The study, led by Sungbae Jo, drew on public-use data from the 2023 National Survey on Persons with Disabilities, a nationally representative survey conducted by the Korean government. The researchers restricted their sample to respondents younger than 19 years who held official disability registrations, yielding 399 respondents that, after statistical weighting, represent an estimated 88,611 children and adolescents nationwide. This weighting procedure allows the small sample of registered young people to stand in for the full population of children with disabilities across the country, a standard technique in survey-based health services research.

What sets this analysis apart methodologically is its two-stage framework for thinking about access. Rather than treating rehabilitation use as a single yes-or-no question, the researchers separated the problem into two distinct barriers: first, whether a child enters any medical-institution rehabilitation at all, and second, whether that care happens inside or outside the child’s own region. This distinction matters because the policy remedies for the two problems are different. A child who never enters care may need outreach, referral, or financial support, while a child who bypasses local facilities points to gaps in regional capacity that only infrastructure investment can close.

The headline numbers are stark. Overall, 50.0 percent of children and adolescents with disabilities had no medical-institution rehabilitation use, 31.5 percent used rehabilitation within their own region, and 18.6 percent traveled outside their region for care. Put another way, among the children who did use medical rehabilitation, 37.1 percent reported receiving it outside their home region, a phenomenon researchers call regional bypass. For a country with a well-developed national health insurance system, nearly four in ten young rehabilitation patients bypassing local care signals a significant mismatch between where services exist and where families live.

To identify which factors drove these patterns, the team used modified Poisson regression with robust standard errors, a statistical approach well suited to estimating prevalence ratios for common binary outcomes like whether a child used rehabilitation. Prevalance ratios, reported with 95 percent confidence intervals, express how much more or less likely one group is to experience an outcome compared with a reference group. In the first stage of the analysis, examining entry into any medical rehabilitation, children with non-developmental disability types were significantly more likely to use rehabilitation than those with developmental disabilities, with a prevalence ratio of 1.61, meaning a 61 percent higher likelihood. Meanwhile, children living in eup or myeons, the rural administrative units that correspond to towns and townships in the Korean system, were significantly less likely to use rehabilitation, with a prevalence ratio of 0.66, or roughly a third lower likelihood than urban peers.

The second stage of the analysis, examining out-of-region use among rehabilitation users, revealed a different set of drivers. Children living in provinces outside the capital region were more than twice as likely to bypass their local area for care, with a prevalence ratio of 2.13. Non-developmental disability type again raised the odds of out-of-region use, with a prevalence ratio of 1.74, while male sex was associated with lower out-of-region use, with a prevalence ratio of 0.62. The pattern suggests that families facing certain diagnoses, and families outside the densely served Seoul metropolitan area, are the ones most likely to pack up and travel for pediatric rehabilitation services.

The reasons families gave for their choices add crucial texture to the statistics. Among children who received no medical rehabilitation at all, the most common explanation, cited by 27.4 percent, was use of non-medical facilities instead, such as welfare centers or therapy programs that fall outside the medical-institution system. This finding complicates the picture of non-use: some children counted as receiving no medical rehabilitation are in fact receiving services, just not ones delivered by medical institutions, which raises questions about how the formal health system tracks and integrates parallel service streams.

For families who did bypass their local region, the leading reasons were better treatment available elsewhere and the simple absence of nearby medical institutions. These two explanations point to different facets of the same underlying problem. The absence of nearby institutions is a supply problem, a lack of pediatric rehabilitation providers in certain regions, while the pursuit of better treatment reflects perceived quality gaps that may persist even where some local services exist. Both drivers suggest that regional capacity-building, not just local entry support, is essential to keeping care close to home.

The study’s authors frame the findings as having implications for three connected policy areas: local entry support to bring non-users into care, regional capacity-building to reduce the need for bypass, and cross-sector service integration to connect medical rehabilitation with the non-medical facilities many families already rely on. Because the analysis is cross-sectional, capturing a single snapshot in time from the 2023 survey, it cannot establish causal relationships between residence, disability type, and care patterns. The sample of 399 respondents, while weighted to represent nearly 89,000 young people, is also modest, and confidence intervals around some estimates are wide. Still, the two-stage design gives policymakers a diagnostic tool: the barriers to entering care and the barriers to staying local are statistically distinct, and the data show they affect different groups of children in different ways.

For South Korea, where disability registration confers access to a defined set of services and benefits, the results suggest that the geography of pediatric rehabilitation has not kept pace with the geography of need. Rural children in eup and myeons face a double disadvantage, less likely to enter care at all and, when they do, more likely to travel far for it. As the researchers conclude, pediatric medical rehabilitation access involves challenges to both non-use and out-of-region use, and addressing them will require looking beyond the clinic door to the regional systems and cross-sector services that surround it.

Subject of Research: Medical rehabilitation use and regional bypass among children and adolescents with disabilities in South Korea

Article Title: Medical rehabilitation use and regional bypass among children and adolescents with disabilities: Lessons from South Korea

Article References: Jo, S. (2026). Medical rehabilitation use and regional bypass among children and adolescents with disabilities: Lessons from South Korea. PLOS One, 21(10), e0360753. https://doi.org/10.1371/journal.pone.0360753

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360753

Keywords: medical rehabilitation, children with disabilities, regional bypass, South Korea, access to care, developmental disability, health services research, PLOS One, rural health, National Survey on Persons with Disabilities, Medical, rehabilitation