South Korean Pediatric Rehabilitation Access Splits at Two Points in Care
South Korea’s pediatric disability system is exposing a problem that is easy to miss if utilization is treated as a single yes-or-no outcome. In a cross-sectional secondary analysis of the 2023 National Survey on Persons with Disabilities, medical rehabilitation access among children and adolescents with registered disabilities separated into two distinct bottlenecks: getting into medical-institution rehabilitation at all, and then staying within the home region once care had begun.
Among 399 respondents younger than 19 years, representing a weighted national estimate of 88,611, half had no medical-institution rehabilitation use. Another 31.5% received rehabilitation in their own region, while 18.6% received it outside their region. Among those who used rehabilitation, 37.1% reported out-of-region care. Those numbers point to a system in which geographic access is not a peripheral issue; it is built into the way children and families actually obtain therapy.
Non-Use and Bypass Reflect Different Clinical Barriers
The study’s design matters because it separates failure to enter care from regional bypass after entry. In pediatric rehabilitation, those are not the same event. A child who never reaches a medical institution may be facing referral gaps, substitution with non-medical services, transportation barriers, or a mismatch between perceived need and available services. A child who bypasses the local region has already crossed the threshold into care, yet still needs to travel farther to find the right provider, capacity, or expertise.
The most common reason for non-use was reliance on non-medical facilities, reported by 27.4% of non-users. That pattern suggests that families are often assembling rehabilitation from outside the formal medical system, likely because of convenience, access constraints, or the perceived fit of services with a child’s needs. For children with disabilities, the consequences can be concrete: inconsistent therapy intensity, fragmented oversight, and weaker coordination with physicians who can adjust plans as developmental demands change.
Disability Type and Residence Shaped the Probability of Use
Modified Poisson regression with robust standard errors identified several factors associated with the first stage of access. Children with non-developmental disabilities had a higher prevalence of medical rehabilitation use than those with developmental disabilities, with a prevalence ratio of 1.61 and a 95% confidence interval of 1.28 to 2.03. The direction of this association suggests that children with developmental disabilities may face more difficulty entering formal medical rehabilitation, or may be more likely to receive care through alternative channels that fall outside the medical-institution category.
Residence also mattered. Living in an eup/myeon area was associated with lower medical rehabilitation use, with a prevalence ratio of 0.66 and a 95% confidence interval of 0.46 to 0.94. Rural and semi-rural residence carries practical burdens in pediatric rehabilitation: repeated visits, caregiver time, transportation costs, and the need for frequent follow-up all become harder to sustain when services are not close to home. Rehabilitation is cumulative care, and when access is interrupted early, the downstream effect can be a thinner therapeutic dose than the child actually needs.
A single percentage point in a utilization table can conceal weeks of missed therapy, delayed developmental support, and greater strain on families.
Regional Bypass Concentrated Where Local Capacity Was Thin
The second stage of the analysis focused on children who already used rehabilitation and examined who sought care outside their region. Province residence was associated with a substantially higher likelihood of 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 care, 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 reasons families gave for bypassing local care are clinically intuitive. Better treatment and the absence of nearby medical institutions were leading explanations. In other words, distance was not merely a matter of inconvenience. It appears tied to perceived quality and local supply, the two factors most likely to drive families toward larger centers when children need specialized rehabilitation over time. When local services are sparse, families do not simply stay home; they make tradeoffs, travel farther, or shift into non-medical options.
Why the Two-Stage Access Model Fits Pediatric Disability Care
This framework is especially relevant in childhood disability because rehabilitation is rarely a one-time intervention. It is longitudinal, developmental, and family-centered. A child may need repeated reassessment as motor, communication, behavioral, or adaptive needs evolve. When access fails at the entry stage, children may miss early intervention during periods of high neurodevelopmental plasticity. When access fails at the regional stage, families may face greater logistical strain, and regional centers may become overloaded while local systems remain underused or underdeveloped.
South Korea’s health system offers universal insurance and a disability registration structure, yet the data show that formal coverage does not eliminate geographic or organizational barriers. In a country where pediatric infrastructure is already under pressure from low fertility, the findings point toward a health services problem rather than a narrow utilization quirk. Rehabilitation capacity, referral pathways, and service coordination all shape whether children receive timely care close to home or are pushed toward distant institutions.
Cross-Sector Integration Will Matter More Than Coverage Alone
The study’s own interpretation points toward three practical needs: local entry support, regional capacity-building, and cross-sector service integration. Those are not abstract policy phrases. They translate into more reliable referral pathways, stronger local rehabilitation supply, and better alignment between medical institutions and the non-medical services many families are already using. Children with disabilities do not experience health systems as separate silos; they experience whether therapy is reachable, consistent, and workable for the family.
The analysis is cross-sectional, so it cannot determine causality or track how utilization changes over time. It also relies on publicly available survey data from a national disability sample, which captures access patterns at a single point rather than the full clinical course of a child’s rehabilitation needs. Even so, the pattern is clear enough to raise a direct question for service planners: if half of registered children and adolescents are not using medical-institution rehabilitation, and more than a third of users are leaving their region for care, where exactly is the system failing them first?