Purpose: Emergency room bouncing has become a critical social issue in South Korea. While the government seeks to address this problem by imposing stricter penalties, healthcare providers remain reluctant to accept high-risk patients. This study aimed to analyze the structural causes of emergency patient refusal using a game-theoretic framework, with a focus on the asymmetry between emergency care regulations and medical malpractice risks.Methods: A non-cooperative game model was developed to analyze strategic interactions between the government and healthcare providers. A minimax approach was used to evaluate the impact of maximum liability (approximately 1 billion Korean won KRW) and administrative fines for delays in emergency patient transfer. Specifically, a break-even analysis was conducted to estimate the surgical volume required to offset this liability under a realistic fee schedule.Results: The expected loss from accepting a high-risk emergency patient substantially exceeded the penalty for refusal. Simulations indicated that, even under optimistic revenue assumptions, it would take more than 66 years of accident-free operations for a specialist to offset a single liability of 1 billion KRW. Consequently, refusal remains the rational dominant strategy for providers seeking to avoid professional bankruptcy.Conclusion: The primary cause of transfer delays is a structural imbalance characterized by high risk and low returns, in which medical fees do not cover the substantial liabilities imposed by recent judicial rulings. Without state indemnification for accidents caused by force majeure and exemptions from criminal liability, legislative efforts that merely mandate acceptance will accelerate the collapse of the emergency medical infrastructure.
Yoon et al. (Sat,) studied this question.