OBJECTIVES: This mixed-methods observational study aimed to examine the temporal relationship between trends in cigarette smoking prevalence and lung cancer mortality and incidence rates, and to estimate the latency period between smoking initiation and lung cancer diagnosis among smokers at the individual level. METHODS: Smoking prevalence data for 1960–2022 were reconstructed using data from the Korea National Health and Nutrition Examination Survey (1998–2022). Lung cancer mortality data (1983–2022) and incidence data (1999–2022) were obtained from Statistics Korea and the Korea Central Cancer Registry. The population latency period was estimated using peak comparison and distributed lag non-linear models. The individual latency period was estimated as the average time interval between age at smoking initiation and age at lung cancer diagnosis using individual-level data from the National Health Insurance Service cohort. RESULTS: In men, smoking prevalence peaked around 1985, whereas lung cancer mortality peaked around 2000 during 1960–2022, indicating a lag time of approximately 15 years. In women, lung cancer mortality peaked in 2002, while smoking prevalence peaked around the same time. The population-level latency period between smoking and lung cancer incidence was estimated to be 15 years after adjustment for age, gender, and year of outcome. The individual latency period was estimated to be 42.6 years (standard deviation [SD], 12.5) in men and 34.4 years (SD, 14.2) in women. Smoking intensity and age at initiation did not appear to shorten the individual latency period. CONCLUSIONS Estimates of the smoking-attributable lung cancer burden should account for historical smoking prevalence from approximately 15 years earlier.

Purpose: This study evaluated the clinical outcomes and prognostic factors in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX followed by local-regional therapy (LRT), surgical resection (SR), and radiotherapy (RT). We aimed to identify specific patient subgroups for which RT may serve as a reasonable alternative to SR for local tumor control. Methods: We retrospectively analyzed 116 patients (SR group, n= 70; RT group, n= 46) at a single center between 2015 and 2020. Survival outcomes were compared based on LRT modalities, focusing on identifying subgroups in which RT provided an efficacy comparable to that of SR. Results: Among 116 patients, the SR group achieved a significantly higher 5-year overall survival (OS) than the RT group (27.1% vs. 8.7%, P< 0.0001), despite similar progression-free survival (P= 0.23). Significant prognostic factors for OS included carbohydrate antigen 19-9 (CA19-9) response in BRPC (P= 0.02) and radiologic partial response in LAPC (P= 0.05). Subgroup analysis revealed that, while SR provided a survival advantage in CA19-9 responders, no significant difference in OS was observed between SR and RT in CA19-9 non-responders (P= 0.37). Conclusion Although surgery remains the gold standard, RT may be considered a justifiable local alternative for CA19-9 non-responders and surgically ineligible patients with LAPC, yielding comparable outcomes in these specific, biologically unfavorable subgroups.

Background: Transthyretin amyloidosis, a protein-misfolding disorder characterized by systemic amyloid deposition, can be classified as wild-type transthyretin amyloidosis (ATTRwt) or hereditary transthyretin amyloidosis (ATTRv), depending on the presence of transthyretin (TTR) gene variants. We examined the genetic distribution of TTR variants in Korean patients diagnosed with ATTRv. Methods: We retrospectively reviewed 801 participants who underwent TTR analysis at Samsung Medical Center from 2012 to 2024. The participants were categorized into two groups: in-house probands or relatives, and externally referred probands or relatives. Results: Pathogenic or likely pathogenic TTR variants were detected in 36 of 165 in-house probands (21.8%), among which D38A was the most frequent variant (50.0%; 18/36), followed by M13dup and E89K (8.3% each). Among referred probands, D38A was predominant (54.5%; 12/22), followed by M13dup (22.7%; 5/22). Cardiac amyloid involvement was the most common manifestation, observed in 97.2% (35/36) of in-house probands with ATTRv, followed by peripheral nervous system (PNS; 94.4%) and autonomic nervous system (ANS; 88.9%) involvement. In contrast, ANS involvement was most prevalent among in-house relatives who underwent organ evaluation (61.5%; 24/39), followed by cardiac (52.1%; 25/48) and PNS (48.7%; 19/39) involvement. Five of the eight in-house relatives harboring M13dup (62.5%) showed organ involvement, primarily in the ANS, supporting the pathogenicity of this variant. Conclusions This study provides the largest single-institution dataset of Korean patients with ATTRv, incorporating systematic organ assessments. The predominance of the unique TTR variants D38A and M13dup delineates a distinct genetic landscape that may facilitate accurate and timely diagnosis of ATTRv in the Korean population.

The Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) is widely used for risk stratification in pheochromocytoma and paraganglioma (PPGL), but its clinical utility is limited by inter-observer variability of its parameters and inconsistent predictive performance. Methods: We conducted a multicenter retrospective study of 1,518 patients with PPGL from five tertiary referral centers in Korea. Prognostic utility of PASS system was assessed using logistic regression, Kaplan-Meier analysis, and receiver operating characteristic (ROC) curve analysis. Inter-observer variability was inferred by comparing area under the ROC curve (AUCs) across institutions. Simplified PASS systems were developed based on multivariable analysis of key histopathological parameters. Results: The PASS system was a significant predictor of adverse events and recurrence-free survival. Although the PASS system demonstrated only modest discriminative ability (AUC, 0.673), it showed a high negative predictive value (NPV, 0.885), supporting its usefulness as a screening tool for benign behavior. However, there was significant inter-institutional variability in PASS performance (AUC; range, 0.513 to 0.727; p < .05). The 3-factor Simple PASS, which incorporates necrosis, spindling, and mitotic figures, exhibited less inter-observer variation. The 4-factor Simple PASS, which adds vascular invasion to the 3-factor model, also showed reduced inter-observer variability and improved AUC and NPV compared to the original PASS system. Conclusions: In this multicenter cohort, the PASS system demonstrated high NPV and screening potential, but significant inter-observer variability remains a challenge. Simplification of the PASS system and enhanced pathologist training may improve reproducibility and clinical utility in PPGL risk stratification.

Legal risks and liability issues in medical practice serve as a primary catalyst for the current collapse of essential healthcare services in Korea. Currently, medical disputes in Korea are disproportionately focused on criminal prosecutions and high-damages civil litigation. This punitive approach fosters a culture of concealment, encourages defensive medicine, and accelerates the exodus of medical professionals from essential fields. Ultimately, this cycle deprives the system of opportunities for improvement and poses a significant threat to patient safety. In contrast, many advanced nations have adopted principles of “Just Culture” and “Safe Space,” prioritizing non-punitive reporting and systemic root-cause analysis over individual retribution. To address these issues, this paper proposes four key strategies: First, the establishment of an independent “Patient Safety Investigation Agency” to objectively investigate incidents and identify systemic flaws. Second, a transition from criminal punishment to licensing board-led management, focusing on re-education and counseling to maintain quality of care. Third, the enactment of “Apology Laws” to ensure that expressions of regret or apologies cannot be used as legal evidence of liability, thereby fostering trust and psychological recovery. Finally, the creation of a “Patient Safety Fund” to provide prompt and sufficient public compensation to victims regardless of proven negligence. In conclusion, it is imperative to shift the paradigm by defining medical accidents as “system failures” rather than individual faults. Strengthening the social safety net will encourage medical professionals to return to essential care and build a sustainable healthcare environment centered on patient safety.

The South Korean healthcare system has achieved rapid quantitative growth; however, it continues to face critical challenges in ensuring the fundamental right to health of its citizens. From the perspective of healthcare consumers and civil society, this article identifies structural problems such as imbalances in medical accessibility, instability in essential and emergency care, and the limited participation of consumers in healthcare policy-making. Although the constitution stipulates the state’s responsibility to protect public health, current healthcare policies often prioritize administrative efficiency and provider-centered interests over patient experiences and health outcomes. In particular, this article argues that these challenges are closely related to the inadequate functioning of an accountable healthcare management framework. Structural failures in essential care, workforce shortages, and regional disparities are insufficiently monitored and addressed at the system level, resulting in responsibilities being blurred or shifted to individual healthcare providers. Consequently, the risks and burdens arising from systemic weaknesses are ultimately borne by citizens. To address these issues, this article emphasizes two major shifts. First, meaningful consumer participation must be institutionalized within healthcare governance to strengthen accountability, transparency, and responsiveness. Second, family medicine and primary care should be reinforced as the cornerstone of a sustainable, community-based healthcare system that ensures continuity of care, prevention, and chronic disease management. Re-establishing the healthcare system based on the right to health is not merely a technical adjustment, but a structural transformation toward a responsible and accountable system in which the state clearly assumes responsibility for monitoring, learning, and corrective action.

