"A super-aged society began in Dec. last year, and chronic diseases are increasing rapidly. With the current medical system, it is difficult to respond to the new demand."
The Ministry of Health and Welfare has brought back the "community primary care innovation pilot project." In short, this pilot is not a gatekeeping primary doctor system that restricts hospital use, but an experiment to build a management-centered primary care system. If residents choose and register with a neighborhood clinic, they will receive continuous management tailored to their disease type and condition, and the government will compensate medical institutions based on management outcomes rather than the number of visits. It does not restrict the use of higher-level hospitals through a primary doctor.
At the Health Insurance Policy Deliberation Committee on the 23rd, the ministry presented a draft of the project and assessed that super-aging, the rise in chronic diseases, and the concentration at large hospitals are worsening simultaneously. It judged that restructuring tertiary general hospitals to focus on severe and emergency cases and fostering secondary hospitals alone will not change the utilization structure, and that it is necessary to reestablish the functions of primary care, the starting point of the delivery system.
The solution proposed by the government is a "Korean-style primary care model." Park Eun-jeong, Director of the Community Healthcare Innovation Division at the ministry, said at a recent advance briefing for reporters that "this is not a structure that regulates patient choice," adding that it is "a pilot to verify whether a management system based on voluntary clinic selection and registration, and on a relationship of trust, actually works."
The core of this project is that patients will not be treated in the same way. Registered patients are divided into four groups according to the number of diseases, functional status, and care needs. Relatively healthy residents will focus on prevention and lifestyle management; those with chronic diseases such as hypertension and diabetes will focus on regular monitoring and medication management; and high-risk patients with complex conditions will receive intensive management. Patients with mobility difficulties will be linked to home visits, home-based care, and care services. The intensity of management and the level of compensation will also vary by patient group.
Patient classification is data-based. The ministry plans to verify appropriate medical costs and management levels for each patient group by analyzing existing research using health insurance claims data alongside pilot project data. Next year, it will start with those 50 and older, when medical costs begin to rise in earnest, and then gradually expand the age and target range.
The mode of care presumes a multidisciplinary team rather than a "single-physician primary doctor." Given the prevalence of solo practices, a hub support organization will be established to support multiple clinics and back home visits, home-based care, and collaboration among multiple professions. Depending on local conditions, various operating models—such as secondary-hospital-linked, local-government-led, and public health center–centered—will be tested simultaneously.
The compensation system will also change. Each clinic can register and manage up to 1,000 patients, and a per-patient management fee will be paid monthly in advance. Operational support and performance-based rewards will be added. Performance will be evaluated based on service quality, health outcomes, and whether care is used appropriately. However, for areas with large variation, such as tests and procedures, fee-for-service will be maintained for the time being. The patient coinsurance rate will be 20%, and the specific payment method will be set by agreement between the patient and the clinic.
The ministry defines this pilot not as a simple expansion of the existing chronic disease management project or home-visit fee schedule, but as the groundwork for a nationwide primary doctor discussion. Director Park said, "We can only discuss institutionalization after management by patient group, appropriate medical costs, and compensation structures are first organized," adding, "We will also review integration after evaluating overlap with existing programs."
The pilot is slated to begin in Jul. next year, proceeding through a regional call for applications and preliminary designation. The government plans to establish the model through data accumulation and evaluation through 2028, and then consider institutionalization from 2029.
The medical community agrees with the direction but says incentives to participate must be adequately designed. At a National Assembly forum on the 17th, Yi Chung-hyeong, executive director of the Korean Medical Association Organization, said, "Past pilots were well designed, but participating clinics did not even reach 1%," adding, "The structure must be simple, and fiscal input must be sufficient." Nursing circles and academia are calling for clearer definitions of the roles, responsibilities, and compensation structures of multidisciplinary personnel.