South Korea is considering expanding access to pediatric care with “dawn star” clinics, offering services during early morning hours to accommodate working parents-a move already being tested in cities like Busan. However, the ministry of Health and Welfare has expressed concerns over a nationwide rollout, citing a persistent shortage of pediatric specialists and the potential for exacerbating regional healthcare disparities. Following discussions at a recent National Assembly forum, officials are weighing the logistical and financial challenges of ensuring sustainable and equitable access to pediatric care across the country.
South Korea’s Ministry of Health and Welfare has expressed reservations about expanding pediatric care access through the creation of “dawn star” clinics offering early morning hours, citing a critical shortage of pediatric specialists.
The concern comes as local governments explore ways to supplement existing “moonlight” pediatric clinics – facilities offering extended evening hours – to better serve working families. The move underscores the challenges of ensuring equitable healthcare access across the country.
During a National Assembly forum on expanding support for pediatric hospitals on December 12, officials acknowledged the growing competition for limited pediatricians between regions and medical institutions. “The number of pediatric specialists being produced is insufficient, and it will be difficult for the number of new personnel to increase in the coming years,” said Cho Young-dae, an official in the Ministry of Health and Welfare’s Emergency Medical Affairs Office. “As a result, a situation is emerging in which competition is intensifying among regions or medical institutions for a limited number of pediatric specialists.”
The discussion was prompted by a successful initiative in Busan’s Saha District, which recently passed an ordinance supporting “dawn star” pediatric clinics. Gang Hyeon-sik, a member of the Saha District Council, explained that residents repeatedly requested earlier access to pediatric care. “The ‘Dawn Star Pediatric Hospital Support Ordinance’ provides a basis for local governments to support medical institutions that provide pediatric outpatient care during pre-commute hours, expanding on the purpose of the existing ‘Moonlight Pediatric Hospital’ system,” Gang said.
Gang emphasized the need for long-term financial support to ensure the viability of such clinics. “In order for the ordinance to be effective, a mid- to long-term support structure for pediatric outpatient care must be established. A sustainable support system for a certain period is essential before medical institutions can participate, and discussions on medical fees and compensation systems that can alleviate the burden on medical personnel during dawn hours should be considered together,” he stated.
However, the Ministry of Health and Welfare signaled that implementing a nationwide “dawn star” system would be difficult. Cho Young-dae explained that when regions offer financial incentives to attract pediatricians, it often leads to a redistribution of doctors, creating shortages in surrounding areas. “If support measures are introduced to improve pediatric care in a region, personnel will move to that region, temporarily improving the medical conditions in that region, but conversely, a void will occur as medical personnel in the surrounding areas decrease,” he said.
He also noted that the existing support policies, like the “moonlight” clinics, can inadvertently draw pediatricians away from university hospitals. “Because the pediatric field is very difficult, when support policies such as moonlight pediatric hospitals are implemented, university hospital professors are also moving to local areas,” Cho said. “It is not appropriate for local governments to discuss this, and a large-scale institutional improvement discussion is needed at the national level.”
Concerns were also raised about the potential for uneven distribution of resources and the financial sustainability of the clinics. Cho pointed out that patient volume during the proposed hours of 6 a.m. to 9 a.m. is relatively low, around 5%, making it difficult for clinics to remain profitable even with support.
Choi Yong-jae, president of the Korean Pediatric Hospital Association, cautioned against designing the program in a way that would further strain already overworked pediatricians. “The ‘Dawn Star Pediatric Hospital Ordinance’ must not be designed as a program that further exhausts aging pediatricians,” Choi said. “A one-year pilot project structure is doomed to fail. Sustainability for at least 3-5 years is essential, and a connection to institutional improvements with the central government is essential.”
