{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:53:29Z","timestamp":1791546809126,"version":"4.3.4"},"reference-count":44,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Medical Center, Seoul, South Korea","award":["NMC2021-General Research Program-09"],"award-info":[{"award-number":["NMC2021-General Research Program-09"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Social Determinants of Health and Health Services"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>The COVID-19 pandemic was a global public health crisis that demanded a \u201cwhole-of-society\u201d response. In many countries, coordinating efforts across public and private health care sectors proved challenging. Yet South Korea maintained one of the world's lowest excess mortality rates despite having a predominantly privatized health care system, with 90.3% of hospital beds privately owned. This outcome was enabled in part by the government's strategy of disproportionately mobilizing and repurposing public hospitals as dedicated COVID-19 treatment facilities. These hospitals, historically few in number, chronically under-resourced, and marginalized as safety nets for vulnerable populations, became the backbone of Korea's health care system response. This qualitative study examines how this process unfolded and its consequences for public hospitals and marginalized populations they serve, drawing on in-depth interviews with public hospital staff and community activists, complemented by publicly available government reports and administrative data. Our findings reveal that the repurposing of public hospitals was carried out through a highly centralized, top-down process with minimal coordination, inadequate legal safeguards, and no institutional protection. This approach generated short-term gains but ultimately led to reduced patient trust, financial instability, and a staffing exodus that compromised the long-term capacity of the public health sector.<\/jats:p>","DOI":"10.1177\/27551938261449602","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:33:41Z","timestamp":1781847221000},"page":"478-490","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Privatized Health Care System in Times of Crisis: South Korea's Health Care System Response to the COVID-19 Pandemic"],"prefix":"10.1177","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6235-6043","authenticated-orcid":false,"given":"Juyeon","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Public Health, Keimyung University, Daegu, Republic of Korea"},{"name":"School of Public Health Sciences, University of Waterloo, Waterloo, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jungwook","family":"Kim","sequence":"additional","affiliation":[{"name":"Seoul National University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rora","family":"Oh","sequence":"additional","affiliation":[{"name":"Seoul National University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rangkyung","family":"Ha","sequence":"additional","affiliation":[{"name":"Seoul National University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myoung-Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"National Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"WHO. An Action Plan to Engage the Private Health Service Delivery Sector in the Response to COVID-19. 2021. https:\/\/www.who.int\/publications\/m\/item\/an-action-plan-to-engage-the-private-health-service-delivery-sector."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/27551938231201070"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.p329"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/00207314211024900"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.878225"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2021.1874470"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-022-05522-2"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwaa217"},{"key":"e_1_3_3_10_2","unstructured":"OECD. Hospital beds by sector. 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Kong-kong-\u016di-lyo hwak-ch\u2019ung p\u2019il-yo-s\u014fng-kwa ch\u014fn-lyak [The Necessity and Strategy for Expanding Public Healthcare]. 2020. Health Insurance Research Institute Issue Report 2020 (November)."},{"key":"e_1_3_3_15_2","unstructured":"K\u2019o-lo-na-1-9 mu-ch\u016dng-sang ky\u014fng-ch\u016dng-hwan-cha chae-t\u2019aek-ch\u2019i-lyo s\u014fn-t\u2019aek a-nin p\u2019il-su [\u201cAt-home care for asymptomatic or mild COVID-19 patients.\u201d Not a choice but a necessity]. Health Insurance Review & Assessment Service; 2021. Accessed August 15 2024. https:\/\/www.hira.or.kr."},{"key":"e_1_3_3_16_2","unstructured":"Kim M Lim D. K\u2019o-lo-na-1-9 \u016di-lyo-tae-\u016dng-\u016dl wi-han py\u014fng-sang-cha-w\u014fn hy\u014fn-hwang [Hospital bed resources for COVID-19 response in Korea]. Korean Social Trends 2022. 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