J Korean Med Sci.  2025 Mar;40(8):e109. 10.3346/jkms.2025.40.e109.

Reinforcing Primary Care in Korea: Policy Implications, Data Sources, and Research Methods

• Kim CN
• Yoon SJ

• KMID: 2565789
• DOI: http://doi.org/10.3346/jkms.2025.40.e109

Abstract

Korea has undergone rapid transformation, achieving significant advancements in both economic development and social security. Notably, the country achieved universal health coverage within a remarkably short period, representing a significant institutional milestone in healthcare. However, the healthcare system faces substantial challenges due to limited resources, a reliance on private healthcare providers, and a rapidly aging population which threatens its sustainability. Various efforts have been made to strengthen Korea’s primary care environment. This study aims to examine the multifaceted healthcare landscape surrounding primary care in Korea, analyze associated systems to identify institutional limitations, and propose strategies to enhance primary care in the future. Additionally, it seeks to raise awareness of the current state of primary care in Korea and serves as an example for other countries striving to improve their primary care systems. Furthermore, this review provides a comprehensive overview of key data sources relevant to primary care research in Korea, such as the National Health Insurance Service claims data and the Korea Health Panel Survey. It also outlines practical research methodologies—from epidemiological studies to policy analyses—serving as a valuable reference for both domestic and international scholars seeking to enhance primary care systems.

Keyword

Primary Health Care; Public Health; Health Policy; Health Care Reform

Figure

• 

  Fig. 1 Trends in healthcare utilization by age group. (A) Per capita healthcare benefits expenditure by age group for national health insurance beneficiaries. (B) Per capita number of total number of hospitalizations and outpatient visits at medical institutions, excluding pharmacy visits by age group for national health insurance beneficiaries.

• 

  Fig. 2 Policy classification by primary care functions tailored to the context of Korea.LTC = long-term care.

Reference

1. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024; 403(10440):2133–2161. PMID: 38642570.

2. Jung YS, Kim YE, Ock M, Yoon SJ. Measuring the burden of disease in Korea using disability-adjusted life years (2008–2020). J Korean Med Sci. 2024; 39(7):e67. PMID: 38412612.

3. Kim CN, Jung YS, Kim YE, Ock M, Yoon SJ. Korean national burden of disease: the importance of diabetes management. Diabetes Metab J. 2024; 48(4):518–530. PMID: 39091003.

4. Institute for Health Metrics and Evaluation. GBD compare. Updated 2024. Accessed December 6, 2024. https://vizhub.healthdata.org/gbd-compare/ .

5. Kim KW, Kim OS. Super aging in South Korea unstoppable but mitigatable: a sub-national scale population projection for best policy planning. Spat Demogr. 2020; 8(2):155–173. PMID: 34222615.

6. Kontis V, Bennett JE, Mathers CD, Li G, Foreman K, Ezzati M. Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. Lancet. 2017; 389(10076):1323–1335. PMID: 28236464.

7. World Health Organization (WHO). Republic of Korea Health System Review. Manila, Philippines: WHO Regional Office for the Western Pacific;2015.

8. Park EC. Strategies for improving healthcare delivery system in Korea. HIRA Res. 2021; 1(1):9–15.

9. Lee JY, Jo MW, Yoo WS, Kim HJ, Eun SJ. Evidence of a broken healthcare delivery system in Korea: unnecessary hospital outpatient utilization among patients with a single chronic disease without complications. J Korean Med Sci. 2014; 29(12):1590–1596. PMID: 25469056.

10. Lee HJ, Jang SI, Park EC. The effect of increasing the coinsurance rate on outpatient utilization of healthcare services in South Korea. BMC Health Serv Res. 2017; 17(1):152. PMID: 28219377.

11. Song YJ. The South Korean health care system. Japan Med Assoc J. 2009; 52(3):206–209.

12. Jeong HS. Korea’s National Health Insurance--lessons from the past three decades. Health Aff (Millwood). 2011; 30(1):136–144. PMID: 21209449.

13. Kim YE, Pyo J, Lee H, Jeong H, Park YK, Seo JW, et al. Relevance index regional variation by each disease and its essential medical field: a retrospective data analysis from 2016–2020 in Korea. J Korean Med Sci. 2023; 38(16):e130. PMID: 37096313.

