Essential healthcare on verge of collapse in Incheon's island districts, shut out of government aid

Essential healthcare infrastructure in Incheon's Ganghwa-gun and Ongjin-gun has effectively collapsed, a new analysis shows.

The two districts rely heavily on other regions for maternity care, neonatal treatment and critical emergency services. Yet because they fall within the Greater Seoul metropolitan area under administrative classifications, they are being left behind by government policies designed to support essential healthcare in underserved regions, critics say.

Rep. Heo Jong-sik of the Democratic Party of Korea — who represents Incheon's Dong-gu and Michuhol-gu Gap constituency — released an analysis Wednesday of data from the National Medical Center's HealthMap and the Ministry of Health and Welfare's public health records. It found that in 2023, the in-district utilization rate for delivery rooms in both Ganghwa-gun and Ongjin-gun stood at 0%.

High-risk delivery units, newborn nurseries and neonatal intensive care units likewise recorded in-district utilization rates of 0%. Neither district has any functioning local infrastructure to serve expectant mothers or newborns requiring medical care.

The picture is no better for emergency care. Both Ganghwa-gun and Ongjin-gun showed 100% out-of-district reliance for regional and local emergency medical centers alike.

Ongjin-gun, made up entirely of islands, fared worst: its in-district emergency room utilization rate was limited to 1.5%, meaning more than 98 out of every 100 emergency patients are transferred elsewhere for treatment.

Emergency access ranks among the worst in the country. In Ongjin-gun, 93.5% of the population cannot reach a regional emergency medical center within 60 minutes, and 100% of residents cannot reach a local emergency medical center within 30 minutes.

Ongjin-gun has also been designated a vulnerable area across multiple core medical fields simultaneously — maternity care, pediatrics, emergency medicine and dialysis. The share of the population classified as underserved stands at 95.1% for maternity care, 95.9% for pediatrics and 93.6% for dialysis services.

The absence of resident internists and obstetricians at hospital-level facilities underscores the severity of the healthcare gap. Not a single full-time specialist in internal medicine or obstetrics and gynecology is stationed at any hospital-grade institution in either district.

Since July 2024, an obstetrician has been working at Baengnyeong Hospital through a program targeting maternity care deserts, but no actual deliveries have been recorded there so far.

The lack of medical infrastructure is taking a measurable toll on residents' health. Ongjin-gun's age-standardized mortality rate stands at 381.8 per 100,000 people — the highest in the country.

Ganghwa-gun faces serious challenges as well. Some 42.5% of its population cannot reach a regional emergency medical center within 60 minutes, and 98.9% cannot access a local emergency medical center within 30 minutes.

Particularly concerning, 37.2% of Ganghwa-gun's population is aged 65 or older, making it a super-aged community. Older residents have greater needs for emergency and chronic disease management, yet the district's only general hospital emergency room is struggling to stay operational due to staff shortages and financial difficulties.

The gap in essential healthcare between regions is severe nationwide. As of 2023, 70 of the country's 229 cities, counties and districts were classified as pediatric care deserts, with two or fewer pediatric specialists. Ganghwa-gun and Ongjin-gun stand out even within that group, facing simultaneous shortfalls across maternity, emergency and pediatric care — making the need for action more urgent, analysts say.

The core problem, critics argue, is that the government's criteria for essential healthcare support do not adequately reflect actual local conditions.

Various government essential-care initiatives — including support programs for general hospitals and the building of regional pediatric care networks — are designed primarily around large cities and major hospitals. Because Ganghwa-gun and Ongjin-gun belong to Incheon, which falls within the Greater Seoul area, they risk being placed at a disadvantage when support eligibility is determined.

Particular concern surrounds a planned special fiscal account for regional and essential healthcare, worth around 1.2 trillion won, set to be established in 2027. If a blanket exclusion of the Greater Seoul area is applied, the islands and border communities that are the most medically underserved within that zone could paradoxically be shut out of national support.

Fiscal capacity is another obstacle. Ganghwa-gun's fiscal self-reliance ratio stands at 12.3% and Ongjin-gun's at 8.7%, leaving both districts unable to fund large-scale medical infrastructure or recruit specialists on their own, observers note.

Rep. Heo called on the Incheon city government and the central government to work together to establish a dedicated "island essential medical support center" backed by national funding.

"The reality for Incheon's island communities is that pregnant women must travel to other regions to give birth, and newborns needing treatment must depend on the mainland," Heo said. "Support eligibility cannot be determined solely on the basis of an administrative label like 'Greater Seoul area.'"

He added that the government should establish separate national support criteria that assess the medical conditions of island and border communities on their own terms, apply healthcare exemptions under the Seoul Metropolitan Area Readjustment Planning Act, and create distinct allocation standards for islands and underserved areas within essential healthcare support programs.

Heo also identified improving the emergency transport system as a priority, calling for an expanded air medical evacuation network including doctor helicopters, priority deployment of regional essential physicians to medically vulnerable areas, and state support for the costs borne by patients transferred for emergency care.

"A person's life and health should not depend on whether they happen to live in an area with access to medical services," Heo said. "I will do everything in my power at the National Assembly to build a comprehensive national response — including establishing an island essential medical support center backed by government funding and expanding the emergency transport network — to close the healthcare gap in Ganghwa-gun and Ongjin-gun."