Introduction of a Pilot Project to Establish a Regional Comprehensive Medical Response System in 2023

Abstract

To overcome the repeated experience of hospital bed and medical personnel shortages for epidemics such as coronavirus disease 2019 delta and omicron, the Korea Disease Control and Prevention Agency (KDCA) announced the “Mid- to Long-term Plan for Emerging Infectious Disease Pandemics” in May 2023. A key goal of this was “establishing a response system capable of responding to 1 million confirmed cases per day.” Accordingly, the KDCA promoted “A Pilot Project to Establish a Regional Comprehensive Medical Response System” as one of its core tasks of “significantly expanding medical response infrastructure and establishing a specialized treatment system.” In 2023, each region established consultative bodies focused on infectious diseases, centered on regional hospitals, thereby laying the foundation for tailored medical response systems. However, budget constraints leading to a lack of dedicated personnel, participating organizations' limited understanding, and policy gaps due to exclusion of key bodies like the Ministry of Health and Welfare and Central Infectious Disease Hospital emerged as challenges. To further develop a medical response system tailored to the characteristics of the region, the performance of the project needs to be strengthened and its limitations improved.

Key messages

① What is known previously?

After the Middle East respiratory syndrome outbreak in 2015, a regional infectious disease hospital was designated to respond to the national public health crisis caused by a new infectious disease. Furthermore, procedures are being carried out in accordance with the total project cost management guidelines.

② What new information is presented?

The pilot project to establish a regional comprehensive medical response system will enable each region to strengthen its capacity to respond to infectious disease crises.

③ What are implications?

To strengthen the region's medical response capacity in the event of a new infectious disease, the performance of the aforementioned pilot project needs to be strengthened, its limitations improved, and a medical response system tailored to the characteristics of the region developed.

Introduction

As new infectious diseases such as Middle East respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19) emerge periodically and outbreak cycles become shorter, establishing a permanent medical response system for these diseases has become a priority. For instance, the lack of a control tower in the response system exposed issues such as a shortage of beds, a lack of infrastructure for treatments intended for critically ill and special patients, and an insufficient number of testing facilities for patients with infectious diseases during the MERS epidemic.

Accordingly, Article 8.2 (pertaining to infectious disease hospitals) of the Act on Prevention and Control of Infectious Diseases was enacted to serve as the legal basis for the establishment and operation of hospitals specialized in treating infectious diseases. Additionally, the amendment of the “National Quarantine System Reorganization Plan” (September 1, 2015) and construction of regional infectious disease hospitals were promoted as national tasks. Following the designation of Chosun University Hospital as the first infectious disease-specialized hospital in the Honam region in 2017, Soonchunhyang University Cheonan Hospital and Pusan National University Yangsan Hospital were additionally designated in the Chungcheong and Gyeongnam regions, respectively, in 2020. Then in 2021, Kyungpook National University Chilgok Hospital was designated in the Gyeongbuk region, followed by the designation of Seoul National University Bundang Hospital in the capital region in 2022. Thus, overall, five hospitals were designated as specialized in treating infectious diseases and are currently under construction (Table 1).

Table 1. Status of regional infectious disease hospital designation.

Region	Honam	Chungcheong	Gyeongnam	Gyeongbuk	Capital region
Hospital name	Chosun University Hospital	Soonchunhyang University Cheonan Hospital	Pusan National University Yangsan Hospital	Kyungpook National University Chilgok Hospital	Seoul National University Bundang Hospital
Designated date	August 21, 2017	July 31, 2020	July 31, 2020	July 26, 2021	April 13, 2022

These hospitals will focus on diagnosing and treating patients with novel infectious diseases in their respective geographical regions; educating and training specialists in responding to these emerging diseases; assigning and coordinating the transfers of patients with infectious diseases between cities; and treating critically ill patients requiring surgery or dialysis or who are due for childbirth. To preemptively perform the functions of an infectious disease-specialized hospital even before its completion, the “Pilot Project for Establishing a Regional Medical Response System” was launched in 2023.

In this policy report, we examine the results of the pilot project to establish a regional comprehensive medical response system, review the limitations of the project, and explore ways to improve the project for future applications.

Results

1. Overview of the Pilot Project for Establishing a Regional Medical Response System

During the COVID-19 pandemic, the Korea Disease Control and Prevention Agency (KDCA) faced limitations of centrally led medical response systems, such as medical gaps due to administrative boundaries, patient deaths during transport from one region to another owing to imbalance of medical resources between regions, patient deaths while waiting at home owing to a lack of beds, and on-site medical response by unskilled personnel employed on an ad hoc basis, resulting in excessive social costs [1-4]. To tackle these challenges and prepare for the management of emerging infectious diseases, the KDCA launched a pilot project to establish a regional comprehensive medical response system in April 2023. In accordance with mid- to long-term plans to prepare for pandemics of emerging infectious diseases, the task of expanding the medical response infrastructure was promoted by constructing regional infectious disease hospitals and nationally designating inpatient and emergency treatment beds while promoting the establishment of a functional medical response system [5].

