Regional disparity persists in Korean pediatric CHD care, with marked centralization of surgery in Seoul, while regional access to catheterization has improved, yet high-risk subgroups (infants and cyanotic CHD) continue to receive out-of-region care.
Key Findings
Results
Surgical volume for congenital heart disease in Korea declined over the study period, but the proportion of complex surgeries rose significantly.
The study analyzed 6,438 surgeries and 11,276 catheterizations across 2012, 2017, and 2022 datasets.
The proportion of complex surgeries rose from 42.9% in 2012 to 54.1% in 2022.
Data were drawn from the National Health Insurance Sharing Service database, covering patients aged 0–19 years.
The study design was a procedure-level, cross-sectional analysis.
Results
Surgical care for congenital heart disease was highly centralized in Seoul, with a Regional Utilization Ratio (RUR) greater than 4.0 in 2022.
RUR was defined as the number of procedures performed within a region divided by the procedures received by its residents.
Seoul's RUR for surgery exceeded 4.0 in 2022, indicating that the region performs far more surgeries than its own resident population requires.
53.8% of surgeries were performed outside the patient's residential region.
Out-of-region surgery was more likely for complex procedures, cyanotic CHD, and patients aged 1–5 years, as identified by multivariable logistic regression.
Results
Catheterization volume increased nationally and regional access improved, with the proportion of inter-regional catheterizations decreasing substantially over the study period.
The proportion of inter-regional catheterizations decreased from 29.2% in 2012 to 15.2% in 2022.
Regional RUR for catheterization rose over the study period, indicating greater local availability.
Despite overall improvement, migration for catheterization remained more frequent among infants, those with cyanotic CHD, those with higher socioeconomic status, and those with cardiac disability registration.
These determinants of out-of-region catheterization were identified through multivariable logistic regression.
Results
Infants and patients with cyanotic congenital heart disease consistently represented high-risk subgroups more likely to receive care outside their residential region for both surgery and catheterization.
Cyanotic CHD was a significant determinant of out-of-region care for both surgical and catheterization procedures.
Infant age was associated with increased likelihood of inter-regional migration for catheterization.
Age 1–5 years was associated with increased likelihood of out-of-region surgery.
These patterns persisted across the study years 2012, 2017, and 2022.
Results
Higher socioeconomic status and cardiac disability registration were associated with greater likelihood of seeking care outside the residential region for catheterization.
Multivariable logistic regression identified higher socioeconomic status as a determinant of out-of-region catheterization care.
Cardiac disability registration was also identified as a determinant of inter-regional migration for catheterization.
The authors suggest that patient perceptions and preferences, in addition to structural access barriers, may contribute to out-of-region care-seeking behavior.
The study calls for 'efforts to shift patient perceptions and strengthen institutional collaborations' as part of addressing disparities.
Conclusions
The authors identified strategic investment in regional infrastructure and workforce development as essential to addressing persistent geographic disparities in pediatric CHD care in Korea.
The study recommends 'strategic investment in regional infrastructure and workforce development' to ensure equitable care.
The authors note that both supply-side factors (regional capacity) and demand-side factors (patient perceptions) contribute to migration patterns.
Strengthening institutional collaborations was also recommended as a strategy.
The goal articulated is 'timely, equitable, and high-quality CHD care for all children across Korea.'
What This Means
This research examined where children with congenital heart disease (CHD) in Korea received surgical and catheterization procedures over a decade (2012–2022), using a nationwide insurance database. The study found that while the total number of heart surgeries declined, the operations being performed became more complex over time. Heart surgery remained heavily concentrated in Seoul, with more than half of all CHD surgeries performed outside a patient's home region. In contrast, access to catheterization procedures (a less invasive diagnostic and treatment approach) improved markedly across the country, with the share of patients traveling outside their region for these procedures dropping from about 29% to 15%.
Despite overall improvements in catheterization access, certain groups of children were consistently more likely to travel far from home for care. Infants, children with cyanotic (oxygen-deficient) forms of CHD, and those with more complex conditions were especially likely to seek care outside their residential region for both surgery and catheterization. Interestingly, children from higher socioeconomic backgrounds and those registered as having a cardiac disability were also more likely to travel, suggesting that both structural barriers and patient or family preferences play a role in care-seeking behavior.
This research suggests that Korea has made meaningful progress in expanding regional access to catheterization for children with heart defects, but surgical care remains highly centralized in the capital. High-risk children, particularly infants and those with more severe forms of CHD, continue to bear the burden of long-distance travel for essential care. The findings point to the need for investment in regional hospital capacity and specialized workforce training, as well as efforts to build public confidence in care available outside major urban centers, so that all children with CHD can access timely, high-quality treatment closer to home.
Jeong S, Kim H, Kim H. (2026). Nationwide Analysis of Surgery and Catheterization Services for Congenital Heart Disease: Regional Disparities and Patient Migration in Korea.. Journal of Korean medical science. https://doi.org/10.3346/jkms.2026.41.e120