A bill titled “Special Act on Strengthening Primary Care” has been proposed in the National Assembly to reinforce primary care. According to the bill, primary care is defined as the medical services that citizens first encounter, providing continuous and comprehensive care for the treatment and management of common diseases among local residents, as well as disease prevention and health promotion. To establish primary care functions, the bill mandates the operation of “Regional Primary Care Support Centers.”

In this bill, local governments will implement a “primary care physician system” where individuals receive comprehensive health management, including prevention, treatment, and management, from their primary care physician. The reason for proposing this bill is that “our country has not established a healthcare system centered on primary care, which has exacerbated imbalances and inefficiencies in the allocation of medical resources,” and “the background for promoting this special law is to enable primary care to play a central role in the healthcare system."

The special law on strengthening primary care revives debate over UK-style ‘capitation’ system

The proposed bill does not specify which doctors will serve as primary care physicians or whether they will be assigned gatekeeping roles. The primary care physician system is based on the U.K.'s healthcare system. The terms “U.K.-style primary care physician system” or “capitation system” have long been taboo in Korea's medical community. Academic discussions on the primary care physician system itself have been met with significant skepticism. The system appears to encompass significant changes to the payment system, specifically the “capitation” system, which seems to evoke strong resistance. However, there do not appear to be many opponents to the slogan of strengthening primary care. Additionally, the argument that the primary care physician system in Korea should be tailored to the country's specific circumstances is understandable. Nevertheless, the medical community is likely to strongly oppose a payment method based on the capitation system. The government's efforts to improve the low-pay system, which is already causing the collapse of medical care, seem inadequate, and there are signs that it will introduce a capitation system while maintaining the current low-pay policy, which is absurd. Given the government's behavior so far, this concern is understandable.

The U.K. recommends that each primary care physician register up to 2,000 patients. Some primary care physicians exceed this limit. Primary care physicians receive approximately 164.64 pounds (about 300,000 won) per year per registered patient. However, this amount may vary slightly depending on the region and performance. Regardless of whether a registered patient visits the primary care physician once or receives more than 10 treatments in a year, a fixed cost is set and paid. Theoretically, if a primary care physician meets the NHS-recommended patient-to-physician ratio of 2,000 patients, this would generate a basic annual revenue of approximately 600 million won. Additionally, the portion settled through a “fee-for-service” system based on the primary care physician's clinical activities is calculated separately. The U.K. particularly encourages group practices over solo practices. The salaries of primary care physicians in salaried positions do not appear to be very high. However, there have been cases where primary care physicians working independently have attracted attention and become a topic of discussion due to their high annual income of 500 million won to 700 million won.

UK and Canada’s gatekeeper model seen as unrealistic in Korea under current visit fees

Canada does not enforce capitation or fee-for-service systems, leaving the choice to individual doctors. The operating costs of the two systems are said to be similar. In Korea, it seems impossible for primary care physicians to play the gatekeeper role of controlling a portion of medical consumption, as in the U.K. and Canada, given the current costs of initial and follow-up visits. Persuading patients to refrain from certain tests or treatments and wait would require significantly more time and effort. If negative medical outcomes arise while patients are waiting or under observation, this could lead to violence and criminal complaints. The medical malpractice compensation system in Korea is still in its developmental stage. Considering this, it seems reasonable to abandon the gatekeeper role for physicians in the current medical environment. According to a recent OECD report (How Do Health System Features Influence Health System Performance? : OECD/The Health Foundation 2025), countries that do or do not have a gatekeeper role report similar medical outcomes. France recently published a report by L'Académie de médecine (Academy of Medicine), stating that to alleviate medical desertification and waiting times, institutional reforms are necessary to allow patients to see specialists directly without first consulting a primary care physician. It appears that the gatekeeper role of primary care physicians is gradually being eroded.

Amid medical system strain, Korea must prioritize sustainability over an uncompensated primary care model

In Korea, many specialists are opening clinics to provide general medical care outside their specialty fields. From a human resource perspective, the British model of primary care provision and the role of general practitioners do not appear to align with the Korean medical environment. However, it is expected that specialist general practitioners could serve as intermediaries between patients and higher-level medical institutions. This could be explored as a way to improve the sustainability of medical care, which is a weakness in the Korean healthcare system. Maintaining continuity of care may be possible through consultations where doctors refer patients to other clinics or hospitals for issues outside their specialty. However, appropriate compensation for such consultations and referrals must follow. The most vulnerable aspect of this country's healthcare system is the lack of continuity of care due to the absence of a primary care physician system. It is said that when continuity of care is ensured, patients are more likely to follow their doctors' advice and trust them. High trust also plays a role in reducing unnecessary hospitalizations.

Korea was criticized in the recent OECD report for unnecessary hospitalizations. I am very curious to see if this can be resolved through the primary care physician system. This is because Koreans have a different preference for hospitalization, and hospitalization costs are relatively low, so many people prefer hospitalization over outpatient care, even if it means traveling long distances. There is also a culture where hospital rooms are perceived as places where patients and their families seek stable care rather than active medical treatment. As we often see in the news, when politicians face difficult situations, they often disappear into hospitals.

The urgent need for honest dialogue on building a Korean primary care physician system in an aging society

In the aging society, the role of doctors in the recently discussed “integrated care” system, as well as home visits and mobile clinics, all require primary care physicians. Despite having the world's highest rate of medical care utilization, legislation for telemedicine has been proposed multiple times. In fact, telemedicine is being discussed internationally within limited conditions and scope. Even without a primary care physician system, Korea's accessibility and efficiency in primary care provided by specialists alone are unmatched by other countries. With the world's highest level of hospital beds, the hospitalization rate is naturally high. It is now time for in-depth discussions on Korean-style primary care and the family doctor system. Criticizing the discussions themselves as a form of policy acceptance is not appropriate, as even institutional opposition requires reasonable reasons and evidence.

It is time to collectively consider how to develop a Korean-style primary care physician system and primary care in an aging society.

References:
1. NHS Payments to General Practice, England 2022/23

2. How Do Health System Features Influence Health System Performance? : OECD/The Health Foundation 2025

3. L’Académie de médecine veut assouplir les accès directs à certains spécialistes pour réduire les délais | Le Quotidien du Médecin | Libéral / Soins de ville