The pilot project for establishing a regional comprehensive medical response system was aimed at creating a plan tailored to the characteristics of each region, centered on regional infectious disease hospitals, and establishing a step-by-step (central-regional-local) coordination and cooperative system. The goal was to institute a region-specific medical response plan for infectious diseases, which would include medical response resource surveys, resource mobilization plans, and patient referral and transfer plans. In addition, a consultative body involving local governments, regional medical institutions, infectious disease experts, and others was established to serve as a permanent cooperative network within regions.

The details are as follows.

First, a medical response council for emerging infectious diseases was formed. It comprised local governments and medical institutions, centered on infectious disease-specialized hospitals in the five specified regions and KDCA disease response centers. This council discussed medical response plans according to epidemic patterns of infectious diseases, shared infectious disease information as well as domestic and international response cases, and formed a permanent cooperation network within the region.

Second, a survey of resources in the area, such as infectious disease response personnel and hospital beds, was conducted. Previously, there were problems in understanding the status of hospital bed resources during the COVID-19 response. Therefore, to reduce such problems during future pandemics, a survey of resources must be conducted beforehand.

Third, infectious disease response personnel were educated and trained. Training programs for healthcare personnel were developed and implemented, and joint regional exercises that simulate an outbreak of an emerging infectious disease were conducted. The goal of these programs was to enhance the capacity of medical personnel to respond to infectious disease crises and, in the future, enable rapid initial response to new infectious diseases to curb their spread.

2. Results of the Pilot Project for Establishing a Regional Medical Response System

The pilot project, which was launched in 2023, was the first of its kind to focus on regional infectious disease-specialized hospitals and resulted in the enhancement of communication capabilities within regions by forming a regional network among the key medical response entities, the KDCA (regional disease response centers), local governments, and private medical institutions. In addition, the medical resource survey laid the foundation for the development of a national resource management system in the future, and it is significant that by conducting medical personnel education and mock training sessions, each regional infectious disease-specialized hospital was the first to perform its statutory functions even before the completion of the infectious disease wing in each hospital.

1) Capital region

In capital region, a medical response roadmap centered on Seoul National University Bundang Hospital, headed by Professor Eui-suk Kim, was established. An advisory group of medical response experts focused on capital region infectious disease hospitals and disease response centers was formed, and through the involvement of this group, a roadmap for medical responses to novel infectious diseases was created to ensure the efficient management of and response to infectious diseases. By conducting literature reviews of infectious disease responses through an advisory group including various experts and researching medical responses by local governments and public hospitals overseas (Tokyo, Japan), we not only developed a roadmap for medical responses but also formed a regional cooperative network.

In addition, a survey was conducted of 40 medical institutions including tertiary hospitals, general hospitals, and public medical institutions in the Gyeonggi region to investigate medical response resources as well as education status and needs. Support was provided for the establishment of training programs applicable to each institution and joint public-private mock training sessions were conducted.

2) Chungcheong region

In the Chungcheong region, a consultative body was formed with related organizations such as the designated Soonchunhyang University Cheonan Hospital, headed by Professor Min-hyeok Jeon, the regional KDCA disease response center, local governments, and 12 medical institutions in the region. The council shared experiences in responding to COVID-19 and discussed problems that arose during the response process and improvement measures.

In addition, the status of medical resources in the region was updated through the consultative body, and a course was conducted by the Chungcheong Infection Control Academy to provide infectious disease education to medical personnel. The course was conducted four times and completed by 246 medical personnel. It included theoretical and practical training on donning and doffing personal protective equipment used in infectious disease crises. The joint mock training sessions were large-scale public-private-military collaborations in which the Armed Forces Medical Research Institute also participated.

3) Gyeongbuk region

A simulated bed control scenario was developed through a regional council led by the designated Kyungpook National University Chilgok Hospital, headed by Professor Ki-tae Kwon. The number of critically ill patients and the demand for intensive care units owing to an infectious disease outbreak in the region were estimated using a mathematical model that reflects regional and age-specific characteristics, and based on this, a scenario adjusting for the number of hospital beds was presented.

Moreover, based on the results of the survey on resources such as manpower, beds, and equipment of medical institutions in the region, as well as the survey itself, medical institutions were divided into four levels (A to D) and an operating model for each level of medical institutions was developed. Since medical resources vary greatly by medical institutions, applying a uniform operation model may result in issues such as compatibility. Hence, separate operation models were created based on each medical resource.

4) Gyeongnam region

A focus group interview was conducted with local governments (nine municipal and provincial health centers, 11 participants) and medical institutions (five medical centers and general hospitals, nine participants) within the regional council, led by the designated Pusan National University Yangsan Hospital. Based on a review of the COVID-19 response experience, an in-depth evaluation of the current response system was conducted in five categories, including medical resources, patient care system, education and training, and governance. The results were shared with the council to analyze problems and identify improvement measures.