14. Jung YS, Kim YE, Ock M, Yoon SJ. Trends in healthy life expectancy (HALE) and disparities by income and region in Korea (2008–2020): analysis of a nationwide claims database. J Korean Med Sci. 2024; 39(6):e46. PMID: 38374624.

15. Kim CN, Jung YS, Kim YE, Ock M, Jin DL, Yoon SJ. Trends of gaps between health-adjusted life expectancy and life expectancy at the regional level in Korea using a group-based multi-trajectory modeling approach (2008–2019). J Korean Med Sci. 2024; 39(17):e145. PMID: 38711316.

16. Chi Y. A Policy Package to Bring Essential Healthcare Back From the Brink of Collapse. Sejong, Korea: Ministry of Health and Welfare;2024.

17. Chi Y. The Government to Start Social Discussion on Healthcare Reform in Earnest. Sejong, Korea: Ministry of Health and Welfare;2024.

18. The Lancet Regional Health-Western Pacific. Junior doctor strikes in South Korea: more doctors are needed? Lancet Reg Health West Pac. 2024; 44:101056. PMID: 38654747.

19. Park H. Junior doctors’ strike in South Korea: systemic barriers undermine medical practice. BMJ. 2024; 385:q752. PMID: 38580385.

20. Seth MJ. South Korea’s economic development, 1948–1996. Oxford Research Encyclopedia of Asian History. Oxford, United Kingdom: Oxford University Press;2017.

21. Kim KS, Lee YJ. Developments and general features of national health insurance in Korea. Soc Work Public Health. 2010; 25(2):142–157. PMID: 20391258.

22. Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan. 2009; 24(1):63–71. PMID: 19004861.

23. Organisation for Economic Co-operation and Development (OECD) Library. Health at a glance 2023: OECD indicators. 2023. Updated 2023. Accessed December 18, 2024. https://www.oecd.org/en/publications/2023/11/health-at-a-glance-2023_e04f8239.html .

24. Kim H, Cheng SH. Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations. Health Policy. 2018; 122(11):1222–1231. PMID: 30274936.

25. Kim SJ, Hwang JY, Seon JY. The effect of healthcare environment on quality improvement in primary care: panel analysis using 2008–2017 OECD health statistics data. J Health Inform Stat. 2020; 45(3):302–310.

26. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005; 83(3):457–502. PMID: 16202000.

27. Winpenny E, Miani C, Pitchforth E, Ball S, Nolte E, King S, et al. Outpatient services and primary care: scoping review, substudies and international comparisons. Health Services and Delivery Research. 2016.

28. HIRA Bigdata Open Portal. Current status of human resources. Updated 2024. Accessed December 25, 2024. https://opendata.hira.or.kr/op/opc/olapHumanResourceStatInfoTab1.do .

29. Lee JY, Eun SJ, Kim HJ, Jo MW. Finding the primary care providers in the specialist-dominant primary care setting of Korea: a cluster analysis. PLoS One. 2016; 11(8):e0161937. PMID: 27560181.

30. Yun JM, Choi S, Cho Y, Park SM, Kim Y. Definition and status of functional primary clinic in Korea. Korean J Fam Pract. 2021; 11(1):3–9.

31. Kim HJ, Shin JY, Yang YJ, Cho B, Yun JM. Analysis of the comprehensiveness of primary care clinics in Korea. Korean J Fam Med. 2021; 42(1):47–52. PMID: 32418395.

32. HIRA Bigdata Open Portal. Statistics of current health insurance care. Updated 2022. Accessed December 25, 2024. https://opendata.hira.or.kr/op/opc/olapHthInsRvStatInfoTab20.do?docNo=03-036 .

33. Seo EW, Chung SH. A review of healthcare provider payment system in Korea. Health Policy Manag. 2023; 33:379–388.

34. Gosden T, Forland F, Kristiansen IS, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst Rev. 2000; 2000(3):CD002215. PMID: 10908531.

35. Choi Y, Kweon S, Baek M. Inequalities in primary care provision in Gwangju Metropolitan City, South Korea. Eur J Public Health. 2024; 34(Suppl 3):ckae144.953.

