Major large hospitals, including the so-called "Big 5" — Seoul National University Hospital, Asan Medical Center, Samsung Medical Center, Severance Hospital and Seoul St. Mary's Hospital — are flocking to apply for regional emergency medical center designations. The rush is seen as a competition for bonus points in the upcoming tertiary general hospital designation review, where a single point can decide success or failure.
According to the Ministry of Health and Welfare (MOHW) and medical industry sources on Wednesday, the so-called "Big 5" hospitals — Seoul National University Hospital, Asan Medical Center, Samsung Medical Center, Severance Hospital and Seoul St. Mary's Hospital — have all applied for regional emergency medical center designation. Virtually all of Seoul's major tertiary general hospitals are reported to have applied for the designation. Regional emergency medical centers, which handle severe emergency patients around the clock, face stringent statutory requirements for facilities, equipment and personnel, while offering low profitability, making medical institutions reluctant to apply. The Big 5 hospitals, already overwhelmed with patients from across the country, had no particular reason to apply. In fact, during the 2023 round of applications, five regions — northwestern Seoul, Busan, northwestern and southwestern Gyeonggi, and Cheonan in South Chungcheong — fell short of applicants, prompting the welfare ministry to launch an additional call.
The complete reversal in just three years is attributed to the tertiary general hospital redesignation review. Tertiary general hospitals are the top-tier institutions in the medical delivery system, designated every three years by the welfare ministry based on a comprehensive evaluation of medical functions, facilities, equipment and personnel. After 47 hospitals nationwide were designated as fifth-cycle tertiary general hospitals in 2024, applications for the sixth cycle, which takes effect next year, will be accepted in July and finalized in December. Since designation as a regional emergency medical center earns bonus points in the tertiary general hospital review, application rates have surged to unprecedented levels.
Tertiary general hospitals receive concentrated policy benefits beyond reimbursement premiums. Hospitals that participated in the tertiary general hospital structural transformation pilot project and significantly reduced their general bed counts would face a fatal blow to their operations if they fail this round. Designation requirements have also been tightened — the severe patient ratio threshold has been raised to 38% and the mild patient ratio must be lowered to 5% or below — while medical service regions have been expanded from 11 to 14, further heightening tensions among hospitals. "We even reduced bed counts to align with the tertiary general hospital structural transformation, and if we fail this time, the losses over three years would be enormous," an official at one university hospital said. "With everyone scrambling to apply for regional centers, competition will only intensify."
