These specialty hospitals encompass specialty areas including spine, joint, colorectal-anal, burn, breast, heart, ENT (ear, nose

and throat), ophthalmology, alcohol treatment, OBGYN, neurosurgery and physical rehabilitation, etc. The highest number of hospitals with this designation (17) includes spine specialty hospitals. sellckchem Since South Korea established a national health insurance (NHI) programme in 1989, hospitals have faced many challenges such as an ageing population, rapidly rising healthcare costs and growing chronic disease burden.1 These challenges are being addressed by various policy initiatives at the government level. In addition, physicians altering the mix of treatments to increase profit margin2 and the increased level of competition among providers present incentives for increasing efficiency.3 Moreover, providers have experienced financial challenges,3 due in part to the rapid increase in small general hospitals, from 581 in

2000 to 1295 in 2010.4 In order to address these challenges, small hospitals have begun to specialise in order to better compete with small general, mid-sized general and even tertiary research hospitals.5 To be designated as a specialty hospital by the Korean Ministry of Health-Welfare, institutions must submit an application and be equipped with a certain number of beds, number of physicians and must have medical service departments in their specialty area. The inpatient volume of these institutions must be above the 30th centile among all small and mid-sized general hospitals, and the ratio of specialty-area inpatients to total inpatients must be above a certain percentage depending on the specialty area. The concept of specialty hospitals was first introduced in the USA beginning in the 1990s. The first specialty hospitals typically were located in

fast-growing cities in states where a ‘certificate of need’ was not required.6 Subsequently, there was a rapid increase in the number of small hospitals specialising in cardiac, orthopaedic and surgical services.7 Furthermore, Cilengitide most of these hospitals were physician-owned, for-profit and specialty-specific.8 Proponents argue that specialty hospitals provide high-quality medical services at a lower cost,9–11 bring added value to the healthcare system12 13 and lead to greater patient satisfaction.14 15 The increase in patient volume and concentration of expertise allows specialty hospitals to achieve better outcomes and maximise efficiency.16 However, opponents contend that specialty hospitals have lower quality and higher costs, since they are for-profit and specialise in only the most profitable services, target healthier patients who are more well-off and induce demand for their specialised services.