Navigating spatial barriers in healthcare: health equity and end-of-life care infrastructure in South Korea and China.

INTRODUCTION: East Asia is experiencing an unprecedented demographic transformation, with rapidly aging populations creating an urgent public health demand for accessible hospice and palliative care facilities. However, infrastructural planning regulations may implicitly marginalize these essential health services as stigmatized facilities, creating regulatory and institutional conditions that can constrain community-adjacent access to end-of-life care.

METHODS: This study conducts a structured comparative legal and health policy analysis of facility-siting frameworks in South Korea and China. It combines national-level legal and policy analysis with illustrative city-level cases of Seoul and Beijing to examine how divergent structural systems-market-based land acquisition in South Korea and state-led public welfare allocation in China-shape the regulatory conditions for geographic accessibility in end-of-life care. The analysis draws on statutory texts, public health policy documents, descriptive infrastructure indicators, and documented social resistance, including NIMBYism.

RESULTS: South Korea's hospital-centered facility classification and market-based siting system may create regulatory conditions that constrain community-adjacent hospice access. Hospice-compatible facilities are generally embedded within hospital-oriented land-use categories, while high land costs, zoning restrictions, greenbelt constraints, and neighborhood opposition may further limit residential-adjacent development. By contrast, China's administrative land allocation, medical-nursing integration policies, and community health planning create a more explicit formal pathway for embedding hospice-compatible services within community health networks. Nevertheless, this pathway remains constrained by fragmented reimbursement, uneven workforce capacity, variable facility readiness, regional implementation disparities, and persistent rural-urban inequalities.

CONCLUSION: Facility-siting rules, health financing systems, workforce distribution, regional disparities, and culturally rooted resistance to death-adjacent facilities jointly shape the accessibility of hospice and palliative care in South Korea and China. Achieving health equity in end-of-life care therefore requires moving beyond clinical guidelines to address the structural and geographical determinants of facility distribution. Legal and planning reforms should be accompanied by financing support, workforce development, stakeholder engagement, and local implementation mechanisms to integrate end-of-life care infrastructure more effectively into community health planning.