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

Area of Science:

• Health Services Research
• Public Health Policy
• Medical Economics

Background:

• South Korea faces physician shortages, prompting a government plan to increase medical school enrollment.
• This led to a large-scale walkout by trainee physicians, with unclear systemwide implications.

Purpose of the Study:

• To analyze the association of the trainee physicians' walkout with mortality, healthcare utilization, and spending patterns.
• To assess the impact on teaching hospitals during the physician walkout.

Main Methods:

• Retrospective cohort study using nationwide health insurance claims data.
• Employed a historical-control event-study design comparing data before and after the walkout.
• Analyzed weekly hospital-level outcomes including mortality, inpatient/outpatient visits, and spending per encounter.

Main Results:

• The walkout correlated with small, short-term increases in weekly and 30-day mortality, mainly for general conditions.
• Significant reductions observed in both inpatient and outpatient healthcare use, with a greater relative decline in inpatient care.
• Mean spending per hospitalization increased, particularly for general conditions, while outcomes for complex conditions remained stable.
• Little evidence suggested a shift in care to non-teaching hospitals.

Conclusions:

• The trainee physicians' walkout was linked to minor, temporary increases in mortality and reduced healthcare use, concentrated in general condition admissions.
• Teaching hospitals appeared to prioritize high-acuity care for complex conditions, stabilizing those outcomes.
• Swift hospital and governmental interventions may have mitigated harm and aided resource allocation.