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

This cross-sectional secondary analysis examined medical rehabilitation use and regional bypass among Korean children and adolescents with registered disabilities, using a two-stage access framework that distinguished entry into medical-institution rehabilitation from out-of-region use after entry. We analyzed public-use data from the 2023 National Survey on Persons with Disabilities, restricting the sample to respondents younger than 19 years (n = 399; weighted national estimate, 88,611). Weighted descriptive statistics and modified Poisson regression with robust standard errors were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Overall, 50.0% had no medical-institution rehabilitation use, 31.5% used in-region rehabilitation, and 18.6% used out-of-region rehabilitation; among rehabilitation users, 37.1% reported out-of-region care. In stage 1, non-developmental disability type was associated with higher medical rehabilitation use (PR, 1.61; 95% CI, 1.28-2.03), whereas eup/myeon residence was associated with lower use (PR, 0.66; 95% CI, 0.46-0.94). In stage 2, province residence (PR, 2.13; 95% CI, 1.38-3.27) and non-developmental disability type (PR, 1.74; 95% CI, 1.13-2.69) were associated with out-of-region use, while male sex was associated with lower out-of-region use (PR, 0.62; 95% CI, 0.42-0.92). The most common reason for non-use was use of non-medical facilities (27.4%); better treatment and absence of nearby medical institutions were leading reasons for out-of-region care. Pediatric medical rehabilitation access involves challenges to both non-use and out-of-region use, with implications for local entry support, regional capacity-building, and cross-sector service integration.