Health Policy Manag.  2023 Dec;33(4):379-388. 10.4332/KJHPA.2023.33.4.379.

A Review of Healthcare Provider Payment System in Korea

• Seo Ew
• Chung Sh

• KMID: 2551393
• DOI: http://doi.org/10.4332/KJHPA.2023.33.4.379

Abstract

This study aims to propose the implementation of innovative payment models in Korea in order to promote the financial sustainability of the national health insurance system by reviewing the current status of the payment system in Korea and examining other countries’ experiences with various innovative payment models. Korea primarily uses a fee-for-service payment system and additionally uses various payment systems such as case payment, per diem, and pay-for-performance. However, each payment system has its limitations. Many OECD (Organization for Economic Cooperation and Development) countries have pointed out the limitations of existing payment systems and have been attempting various innovative payment models (e.g., add-on payment, bundled payment, and population-based payment). Therefore, it is essential for Korea to consider innovative payment models, such as a mixed payment model that takes into account the strengths and weaknesses of each payment system, and to design and pilot these models. This process requires stakeholders to work together to build a social consensus on the implementation of innovative payment systems and to refine legal and systematic aspects, develop an integrated health information system, and establish dedicated organizations and committees. These efforts towards innovative payment models will contribute to developing a sustainable health insurance system that ensures the public’s health and well-being in Korea.

Keyword

Payment system; Innovative payment model; Health insurance