Mortality, Health Care Use, and Spending Patterns During South Korea's Trainee Physicians' Walkout

초록

QuestionWas the 18-month nationwide walkout by South Korean trainee physicians in 2024 and 2025 associated with changes in mortality, health care use, and spending patterns at teaching hospitals?FindingsIn this cohort study of 200 teaching hospitals in South Korea, the 2024 to 2025 trainee physician walkout was associated with marginal mortality increases, substantial declines in utilization, and higher spending per encounter in 2024, largely driven by patients admitted with general conditions. Mortality, utilization, and spending for patients admitted with complex conditions did not change, and little evidence indicated care shifted to nonteaching hospitals.MeaningThese findings suggest that workforce disruptions may necessitate the prioritization of high-acuity care, potentially constraining general inpatient services, while simultaneously demonstrating both the resilience and vulnerabilities of South Korea's health system.This cohort study investigates associations between the 2024 to 2025 trainee physician walkout and mortality, health care usage, and spending patterns in South Korea.ImportanceIn February 2024, the South Korean government announced plans to increase medical school enrollment by 2000 students to address physician shortages, prompting opposition from the medical community. More than 90% of trainee physicians joined a nationwide walkout that continued through August 2025, but its systemwide implications remain unclear.ObjectivesTo examine the association of the trainee physicians' walkout with mortality, health care use, and spending patterns in South Korea.Design, Setting, and ParticipantsThis retrospective cohort study used nationwide health insurance claims data and a historical-control event-study design. Data from 200 teaching hospitals before and after the walkout in week 8 of 2024 were compared, using October 2023 to September 2024 as the exposed year and October 2022 to September 2023 as the historical control.Main Outcomes and MeasuresThe primary outcomes were mortality, health care use, and spending per encounter measured weekly at the hospital level. The association between the trainee physicians' walkout and hospital-level outcomes was assessed using a group-time average treatment effect framework.ResultsThe analysis included 7 719 828 patients with inpatient admissions (3 520 242 [45.6%] aged >= 65 years; 3 883 073 [50.3%] female) and 41 891 392 with outpatient visits (17 552 493 [41.9%] aged >= 65 years; 21 992 981 [52.5%] female). The walkout was associated with a 0.008-percentage point increase in weekly mortality among hospital users (95% CI, 0.000 to 0.015 percentage points) and a 0.39-percentage point increase in 30-day mortality after hospitalization (95% CI, 0.24 to 0.54 percentage points), concentrated among admissions for general conditions. These associations were largest early in the walkout and attenuated over time. The walkout was associated with reductions in both inpatient and outpatient use, with a larger relative decline for inpatient care (decrease of 19.2 hospitalizations per 10 million people; 95% CI, -24.1 to -14.3 per 10 million people [-17.3%] vs decrease of 158 outpatient visits per 10 million people; 95% CI, -198 to -118 visits [-8.6%]), and with higher mean spending per hospitalization (US $301;95$202-$399).Hospitalizationsforgeneralconditionsshowedthelargestrelativedeclineinservicevolume(-23.5$242; 95% CI, $108to$375), whereas mortality, use, and spending for complex conditions remained stable. Little evidence of care shifting to nonteaching hospitals was found.Conclusions and RelevanceIn this retrospective cohort study of teaching hospitals in South Korea, the trainee physicians' walkout was associated with small, short-term increases in mortality, reductions in hospital use, and higher spending per encounter, concentrated among admissions for general conditions. Outcomes for complex conditions were largely unchanged, suggesting that teaching hospitals prioritized high-acuity care. Rapid hospital and governmental responses may have helped limit harm and support resource allocation.

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