Abstract for: Designing investment strategies for a regionally self-sufficient healthcare system in South Korea: an agent-based modeling and simulation approach

Despite the importance of regionalization in healthcare resource allocation, South Korea continues to experience substantial patient outmigration from local regions toward the capital city Seoul. The government has introduced an investment policy to develop a “regionally self-sufficient healthcare system,” which aims to strengthen local healthcare systems. However, the inherent complexity of the healthcare system hinders the effectiveness of such investments in reducing outmigration. We developed an agent-based simulation model representing patients’ hospital choice and inter-regional bypassing behavior in South Korea. The model evaluated multiple investment scenarios varying in target hospitals, timing, and magnitude, and assessed their effects on patient outmigration. We additionally compared two investment approaches: the leaders strategy (i.e., investing in regional leading hospitals) and the prospective strategy (i.e., investing in hospitals with high potential to grow into regional leaders). Investments in hospitals other than existing regional leaders produced greater reductions in outmigration probability in some regions. Early investments were more effective than delayed ones, while excessively large investments were less effective due to congestion effects. At the national level, the prospective strategy generated more geographically balanced welfare gains than the leaders strategy. The effects of hospital investment on mitigating patient outmigration depend critically on where, when, and at what scale quality enhancements are implemented. Policies aimed at constructing a regionally self-sufficient healthcare system must take into account the dynamic nature of healthcare systems. ChatGPT, to improve the linguistic clarity of the manuscript