Rehabilitation Access Splits Early for Korean Children With Disabilities
A national survey of Korean children and adolescents with registered disabilities shows a two-part access problem in medical rehabilitation: many never enter care at all, while a substantial share who do enter must travel beyond their home region for treatment. The divide is clinically important because pediatric rehabilitation is not a single event. It is a longitudinal process built around early referral, repeated visits, caregiver training, and therapies that must track development over time.
In the weighted sample, 50.0% had no medical-institution rehabilitation use, 31.5% used in-region rehabilitation, and 18.6% used out-of-region rehabilitation. Among rehabilitation users, 37.1% reported out-of-region care. Those proportions point to two different barriers operating in parallel. One barrier prevents entry into formal medical rehabilitation. The other pushes families to bypass their local area once rehabilitation has begun.
A Two-Stage Model Exposes Different Bottlenecks
The study used a two-stage access framework rather than treating rehabilitation as a simple yes-or-no outcome. Stage 1 asked whether a child had any experience of rehabilitation treatment at a medical institution. Stage 2 examined whether rehabilitation users received inpatient or outpatient care outside their residential region. This distinction matters because the forces driving non-use are not necessarily the same as the forces driving regional bypass.
Non-use may reflect substitution toward non-medical facilities, delayed recognition of need, transportation barriers, or weak local entry pathways. Out-of-region care suggests something different: local services may be unavailable, delayed, or perceived as inferior, prompting families to seek treatment elsewhere. In pediatric disability care, geography shapes access in a very direct way. Repeated appointments are hard to sustain when families must cross administrative regions for each therapy cycle.
The strongest descriptive signal came from the reason for non-use. The most common explanation was use of non-medical facilities, reported by 27.4%. Among those who did leave their region for care, better treatment and the absence of nearby medical institutions were leading reasons. In practice, this means that some families are not refusing rehabilitation; they are finding it outside the medical system or outside their own community.
Regional Geography Shaped Entry and Bypass
Regression analysis identified different correlates in each stage. In stage 1, non-developmental disability was associated with higher medical rehabilitation use, with a prevalence ratio of 1.61 and a 95% confidence interval of 1.28 to 2.03. Children living in eup/myeon areas were less likely to use medical rehabilitation, with a prevalence ratio of 0.66 and a 95% confidence interval of 0.46 to 0.94. The pattern is consistent with a service distribution problem: rural residence can depress entry even when disability is already registered.
Stage 2 revealed a different geography. Province residence was associated with greater out-of-region use, with a prevalence ratio of 2.13 and a 95% confidence interval of 1.38 to 3.27. Non-developmental disability type was also associated with out-of-region use, with a prevalence ratio of 1.74 and a 95% confidence interval of 1.13 to 2.69. Male sex was associated with lower out-of-region use, with a prevalence ratio of 0.62 and a 95% confidence interval of 0.42 to 0.92.
The regional gradient is clinically intuitive. When local pediatric rehabilitation capacity is thin, families in provinces may be more likely to cross boundaries to obtain therapy, particularly if the perceived quality or breadth of services is better elsewhere. This can create a hidden access burden: a child is not technically untreated, yet still faces repeated travel, caregiver time loss, and fragmented continuity of care.
Why Pediatric Rehabilitation Depends on Proximity
Pediatric rehabilitation differs from many other forms of care because it often depends on repetition. Children with motor, sensory, communication, cognitive, or adaptive limitations may need ongoing therapy, assistive device support, developmental monitoring, and family coaching. A single visit rarely changes function on its own. Progress is usually cumulative, and gaps in attendance can erode gains quickly.
South Korea offers a revealing setting for this question. The country has universal health insurance and a national disability registration system, but formal coverage does not guarantee that rehabilitation is nearby, timely, or easy to navigate. The problem is especially relevant in a country with low fertility and long-term pressure on pediatric infrastructure. If local rehabilitation services are concentrated in urban centers, families in smaller communities may face a choice between limited nearby care and travel-heavy care elsewhere.
The survey data also reflect the administrative complexity of access. Local residence was defined as urban versus rural, while broader geography separated metropolitan city/Sejong from provinces. Out-of-region care used a nine-region classification that included the Capital Area, Gangwon, Gyeongbuk, Gyeongnam, Chungbuk, Chungnam, Jeonbuk, Jeonnam, and Jeju. The outcome therefore captured real cross-region movement, not merely a small change in local clinic choice.
What the Survey Can and Cannot Show
The analysis drew on public-use microdata from the 2023 National Survey on Persons with Disabilities and restricted the sample to respondents younger than 19 years because the pediatric rehabilitation items were only asked in that age group. The final analytic sample included 399 respondents, representing an estimated 88,611 community-dwelling children and adolescents with registered disabilities nationwide. Because many children could not respond directly, proxy responses were retained.
The investigators used weighted descriptive statistics and modified Poisson regression with robust standard errors to estimate prevalence ratios and confidence intervals. The public-use file did not include primary sampling unit and stratum identifiers, so clustering and stratification could not be fully incorporated into variance estimation. That leaves the point estimates intact, but uncertainty measures should be interpreted with caution because the full survey design was not available in the public file.
Even with that limitation, the main clinical message is hard to miss. Access problems are not confined to one step in the pathway. Some children never enter medical rehabilitation, while others enter but must leave their region to obtain it. Those are distinct failures of access, and they call for different fixes.
Local Entry Support and Service Capacity Remain Central
The policy implications are direct. Local entry support could help families move from disability registration to appropriate medical rehabilitation sooner. Regional capacity-building could reduce the need for out-of-region travel, especially in provinces and rural communities. Cross-sector service integration may also matter, since the high use of non-medical facilities suggests that many families are already navigating between formal medical care and alternative rehabilitation settings.
For clinicians, the findings argue for early questioning about where rehabilitation is delivered, not just whether it is being used. A child who receives therapy far from home may still be counted as “in care,” yet face practical obstacles that undermine consistency, follow-up, and family adherence. In pediatric disability care, distance is not a background detail; it is part of the treatment burden itself.