Who pays for undocumented immigrants’ medical care in Korea?

Case studies on the hospitalization of immigrants South Korea describes as undocumented exposed a potential blind spot in their medical care: few options are available to them, while medical institutions face the burden of unpaid bills.

The recent study showed that those without identification, family members or other support were cut off from the welfare and medical system, forcing them into prolonged hospitalization after the immediate treatment.

A study led by Song Kyong-jun, a professor of emergency medicine at Seoul National University Hospital Boramae Medical Center, revealed the problems hospitals face when caring for such patients. Lack of identification recognized by the Korean government hinders discharge plans and subsequent access to required welfare services.

The study followed six undocumented immigrants who repeatedly moved between a private charitable hospital and public medical institutions between 2017 and 2023. The findings were published in the August issue of the Journal of the Korean Society of Emergency Medicine.

All six patients were initially admitted for acute treatment. However, even after their acute treatment had ended, they could not be discharged or connected with welfare services because they lacked identification documents and family members who could assist them, according to the study.

Because discharge plans had to be established before the patients could leave the hospitals, they were moved between the two types of medical institutions up to four times and ended up with prolonged hospital stays, the researchers said.

Five of the six patients tested positive for multidrug-resistant organisms after developing repeated infections during prolonged hospitalization and transfers between medical institutions. Four patients died, while the other two were transferred to nursing facilities, according to the study.

“These problems stem from structural limitations caused by a disconnect in the medical, welfare and administrative systems,” the researchers said.

“Public hospitals have no choice but to keep patients hospitalized for extended periods even after acute treatment, while private charitable hospitals bear the burden within limited funding.”

The problem also creates a financial burden for medical institutions, which may have little or no means of recovering medical expenses when undocumented patients die or are deported.

A case disclosed by the Anti-Corruption and Civil Rights Commission in July illustrates the problem.

A hospital in Ulsan was left with an unpaid medical bill of 837 million won ($622,000) after treating an undocumented Chinese woman for six years and four months.

The woman had entered Korea on a tourist visa and later worked at a restaurant in Ulsan before collapsing from a cerebral hemorrhage and requiring long-term treatment through April.

Her family in China refused to take her remains or pay the medical expenses. Only part of the expenses was reportedly covered through support from religious groups and fundraising efforts in China.

The commission recommended that the Ministry of Health and Welfare and the Ministry of Foreign Affairs work with the patients’ home countries to address unpaid medical expenses and facilitate their return.

“While medical institutions have an obligation to provide emergency treatment and care for severely ill, long-term foreign patients without family members or other support, there are no support systems for unpaid medical expenses or repatriation,” a commission official said.

The challenge is how to ensure minimum access to essential medical care for undocumented immigrants while maintaining fairness and financial sustainability in the existing healthcare system.

The number of foreign nationals without legal residency status in Korea stood at 357,598 in 2025, down from 423,675 in 2023. Their share of the total foreign population also fell from 19.9 percent in 2021 to 12.8 percent in 2025.

Yet the issue remains, as undocumented immigrants often have limited access to social protection while working in jobs that can expose them to occupational risks.

Researchers said a system is needed to fill gaps in public healthcare by providing them with medical care, managing prolonged hospitalization and addressing unpaid medical expenses.

In the longer term, the Boramae researchers said policies should be considered to provide access to essential medical care regardless of residency status.

“It would be desirable to guarantee at least minimum access to emergency and essential medical care, while operating it through a separate public support system outside the insurance benefit system,” the researchers said. “This would help balance financial sustainability and social equity.”