As countries strive to make universal health coverage (UHC) more than just a constitutional promise or aspirational goal, the core challenge persists: How can health systems be designed, financed, and governed to deliver equitable, efficient, and resilient care?
The World Bank has set a target of enabling 1.5 billion people to access UHC, recognizing that knowledge exchange is critical to achieving this ambition. Through the World Bank Group Academy, the Bank helps build capacity and share knowledge to support its mission of ending extreme poverty and promoting shared prosperity, including in the health sector. This platform is increasingly being used to complement study tours and technical assistance, extending the reach of global experience to policymakers and practitioners worldwide.
Korea provides one of many reference points. Over the past few decades, it has transitioned from a lower-income county with limited public health services to one with a nationally integrated insurance system that emphasizes broad coverage, cost control, and technology-enabled oversight. While Korea’s context and trajectory are unique, elements of its institutional and policy design may offer useful lessons for other countries navigating their own health system transformations.
For instance, a recent World Bank–facilitated study tour brought together policymakers from several countries to explore Korea’s reforms, with delegates from countries such as Nepal reflecting on how to tailor lessons to their own systems. This study tour is part of the World Bank’s broader commitment to knowledge sharing, creating platforms for cross-country learning that connect global experience with country-level reform agendas. By facilitating these exchanges, the Bank helps policymakers translate abstract policy goals like UHC into actionable strategies grounded in real-world practice.
Why Korea’s experience is worth examining, cautiously
Korea expanded health coverage over decades of incremental reform, learning by doing, and adapting policy instruments to changing demographic, economic, and political conditions. Korea operates a single-payer health financing system, meaning that a single public entity manages the majority of health coverage and financing for the population.
Within this system, two separate institutions play distinct but complementary roles:the National Health Insurance Service (NHIS), which manages enrollment, premium collection, and risk pooling, and the Health Insurance Review and Assessment Service (HIRA), which oversees claims review, cost control, and strategic purchasing of health services. This model is not without its challenges. Coordination across agencies requires strong data systems, aligned incentives, and continuous policy refinement. While the separation of functions has helped reduce conflicts of interest and improve oversight, it also demands robust inter-agency collaboration-something that took Korea years to build and may not be easily replicated in other settings.
Delegates noted Korea’s meticulous attention to detail, from policy design to operational processes and implementation, with digital systems serving as the backbone of its service delivery and oversight. Particularly noteworthy is Korea’s use of digital infrastructure to enhance transparency, streamline claims processing, and support data-driven policy feedback. Implementing these systems required persistent effort and continuous adaptation. Countries looking to draw from Korea’s experience must recognize that its model reflects specific historical, economic, and institutional choices, and the model may need to be adjusted to fit different realities.
Korea continues to rely on a fee-for-service system, the origins of which lie in a specific political and institutional history, and the model may not be easily transferable to other contexts.
Lesson 1: Clarify institutional roles to balance efficiency and accountability
Korea’s division of responsibilities between NHIS and HIRA demonstrates how clear mandates and role separation can support system-wide governance. This institutional architecture has enabled effective cost control, purchasing, and data analytics. The separation of NHIS and HIRA in 2000 was a deliberate policy decision to promote checks and balances between the insurer and the reviewer, although it also introduced some inefficiencies in coordination and operations. Other countries can learn from both the strengths and limitations of Korea’s approach. For example, defining complementary roles between payer, provider, and regulator institutions can help avoid duplication and create accountability.
Lesson 2: Embed digital tools within policy frameworks that prioritize equity and responsiveness
Among Korea’s many achievements, its digital infrastructure stands out as one of its greatest strengths. The ability to collect, analyze, and act on real-time data has enabled responsive policymaking, efficient service delivery, and system-wide transparency.
Korea uses digital tools, such as AI-powered fraud detection, real-time claims tracking, and health data analytics to support policy and operational decisions. These technologies are not standalone solutions—they are embedded within broader governance structures with clear mandates and feedback loops. By integrating digital innovation into national priorities, countries can enhance service delivery and public trust. Importantly, Korea’s current digital ecosystem is the result of more than 30 years of iterative development. Meticulous planning, long-term investment, and learning from both successes and failures were critical to building a system that works. Countries aiming to replicate or adapt Korea’s digital approach must do so with careful sequencing and clear objectives.
Lesson 3: Transition toward strategic purchasing
The same lesson applies to provider payment systems. Korea’s gradual shift from fee-for-service toward bundled and performance-based payments reflects a broader trend toward strategic purchasing. However, Korea remains heavily reliant on fee-for-service, which has proven very difficult to reform due to entrenched political, institutional, and stakeholder dynamics. This experience underscores the importance of setting the right foundations early.
Countries designing or reforming their systems have an opportunity to consider alternative payment models from the start, ones that better align with efficiency and quality goals. Korea’s case offers valuable lessons not only in what has worked, but also in understanding the constraints that come with legacy systems.
Lesson 4: Strengthen national-subnational collaboration
Visits to local health centers and private hospitals illustrated how innovations like telemedicine and robotic logistics are being deployed to improve access and efficiency. While Korea operates a relatively centralized health system compared to many countries, it still places strong emphasis on coordination between national and subnational levels. This collaboration has been essential to ensuring that digital tools, policy reforms, and service standards are consistently implemented across the country. In other contexts, strengthening the link between central policy frameworks and local service delivery can unlock similar innovation while maintaining standards.
Shared challenges, contextual solutions
What works in Korea may inspire, but must not be transplanted without contextual grounding. For example, Nepal’s leaders emphasized the need for country-specific adaptations, such as simplifying claims review processes for settings with limited internet connectivity, prioritizing digital health tools that are compatible with local language and literacy levels, and phasing in electronic medical records (EMRs) in alignment with broader health workforce strengthening. These kinds of adjustments help ensure that reforms are both feasible and sustainable in local contexts.
As the Bank continues facilitating cross-country learning, Korea’s lessons reaffirm a core truth: the best reforms are rarely imported wholesale. They emerge through shared dialogue, grounded experimentation, and the courage to adapt what works, locally and sustainably.
Source: blogs.worldbank
