KJCKorea
Journal Central

Purpose: In July 2025, Korea's Ministry of Health and Welfare began designating general hospitals meeting three criteria - acute-care accreditation, regional emergency institution status or higher, and 350+ surgical/procedural service types - as "Comprehensive Secondary General Hospitals," creating a new intermediate tier between tertiary and general hospitals. This study examines the actual facility and staffing characteristics of this new category, comparing medical resource allocation and architectural floor area across hospital tiers. Methods: Using data from 376 general hospitals and above nationwide (47 tertiary, 175 comprehensive secondary, 154 general secondary), the study compared beds, specialist physicians, major medical equipment, and floor area by category, testing statistical significance (ANOVA) and calculating coefficients of variation (CV) to assess within-category dispersion. Results: All indicators - including number of beds, number of specialist physicians, major medical equipment, and floor area - showed statistically significant differences across hospital categories (p < .001). Medical-facility floor area per bed differed markedly by category (105.6 ㎡ for tertiary general hospitals, 76.9 ㎡ for comprehensive secondary hospitals, and 56.2 ㎡ for general secondary hospitals; F = 56.95, p < .001). However, the coefficient of variation within the comprehensive secondary hospital category (44.0%) was notably higher than that of tertiary general hospitals (26.4%), indicating substantial internal variation in facility levels within the same category. The coefficient of variation for the number of DRGs was likewise the largest among comprehensive secondary hospitals (31.0%) of the three groups. Implications: These findings suggest that although comprehensive secondary general hospitals constitute a single category institutionally, they may in practice be a heterogeneous group. This offers exploratory evidence for the need to establish minimum facility standards that architecturally support the intent of this designation.

Purpose: This study examines how the Designated Block System and Fixed-term Land Lease Right combined to enable the redevelopment of St. Luke's International Hospital, and compares this mechanism with corresponding Korean institutions to examine the structural constraints underlying their limited implementation to date. Methods: The redevelopment process of St. Luke's International Hospital was analyzed through literature review and field observation, and compared with Korean institutions. Results: St. Luke's International Hospital combined cross-block floor area redistribution under a single designated block with Fixed-term Land Lease Right agreements that preserved land ownership, channeling development revenue into reconstruction financing. This institutional combination allowed density-independent building form, extensive non-revenue communal space, and a mixed-use urban environment. In contrast, corresponding Korean institutions are limited to single-site FAR relaxation, mandate public contributions entailing perpetual operational burdens while blocking revenue-generating uses, and lack pathways for external capital due to restrictions under the Medical Service Act. Implications: This study suggests introducing multi-site floor area redistribution instruments, reconsidering the balance between public contribution and financial sustainability, and revising the Medical Service Act to enable external capital utilization.

Purpose: This study analyzes healthcare facility construction procedures and cost review processes to identify the causes of construction cost increases and corresponding measures. Methods: Relevant laws, guidelines, and 59 local government investment review cases from 2021 to 2025 were analyzed. Two public healthcare facility projects under KRW 50 billion were compared in terms of cost changes, estimation methods, and adjustment processes. Results: Among the reviewed projects, 81.4% were under KRW 50 billion. In both cases, concerns about insufficient construction costs were raised before design, and construction costs increased as the design progressed due to higher unit costs and additional construction requirements. Both projects consequently underwent adjustments in scale and functions. Differences were found in the level of cost estimation during basic design and in responses to subsequent cost increases, particularly in the use of contingency funds. The two case analyses suggest realistic initial unit cost estimation reflecting healthcare facility characteristics, incorporation of cost review recommendations after the investment review, contingency funds for projects under KRW 50 billion, and detailed cost estimate reviews during basic design. Implications: Construction cost management should be coordinated throughout the project, from realistic initial cost estimation to cost review and adjustment during design. Relevant procedures and criteria should also be improved to respond effectively to construction cost fluctuations during healthcare facility construction.