36. Lee JR. Review the change of chronic disease care in Korea. J Korean Diabetes. 2022; 23(4):251–257.

37. Seo SY, Kim HJ, Oh HK, Lee SK. Propulsion status of a community-based hypertension and diabetes control program. Public Health Wkly Rep. 2021; 14(21):1414–1421.

38. Korea Disease Control and Prevention Agency. Community-based Hypertension and Diabetes Control Program Standard Manual. Cheongju, Korea: Korea Disease Control and Prevention Agency;2024.

39. Ministry of Health and Welfare (KR). Enforcement Decree of the National Health Insurance Act, Presidential Decree No. 22099; Mar 26, 2010. Sejong, Korea: Korea Legislation Research Institute;2010.

40. Kim HS, Yoo BN, Lee EW. Evaluation of the national chronic diseases management policy: performance and future directions. Public Health Aff. 2018; 2(1):105–120.

41. Cho JJ, Kwon YJ, Jung SH. Community based health care service design on chronic disease for enhancing primary care and the status of community based primary care project. Korean J Fam Pract. 2015; 5:173–178.

42. Ha R, Kim D, Choi J, Jung-Choi K. A national pilot program for chronic diseases and health inequalities in South Korea. BMC Public Health. 2021; 21(1):1142. PMID: 34130679.

43. Song E, Kim YE, Ji S. Impact of a primary health care chronic diseases management pilot program. Korean J Med. 2021; 96(1):7–12.

44. Lee EW, Kim HS, Yoo BN, Lee EJ, Park JH. Effect of a primary care-based chronic disease management program for hypertension patients in South Korea. Iran J Public Health. 2022; 51(3):624–633. PMID: 35865058.

45. Ritchie CS, Leff B. Population health and tailored medical care in the home: the roles of home-based primary care and home-based palliative care. J Pain Symptom Manage. 2018; 55(3):1041–1046. PMID: 29031914.

46. Zimbroff RM, Ornstein KA, Sheehan OC. Home-based primary care: a systematic review of the literature, 2010-2020. J Am Geriatr Soc. 2021; 69(10):2963–2972. PMID: 34247383.

47. Kim CO, Jang SN. Home-based primary care for homebound older adults: literature review. Ann Geriatr Med Res. 2018; 22(2):62–72. PMID: 32743249.

48. Health Insurance Review & Assessment Service (KR). Notice: guidelines for the “Pilot Project for Home Care of Peritoneal Dialysis Patients”. Updated 2019. Accessed December 24, 2024. https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=7641 .

49. Health Insurance Review & Assessment Service (KR). Guidelines for home care pilot project for cancer patients. Updated 2021. Accessed December 24, 2024. https://www.hira.or.kr/bbs/157/2022/10/BZ202210318044205.pdf .

50. Health Insurance Review & Assessment Service (KR). Notice: guidelines for revision of the “Type 1 Diabetes Patient Home Care Pilot Project”. Updated 2024. Accessed December 24, 2024. https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=10743&pageIndex=1&pageIndex2=1 .

51. Health Insurance Review & Assessment Service (KR). Guidelines for home care pilot project for rehabilitation patients. Updated 2024. Accessed December 23, 2024. https://www.hira.or.kr/bbs/157/2023/12/BZ202312049364563.pdf .

52. Health Insurance Review & Assessment Service (KR). Notice: guidelines for revision of the “Severely Ill Pediatric Home Care Pilot Project”. Updated 2024. Accessed December 24, 2024. https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=10147&pageIndex=1&pageIndex2=1 .

53. Health Insurance Review & Assessment Service (KR). Notice: guidelines for revision of the “Home Medical Care Pilot Project for Patients with Home-use Ventilators”. Updated 2022. Accessed December 25, 2024. https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=10049&pageIndex=1&pageIndex2=1 .

54. Health Insurance Review & Assessment Service (KR). Notice: guidelines for revision of the “Pilot Project for Home Medical Care for Heart Disease Patients”. Updated 2022. Accessed December 25, 2024. https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=10051 .

55. Health Insurance Review & Assessment Service (KR). Notice: announcement of revision of guidelines for “Pilot Project for Home Medical Care for Tuberculosis Patients”. Updated 2022. Accessed December 25, 2024. https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=9550&pageIndex=1 .

