-December last year that it would cease delivery services including natural births and cesarean sections. In a notice sent to expectant mothers at the time, the hospital stated, "Since opening 18 years ago, we have handled deliveries for the Gwanjeo-dong, Gasuwon-dong, Jinjam-dong areas as well as Gyeryong City and Nonsan region, but birth rates have dropped sharply in recent years, with the 2024 total fertility rate falling to 0.748." It continued, "Despite difficult circumstances caused by low birth rates, we tried to continue serving this region's deliveries, but we have now reached a point where 24-hour hospital operation is impossible."

The situation is not unique to OB-GYN. As unprecedented low birth rates persist, pediatric clinics face crisis not only in non-capital regions but across the entire capital region including Seoul. Pediatric clinics in the capital region decreased from 1,296 in 2016 to 1,280 in 2025, a drop of 16 clinics (1.2%). Non-capital regions barely maintained status quo, going from 876 to 879 clinics, but detailed figures show severe declines in Ulsan (-17.9%), South Jeolla Province (-14.3%), and Daejeon (-11.1%). Pediatrics is the only specialty among the four where capital region clinic numbers fell compared to a decade ago. According to "Healthcare Facility Opening and Closure Status" data from the Health Insurance Review and Assessment Service, 59 pediatric clinics opened nationwide last year while 89 closed, giving pediatrics the highest closure-to-opening ratio among all medical specialties.

Over the past decade, surgery clinics increased by 115 (27.1%) in the capital region while decreasing by 28 (5%) in non-capital regions, widening the regional gap. Internal medicine clinics, however, grew by 767 (35.5%) in the capital region and 495 (21.8%) in non-capital regions, totaling 1,262 new clinics (28.5%) nationwide. This is interpreted as reflecting the growing elderly population seeking medical care while hospitals for children close down.

These changes in the healthcare landscape directly reflect regional extinction phenomena caused by sharp fertility declines. Comparing newborn rates between 2016 and 2025, both capital (-30.7%) and non-capital regions (-41.3%) recorded severe negative growth. During this period, the population under 18 continued declining at an annual average rate of 3.0%. While the decrease in births has temporarily eased since 2024, the under-18 population in all 16 metropolitan cities and provinces except Sejong City has declined continuously over the past decade without a single rebound.

The Healthcare Innovation Committee, a presidential advisory body under the Prime Minister's Office that will lead the Lee Jae-myung administration's healthcare reform, has identified strengthening regional, essential, and public healthcare as a core priority and is proposing various solutions including a "regional physician system." However, critics point out these measures are insufficient to bring tangible changes on the ground amid nationwide population decline and regional extinction crisis. They argue that alongside population policies, active utilization of information and communications technology (ICT) to improve healthcare efficiency must proceed in parallel. Kwon Yong-jin, a professor at Seoul National University Hospital's Public Healthcare Center, emphasized, "There are limits to policies that simply raise fees for underpaid essential medical services and increase the number of doctors. Building systems that can actively utilize telemedicine as well as remote monitoring and consultations using digital technology is urgent."