Korean J Fam Pract.  2025 Mar;15(1):9-16. 10.21215/kjfp.2025.15.1.9.

Current Status and Future Directions of Primary Care in the World: Insights from United States (1) —Primary Care and Payment Reform—

• Kim KH
• Cho B

• KMID: 2565933
• DOI: http://doi.org/10.21215/kjfp.2025.15.1.9

Abstract

The United States has implemented various payment system reforms to strengthen primary care. Since there is no universal healthcare coverage, individuals are enrolled in private insurance or public programs, such as Medicare and Medicaid. Following the enactment of the Affordable Care Act in 2010, the number of uninsured individuals was halved. To reform the payment system, incorporating multiple payers is essential. Fee-for-service alone makes it difficult to provide multidisciplinary care and high-quality, comprehensive primary care, leading to the implementation of various hybrid payment models, such as capitation and performance-based payment systems. Value-based payment is a performance-based incentive that is typically provided as an additional incentive rather than a standalone payment method. Early physician-focused, value-based payment models included the “Physician Value-Based Payment Modifier,” which was later improved with implementation of the “Merit-based Incentive Payment System” and “Alternative Payment Model.” For primary care institutions, performance-based payments are provided based on rating evaluations, with up to 5% in incentive payments. Hybrid payment approaches have proven to be more effective than single-payment methods. Performancebased incentives are particularly effective when tied to specific conditions, such as per patient visit, per medical service, or improvement over previous performance.

Keyword

Payment Reform; Primary Care; Value-Based Payment