A survey of medical resources within the region and a joint mock training session were also conducted in preparation for emerging infectious diseases. In terms of educating and training medical personnel, a preliminary needs survey was conducted, targeting medical institutions responding to infectious diseases. This laid the foundation for developing customized programs for each institution.

5) Honam region

In Honam, as in the other regions, the regional KDCA disease response center and the designated Chosun University Hospital, headed by Professor Jun-Won Seo, organized a council of related organizations including 15 medical institutions and local governments to discuss the division of roles in responding to infectious diseases, lay the foundation for integrated resource mobilization, and establish a cooperative network.

A joint mock training session was also conducted in preparation to respond to new infectious diseases. A joint response situation room was set up for joint simulation exercises involving detailed scenarios such as classifying the severity of patients’ conditions, assigning beds according to disease severity, and implementing an initial response when patients arrive after bed allocation (Table 2).

Table 2. Main results of pilot projects by region.

Region	Main result
Capital region	Development of a ‘roadmap (draft) for responding to new infectious diseases’ through overseas case studies, etc.
Chungcheong	Conducted joint public-private training with participation from 4 cities, provinces, and 12 medical institutions in the region
Honam	Conducted joint public-private training with participation from 4 cities, provinces, and 15 medical institutions in the region
Gyeongbuk	Establishment of a hospital bed response operation model for each stage of crisis through tier classification by medical institution characteristics
Gyeongnam	Conducted joint public-private training with participation from 3 cities, provinces, and 9 medical institutions in the region

3. Limitations of the Pilot Project for Establishing a Regional Medical Response System and Ways to improve

1) Limitations of the pilot project

The pilot project exposed the following limitations.

First, there was a lack of professionalism and continuity in the execution of the project owing to a lack of dedicated personnel. Staff members lacked understanding of the project needs because they were performing additional duties outside of their main job, which led to limitations such as a lack of professionalism and administrative weaknesses in promoting the project.

Second, there was a concern that the Ministry of Health and Welfare and the National Medical Center would not participate in the project, which could lead to a loss of momentum for the establishment of policies and legislation related to emerging infectious diseases. There are also concerns that the performance of the project may not be consistent with the policy direction of the Ministry of Health and Welfare, which is in charge of the overall medical responses in times of crises, or that the functions of regional infectious disease hospitals may not be consistent with the policy direction of the National Medical Center.

Third, there was a lack of legal basis for the designated infectious disease-specialized hospitals to function as control towers within their jurisdictions. In addition to patient care, which is a hospital's key function, infectious disease-specialized hospitals need to collaborate with related organizations to mobilize medical resources (manpower and equipment) within the region, manage referral systems, and conduct education and training programs. Hence, it is necessary to provide institutional support to increase the interest and participation of local governments and medical institutions.

2) Directions for improvement

To overcome the limitations of the 2023 pilot project, several changes were made to the 2024 project. In 2024, the project name was changed to “Medical Response System Construction Project Centered on Infectious Disease-specialized Hospitals.” The project continues to promote the establishment of permanent regional medical response systems with the Ministry of Health and Welfare and the National Medical Center. The budget allocated per region, which was only 50 million won at the time of the pilot project, has been increased to 250 million won per region in 2024, enabling improvements in the effectiveness and quality of the project by securing dedicated personnel.

There were also changes in the project content. In the 2024 project, statutory functions of the designated regional infectious disease hospitals in 2023 will be performed as basic functions and specialized projects by region will be added. The capital region is promoting the “Enactment of the Basic Law for the Smooth Functioning of Infectious Disease-specialized Hospitals” as a specialized project. The purpose of this is to review and clarify the basis for performing the functions of the central government, local governments, infectious disease hospitals, etc. In the case of the Gyeongbuk region, based on prior experience of being mobilized whenever there was a shortage for manpower management without specific standards during the COVID-19 response process, the “Establishment of Standards for Medical Personnel Responding to Infectious Diseases” will be promoted as a specialized project, and the Chungcheong region will develop an infectious disease response training program for medical personnel. The Honam region is developing a program to understand the status of hospital beds. The KDCA is supporting specialized projects in each region and examining ways to institutionalize the results of the projects.

Conclusion

The KDCA has worked to establish a regional medical response system by organizing and operating a consultative body among infectious disease-related organizations through the “Pilot Project for Establishing a Regional Medical Response System” in which regional infectious disease hospitals and local governments participated.

The project showed that in order to establish a permanent regional medical response system, it is important to prepare an operational plan to practically fulfill legal functions such as diagnosis and treatment of patients with infectious diseases, education and training of medical personnel, and assignment of patients with infectious diseases during crises and otherwise, even before the completion of a physical building, and to establish a full-time cooperative network among participating organizations to ensure organic responses.

In the future, the KDCA plans to further strengthen the cooperative system among participating organizations to establish a medical response system for novel infectious diseases and to promote the advancement of projects by initiating specialized projects in each region.