The South Korean resident training system is currently at a critical turning point, facing structural crises characterized by excessive labor-intensive environments and deteriorating quality of education. Since the medical standoff in 2024, the limitations of relying on junior doctors’ labor for hospital operations have become increasingly apparent. This review examines the current status and problems of the resident training system, including long working hours exceeding Organisation for Economic Co-operation and Development (OECD) standards, lack of systematic competency-based education, and worsening regional and essential medical imbalances. By analyzing international cases from the United States, United Kingdom, Japan, and Australia, this article proposes four core strategies for reform: (1) establishing a sustainable working and educational environment through the expansion of hospitalist systems and legalizing physician assistant roles; (2) innovating the curriculum and evaluation systems based on entrustable professional activities and milestones; (3) implementing a network-based training model to bridge the gap between metropolitan and regional healthcare; and (4) securing stable financial support and strengthening governance through the establishment of an independent evaluation body (e.g., K-ACGME). Ultimately, reforming the training system is essential not only for the rights and professional growth of residents but also for ensuring patient safety and the long-term sustainability of the national healthcare system.

While South Korea’s National Health Insurance (NHI) was once disparaged as a rudimentary “discount program,” it has matured into the cornerstone of the nation’s medical safety net owing to sustained governmental initiatives. Nevertheless, the pursuit of expanded benefit coverage, exacerbated by demographic shifts toward low fertility and an aging society, has catalyzed a rapid escalation in aggregate national healthcare spending.Consequently, there is an urgent need for the NHI to implement benefit expansion policies that prioritize cost-efficiency and fiscal prudence. This perspective asserts that coverage enhancement should be strategically focused on high-cost catastrophic illnesses, specifically through the robust fortification of the annual out-of-pocket (OOP) maximum system. Furthermore, the reform of private health insurance is imperative, as its unbridled growth in non-reimbursable services has undermined the efficacy of public coverage efforts. This paper proposes concrete policy frameworks for both the enhancement of the OOP maximum system and the structural reform of private indemnity health insurance.

Recurrent difficulty securing emergency department (ED) acceptance and delayed interfacility transfer, often resulting in multiple sequential transfer attempts (“round-robin” hospital seeking), in the Republic of Korea reflect a patient safety failure across the emergency care continuum, spanning Emergency Medical Services from emergency calls and prehospital care to ED stabilization, definitive treatment, and secondary transfer. We argue that the governance split between the National Fire Agency–led prehospital response and the Ministry of Health and Welfare–led emergency medical system fragments accountability and data, undermining sustainable quality management. We describe a “double bind” in which clinicians face medico-legal risk regardless of acceptance decisions, distorting transfer behavior. We propose an outcome-linked Quality Improvement system—integrated metrics, interoperable data linkage, operational medical control, and routine feedback—to strengthen Continuity of Patient Care. This requires functional integration of the dual command structure; transferring ambulance service functions to the Ministry of Health and Welfare, or an equivalently strong joint-governance model, should be evaluated. Regionally, responsibility-based systems should be implemented through councils that set transfer principles and resource allocation, supported by stable financing and performance review, with the regional emergency medical situation room providing medical control and real-time coordination. For mass-casualty incidents, preparedness should align standardized triage, integrated command and communication, training, and after-action review. Legal reform is a necessary starting point, but trust and sustained patient safety depend more on cultivating a learning-oriented safety culture grounded in patient experience and public deliberation throughout policy design and implementation.

South Korea’s current healthcare system stands at a critical crossroads that will determine whether it can progress in a better direction over the next decade. Behind the relatively stable level of population health that has been maintained until now, it has become clear that the deterioration of patient experiences, the risk of collapse in critical emergency medical services, the burnout of healthcare providers, and the crisis in the sustainability of healthcare finances have all accumulated simultaneously. This crisis can no longer be overcome by partial fixes or short-term measures alone. The answer to what needs to change first must begin with a reaffirmation of what the healthcare system should aim for. Ultimately, what needs to be changed now is not an individual policy, but the criteria and priorities through which we view healthcare. The focus must shift from what to provide more of, to questioning what holds greater social value. If such a shift does not begin now, in ten years we won’t face a better healthcare system, but care enmeshed in a deeper crisis. Now is precisely the time to fundamentally define the direction of the healthcare system.