Clinic / local doctor's office (1st tier) → Hospital → Tertiary general hospital: A complete guide to understanding Korea's medical system

Korea has a 4-step medical system.

Korea’s healthcare system is divided into 4 stages. This is called the "Medical referral system (1차→2차→3차)".

Step 1: Clinic / local doctor's office (1st tier) (clinic)
It is a small hospital in your neighborhood. Places like internal medicine, dermatology, ENT, and dental clinics. It is the easiest place to visit.

Step 2: Hospital (hospital)
It is bigger than a Clinic / local doctor's office (1st tier), and it has inpatient facilities. It has 30 or more beds.

Step 3: General hospital
It is a large hospital with several medical departments. It has 100 or more beds.

Step 4: Tertiary general hospital (3rd tier) (tertiary hospital)
These are places like Seoul National University Hospital, Samsung Medical Center, Asan Medical Center, and Severance Hospital. They are the biggest hospitals in Korea.

This is the key point. The lower you go, the more you pay yourself. If you go to a big hospital for mild symptoms, you just pay more money.

Outpatient copayment rate: 30% → 40% → 50% → 60%

Even for the same NHI-covered service (geupyeo), the rate you pay can be different depending on where you get treatment.

Even for the same NHI-covered service (geupyeo), the rate you pay changes depending on where you get treatment.

Hospitalization is the same everywhere at 20%. Only outpatient care is different.

It’s the same cold, but the cost can be 2 times different. For mild symptoms, it’s smart to go to a Clinic / local doctor's office (1st tier) near your home.

If you go to a tertiary general hospital without a Referral letter (clinic→hospital), you pay 100% yourself.

This is the rule that foreigners most often do not know.

If you go to a Tertiary general hospital (3rd tier) (like Seoul National, Samsung, Asan, Severance) for a mild illness, and you do not have a Referral letter (clinic→hospital) (referral letter), health insurance does not apply. You have to pay 100% yourself.

You can get a Referral letter (clinic→hospital) at a local Clinic / local doctor's office (1st tier) or hospital. If the doctor decides, "this patient needs treatment at a higher-level hospital," they will write it for you.

When people first come to Korea, many do not know this and go straight to a big hospital. First, go to a Clinic / local doctor's office (1st tier) near your home and get a referral letter. That is the way to save money.

A summary of when and where to go

I’ll organize where you should go for each symptom.

Local Clinic / local doctor's office (1st tier) (clinic) — 30% out-of-pocket
Colds, headaches, upset stomach, skin problems, allergies, vaccinations, health consultation
Most everyday health problems can be taken care of here.

Hospital / General hospital — Out-of-pocket 40~50%
Problems that cannot be handled at a Clinic / local doctor's office (1st tier), cases that need tests, or surgery that requires hospitalization.
If the doctor at the Clinic / local doctor's office (1st tier) says, "Please go to a bigger hospital," this is the right place.

Tertiary general hospital (3rd tier) — out-of-pocket cost 60% (referral letter required)
Severe diseases, rare diseases, major surgery, second opinion
Please make sure to get a referral letter.

Emergency room — KTAS criteria
Loss of consciousness, severe bleeding, chest pain, severe difficulty breathing, high fever + change in consciousness
Emergency number ambulance is free. (Covered in detail in EP.8)

Foreigner-friendly hospital guide

This is hospital information for people who still find Korean difficult.

International Medical Center at a major hospital (interpretation service available)

If you make an appointment through the International Medical Center at these hospitals, you can get medical care with an interpreter. It operates separately from the general reception.

Small hospitals with English medical services

Some local Clinic / local doctor's office (1st tier) can also speak English. On the Naver map, try searching for "English medical service" or "foreigner medical service".

International Medical Center: Use it like this

The International Medical Center of a large hospital operates differently from a regular outpatient clinic.

How to make a reservation:
Make a reservation by phone or email. You can find contact information on the website of each hospital’s International Medical Center. You can make a reservation in English.

Cost:
Even if you make a reservation through the International Medical Center, health insurance still applies. The interpretation service itself is often free. However, some hospitals may charge a separate coordinator fee, so please check when making a reservation.

Things to watch out for:
The International Medical Center is open only on weekday daytime hours. At night or on weekends, you need to use the general reception. In an emergency, go straight to the emergency room.

Difference Between Law and Reality (Law vs Practice)

Law: If you go to a tertiary general hospital (3rd tier) without a Referral letter (clinic→hospital), health insurance does not apply.
Reality: The hospital usually does not refuse you. You can register. But payment is charged as 100% out-of-pocket. Later, even if you say "Please apply insurance," it will not work.

Rule: You are supposed to get a referral in this order: Clinic / local doctor's office (1st tier) → hospital → general hospital.
Reality: In real life, many local clinics write a referral letter directly to a Tertiary general hospital (3rd tier). Skipping the middle step is common.

Policy: Interpretation services at the International Medical Center are mostly free.
Reality: Some hospitals charge about 50,000~100,000 KRW under the name of "international care coordinator fee." Please ask before making a reservation.