KDCA safety net serves tuberculosis patients turned away by hospitals

Korea Disease Control and Prevention Agency (KDCA) Commissioner Lim Seung-kwan, center, speaks during a media briefing on the agency’s Tuberculosis Relief Belt Project in Jung District, central Seoul, Wednesday. Left is Hong Jeong-ik, head of the KDCA’s infectious disease policy bureau, and right is Suh Gil-joon, president of the National Medical Center. Courtesy of KDCA

One tuberculosis patient had his infection discovered during emergency surgery after a suicide attempt, with no guardian and a canceled resident registration. Another tuberculosis patient could not afford 31,630 won ($21) for a hospital visit. A homeless tuberculosis patient was refused help by his younger sister.

These real cases are turned away by many hospitals. The Korea Disease Control and Prevention Agency’s (KDCA) Tuberculosis Relief Belt Project (TRBP), however, has stepped in.

Launched in 2014, TRBP provides comprehensive support throughout the course of tuberculosis treatment, covering medical care, caregivers, hospital transfers and nutritional assistance. Operating through a network of 20 medical institutions, the program serves as a safety net for socially and economically vulnerable tuberculosis patients.

“The project, now in its 13th year, is a valuable initiative for the agency because it reflects voices from the field,” KDCA Commissioner Lim Seung-kwan said at a briefing for reporters Wednesday. “Work that requires sustained long-term effort and does not immediately translate into headline-grabbing results ultimately depends on the continued commitment of public medical institutions.”

Tuberculosis, one of the world’s deadliest infectious diseases, spreads through airborne bacteria released when infected people cough, sneeze or speak. In 2023, it killed 1.25 million people, making it the leading infectious killer worldwide, ahead of COVID-19, according to the World Health Organization.

TRBP covers low-income foreign residents and undocumented migrants on the same terms as Korean patients. For suspected cases, medical costs are covered from the first consultation until test results are confirmed, while confirmed tuberculosis patients receive support for both outpatient and inpatient care.

Seo Hae-sook, director of the medical department at Seoul Metropolitan Seobuk Hospital, said her hospital treated several undocumented foreign patients last year whose medical bills often reached several million won because they lacked coverage under the National Health Insurance Service (NHIS), and continued supporting them until they were fully cured.

Participants discuss the Korea Disease Control and Prevention Agency’s (KDCA) Tuberculosis Relief Belt Project, Wednesday, in Jung District, central Seoul. Courtesy of KDCA

In 2024, 17,944 cases were reported in Korea, marking a 64.5 percent decline from the 2011 peak. Still, Korea ranked second among the OECD’s 38 members in tuberculosis incidence in 2024 at around 35 cases per 100,000, and third in mortality at about three deaths per 100,000.

This is largely due to widespread past exposure among Koreans age 65 and older during the 1910-45 Japanese colonial period and in the aftermath of the 1950-53 Korean War, with the disease generally emerging later in life. In 2024, this age group accounted for 58.7 percent of tuberculosis patients.

Intensive management of tuberculosis patients who often struggle to access or maintain treatment — including those age 65 and older, undocumented migrants and low-income patients — is key to the KDCA’s goal of reducing incidence to fewer than 20 cases per 100,000 people by 2027.

“Although overall tuberculosis rates are declining, the drop among socially and economically vulnerable groups has been slower,” said Joh Joon-Sung, a tuberculosis specialist at the National Medical Center.

Joh added that TRBP is crucial because many hospitals refuse to admit such patients, as treatment costs often go unpaid and treatment can be difficult to maintain, leaving public institutions to manage their care.

For patients covered by NHIS, whether Korean or foreign, treatment costs are covered for those with household incomes at or below 120 percent of the government-defined median income — 3,078,000 won per month for a single-person household this year.

Negative pressure isolation rooms for tuberculosis patients at the National Medical Center in Jung District, central Seoul, Wednesday. Courtesy of the Korea Disease Control and Prevention Agency

Caregivers are stationed at Masan National Tuberculosis Hospital in South Gyeongsang Province and Mokpo National Hospital in South Jeolla Province. At other participating institutions, patients may hire caregivers and be reimbursed for actual costs. Support is capped at 150,000 won per day, 170,000 won for patients with mental illness, medical aid recipients and those in the near-poverty group.

For those covered by NHIS, caregiver support applies to households with incomes at or below 140 percent of the government-defined median income.

At select participating institutions, including Gyeonggi Provincial Medical Center Suwon Hospital, patients may also receive daily protein supplements when poor nutritional status slows recovery, based on a physician’s judgment.

TRBP also coordinates transfers for severe patients whose infectiousness may persist for months or who require complex procedures beyond the capacity of smaller hospitals. Before the start of the project, many patients had to travel to other hospitals on their own, risking further community spread, but transfers are now conducted under strict isolation.

The committee that connects the network of participating hospitals helps tuberculosis patients who struggle to find appropriate care identify facilities that are able to provide the treatment they need and arrange transfers.

“We will continue expanding the project so tuberculosis patients can receive treatment with convenient access near where they live,” Lim said, adding that public awareness and social support are essential pillars for sustaining these programs.