Conditions for Success in Korea’s Primary Care Innovation Pilot: Focusing on Payment Reform

is poised to launch a community-based primary care innovation pilot, pursuing improving poor patient experience, curbing unsustainable healthcare expenditure growth, and sustaining avoidable mortality as low as it is.This article describes that payment system redesign is the critical determinant of pilot success, proposing a three-tier payment framework applicable within the single-payer National Health Insurance system.The first tier, base payment, transitions from fee-for-service to condition-based prepayment using Hierarchical Condition Category, pre-paid quarterly per enrolled patients to their preferred participating primary care providers.This redirects provider incentives-rewarding fewer unnecessary procedures and richer patient communication-while remaining budget-neutral to the insurer.The second tier, performance-based shared savings, returns the highest portion of avoided secondary and tertiary care expenditures to best performing providers when patient health outcomes and experience improve.The third tier, transition support funding, offers one-time upfront infrastructure payments to cover service redesign cost such as workforce expansion, digital infrastructure, and care redesign costs during the initial one-to-three years.Providers may choose condition-based prepayment or modified fee-for-service track with shared savings, enabling a soft landing.Together, these mechanisms create aligned incentives for providers, patients, and insurers-a genuine triple-win prerequisite for scalable, sustainable primary care reform.