[Emergency Care on the Brink] 4. "The Law Shouldn't Force Hospitals to Accept Everyone; It Should Build a System That Makes It Possible"

Formalize Compensation for Follow-Up Care, Separate Liability and Compensation
"Set Minimum Safeguards in the Enforcement Decree and Regional Guidelines"

Editor's NoteAn amendment to the Emergency Medical Service Act, dubbed the "Emergency Room Runaround Prevention Act," strengthens designated hospitals' obligation to accept critically ill emergency patients. It has passed the Cabinet meeting and will take effect in April 2027. The government says it based the amendment on results from a three-month pilot program. However, concerns among emergency medical professionals have not subsided: the pilot program's structure and evaluation criteria had shortcomings, and the amendment does little to address the underlying problems. We examine what the amendment overlooks and what needs closer consideration before it takes effect.

1. Pilot program cited as basis for "Emergency Room Runaround Prevention Act" riddled with holes

2. Hospitals are required to accept patients, but there are no doctors to take them or means of assessing conditions

3. Doctors are leaving the front lines: "One mistake can leave you tied up in litigation through the first trial for years"

4. "The law should not force hospitals to accept every patient; it should create a system that makes acceptance possible"

Alongside legal risks, the medical community has consistently cited gaps in follow-up care as a major cause of the "emergency room runaround." It says the vicious cycle cannot be broken without addressing the shortage of doctors and beds for operating on and admitting patients after they arrive at the emergency room. In practice, there is also no system to assess the availability of follow-up care and coordinate which hospitals can accept patients. Although the government has strengthened hospitals' obligation to accept patients through the "Emergency Room Runaround Prevention Act" (an amendment to the Emergency Medical Service Act), professionals on the front lines share the view that it will be difficult to make an impact without a system capable of accepting patients.

The government also appears to recognize this problem. In a report on the results of a pilot program to reform the emergency patient transport system, released by the Ministry of Health and Welfare in June 2026, the ministry identified "weakened hospital capacity to provide care" as a root cause of emergency rooms turning patients away. The ministry said, however, that strengthening hospitals' capacity to provide care takes a long time, so measures to use limited emergency medical resources efficiently must be pursued at the same time. This helps explain why the amendment did little more than somewhat expand the scope for criminal liability relief in relation to legal risks, without moving far beyond requiring hospitals to accept patients unconditionally.

Lee Hyung-min, president of the Korean Society of Emergency Medicine Physicians, said on November 10, "I agree that doing anything possible to address the problem of emergency rooms turning patients away is better than doing nothing, but the current approach is not the answer. If we are not ready, we should delay it and do it properly."

It is also unclear how many patients could not be accepted because of a shortage of follow-up care. The National Fire Agency does not compile figures on how often hospitals report that they cannot accept patients or the reasons for doing so. Nor are 119 ambulance activity logs linked to the National Emergency Department Information System (NEDIS) on a patient-by-patient basis. Without knowing which departments are short-staffed, where, and when, it is difficult to determine where to add personnel. In a report in September 2025, the National Assembly Research Service proposed linking ambulance activity logs, NEDIS, and National Health Insurance claims data by patient, but no solution has been put in place.

A nearby example of an overhaul to the transport system running up against the limits of follow-up care can be found in Japan. After pregnant women died in 2006-2008 following refusals by multiple hospitals to accept them, Japan amended its Fire Services Act in 2009. Rather than imposing an obligation on hospitals to accept patients, local governments were to designate in advance the hospital that would ultimately receive each patient, with coordinators arranging acceptance. According to the Fire and Disaster Management Agency of Japan's Ministry of Internal Affairs and Communications, the share of critically ill patients for whom hospitals were contacted four or more times before one accepted them fell to around 2% in the latter half of the 2010s. But it rose to 7.2% in 2022, after the COVID-19 pandemic, and was still 5.4% in 2024. In 2024, more than half of the reasons hospitals could not accept patients were "no beds available" (35.7%) and "performing surgery" (20.3%).

Concerns are mounting in South Korea because funding for follow-up care is instead declining. In October 2025, the Health Insurance Policy Deliberation Committee converted just two of the 10 items funded under the emergency medical system into regular reimbursement rates. Incentives paid to regional emergency medical centers ended in November 2025. In effect, funding to retain doctors in clinical departments responsible for emergency surgeries at night and on weekends has shrunk.

The amendment renames regional emergency medical centers as critical emergency medical centers, requires emergency departments to have attending specialists on duty in teams of two, and requires that those specialists include doctors able to provide definitive care. However, these provisions will take effect three years after promulgation, two and a half years later than the other provisions. It is also unclear whether they can be implemented as written, and many believe that even if they are, they will do little to solve the current problems. Last month, the Medical Innovation Committee recommended establishing in advance routes for directly transferring patients with severe trauma, cerebrovascular and cardiovascular conditions, and childbirth-related emergencies to specialized centers. This, too, will only work if the designated centers have surgeons available around the clock. Lee said, "Everything the medical community called a minimum safeguard was left out of this law. We are looking for ways to include as much as possible in the enforcement decree and regulations."

The medical community says that, in the short term, priority should be given to recording why hospitals refuse to accept patients, assigning personnel to coordinate acceptance between hospitals, and establishing a system that designates in advance the hospital that will ultimately receive patients for each condition. In the longer term, it continues to call for institutionalizing compensation for staff providing follow-up care and separating compensation for medical accident victims from the personal liability of medical professionals.

This content was produced with the assistance of AI translation services.