56. Ministry of Health and Welfare (KR). Guidelines for the pilot project for the fee of primary care visits. Updated 2022. Accessed December 25, 2024. https://www.mohw.go.kr/boardDownload.es?bid=0003&list_no=1478692&seq=2 .

57. Ministry of Health and Welfare (KR). Announcement of guidelines for pilot project of long-term care home medical center. Updated 2024. Accessed December 25, 2024. https://www.mohw.go.kr/board.es?mid=a10501010000&bid=0003&list_no=1479696&act=view .

58. Ministry of Health and Welfare (KR). Guide of hospice and palliative care project in 2024. Updated 2024. Accessed December 25, 2024. https://www.mohw.go.kr/board.es?mid=a10107010000&bid=0043&act=view&list_no=1480476&tag=&cg_code=&list_depth=1 .

59. Ministry of Health and Welfare (KR). Project overview. Updated 2024. Accessed December 25, 2024. https://www.nrc.go.kr/chmcpd/html/content.do?depth=pi&menu_cd=02_04_01 .

60. Lee H. Changes in the mixed fee-based payment system in primary care: cases and implications. Korean J Fam Pract. 2023; 13(1):2–7.

61. Achelrod D, Welte T, Schreyögg J, Stargardt T. Costs and outcomes of the German disease management programme (DMP) for chronic obstructive pulmonary disease (COPD)-a large population-based cohort study. Health Policy. 2016; 120(9):1029–1039. PMID: 27552849.

62. Hur R, Kim KH, Jin DL, Yoon SJ. Impact of comprehensive primary care in patients with complex chronic diseases: nationwide cohort database analysis in Korea. J Korean Med Sci. 2024; 39(18):e158. PMID: 38742292.

63. Cho YG. Supply of primary care physicians: a key strategy to reduce population mortality. Korean J Fam Med. 2024; 45(2):59–60. PMID: 38528646.

64. Koh H, Kwon S, Cho B. Association of primary care physician supply with population mortality in South Korea: a pooled cross-sectional analysis. Korean J Fam Med. 2024; 45(2):105–115. PMID: 38287214.

65. Kang HC, Yun G, Lee J, Ko J, Kim SK, Moon S, et al. Korea Health Care System Performance (The Year 7): Achievements and Challenges of Innovation in Primary Care Chronic Disease Management. Sejong, Korea: Korea Institute for Health and Social Affairs;2023.

66. Leem JH, Lee S, Lim MK, Ahn E, Kim Y. Evaluation of value-based, community-centered primary care: a case study of Anseong health welfare social cooperative. Korean J Fam Pract. 2024; 14(2):66–74.

67. Mun H, Cho K, Lee S, Choi Y, Oh SJ, Kim YS, et al. Patient-centered integrated model of home health care services in South Korea (PICS-K). Int J Integr Care. 2023; 23(2):6.

68. Al Khashan H, Abogazalah F, Alomary S, Nahhas M, Alwadey A, Al-Khudhair B, et al. Primary health care reform in Saudi Arabia: progress, challenges and prospects. East Mediterr Health J. 2021; 27(10):1016–1026. PMID: 34766328.

69. Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians’ perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health. 2012; 18(8):604–612. PMID: 22352898.

70. Jeon B, Kwon S. Health and long-term care systems for older people in the republic of Korea: policy challenges and lessons. Health Syst Reform. 2017; 3(3):214–223. PMID: 31514668.

71. Pyo J, Lee W, Choi EY, Jang SG, Ock M. Qualitative research in healthcare: necessity and characteristics. J Prev Med Public Health. 2023; 56(1):12–20. PMID: 36746418.

72. Kato T, Ikegami N. How specialists become primary care physicians in Japan. Health (Irvine Calif). 2019; 11(3):322–331.

73. Crisp N. A global perspective on the education and training of primary care and public health professionals. London J Prim Care (Abingdon). 2012; 4(2):116–119.

74. Li X, Krumholz HM, Yip W, Cheng KK, De Maeseneer J, Meng Q, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020; 395(10239):1802–1812. PMID: 32505251.