Illegal patient recruitment and poor operations are rampant in the hemodialysis market, where more than 2 trillion won in health insurance funds is spent annually. Hemodialysis units are openly operating that hand out pocket money to attract patients rather than charging for treatment, while hospitals continue to escape sanctions despite receiving the lowest government ratings for five consecutive years. Critics point out that while Korea records the world's highest growth rate of chronic kidney disease patients, its legal management system is virtually nonexistent.
According to Health Insurance Review and Assessment Service (HIRA) data obtained by the Seoul Economic Daily on Friday through the office of Rep. Nam In-soon of the Democratic Party, a member of the National Assembly's Health and Welfare Committee, 28 medical institutions received the lowest Grade 5 rating in two consecutive hemodialysis adequacy assessments conducted over the past five years. Clinics were the most numerous at 15, followed by seven hospitals, four nursing hospitals, and two general hospitals, spanning various types of medical institutions.
Receiving the lowest grade twice in a row in government assessments indicates structural problems in patient safety, but the current system lacks proper means to impose strong corrective measures or force closures. Although HIRA has conducted adequacy assessments of hemodialysis units nationwide since 2009 and publicly assigns grades from 1 to 5, it has no authority to revoke designation based on assessment results alone. With assessment results merely leading to higher or lower health insurance reimbursements, many voices say this is insufficient to drive improvements in care quality.
As a result, illegal operations persist in which units, rather than charging treatment fees, give patients pocket money (subsidies) and even provide hospital transport and meals to recruit them. Illegal patient brokering also occurs, with referral fees of 200,000 to 300,000 won paid per dialysis patient. Patients who find it difficult to maintain their jobs because of dialysis knowingly seek out such hospitals, moving from one to another every two or three years and falling into what are called "dialysis drifters."
Many patients diagnosed with chronic kidney disease, who have visited hemodialysis units for nearly a decade for four to five hours every other day, still end up in emergency rooms due to complications such as uremia, a condition in which waste products accumulate in the blood and cause toxicity throughout the body. "Because there is no legal management system, side effects are growing, such as the proliferation of hemodialysis units that fail to manage medical quality," said Hwang Won-min, public relations director of the Korean Society of Nephrology and a professor of nephrology at Konyang University Hospital.
This stems from the fact that health insurance covers 90 percent of costs for chronic kidney disease patients, while a single hemodialysis session costs around 140,000 won. Hospitals driven into survival competition have become obsessed with attracting dialysis patients, even paying referral fees to maximize the reimbursement they receive from the National Health Insurance Service. As they spend money to recruit patients, the quality of medical services declines, creating a vicious cycle that threatens patients' health. Cases are also increasing in which dialysis-related "office manager hospitals" — operated by borrowing only the name of a licensed physician — drain health insurance funds. According to "Dialysis-Related Office Manager Hospital Status" data that Rep. Kim Yoon of the Democratic Party received from the National Health Insurance Service, nine dialysis-related medical institutions were under investigation, on trial, or punished on charges of establishing and operating office manager hospitals between 2020 and 2025. The amount subject to recovery from these institutions reached about 162.3 billion won. Nevertheless, the Korean Society of Nephrology only operates its own certification system, and there is no legal basis to systematically manage dialysis hospitals. This contrasts with the United States, the United Kingdom, Germany, Japan, Singapore, and Taiwan, which have established laws and installation standards for hemodialysis unit staffing, facilities, and operations, institutionalizing quality control through certification.
Critics say urgent system reform is needed given that Korea has the world's highest growth rate of end-stage kidney disease patients caused by diabetic chronic kidney disease. A 2024 "Policy Study for Patient-Centered Treatment of End-Stage Kidney Disease" found that annual total medical costs per hemodialysis patient reached 27.36 million won. The resulting social burden is considerable. According to data that Rep. Choi Bo-yoon of the People Power Party received from the Ministry of Health and Welfare, the Korea Disease Control and Prevention Agency, and the Korean Society of Nephrology, chronic kidney disease medical costs approached approximately 2.83 trillion won in 2024. The society projects that total dialysis-related medical costs will reach 6 trillion won within 10 years. This is why critics say it is hard to avoid the charge that poorly run hospitals are being neglected even after more than 2 trillion won in health insurance funds, filled by taxpayers, has been poured in.
The chronic kidney disease management bill, introduced by Rep. Nam in February this year, contains a legal basis for systematically preventing and managing chronic kidney disease, including establishing a national comprehensive plan and providing treatment cost support. However, no discussion has taken place in the National Assembly. "As the number of chronic kidney disease patients in Korea has surpassed 360,000 due to aging and the rise of chronic illnesses such as diabetes and high blood pressure, an urgent legal foundation for integrated national management is needed," Hwang stressed.
