From design to implementation: policy evolution of home-based primary care in Korea.

Abstract

Background and objectives: South Korea's rapid expansion of the older adult population, along with growing health and social care needs, has created an urgent demand for Home-Based Primary Care (HBPC). This study identified key design priorities for a Korean HBPC model and examined their reflection in the national pilot.

Research design and methods: This study was designed as a case study of the development and implementation of Korea's HBPC pilot program, using a dual-method approach for descriptive analysis. First, semi-structured interviews with 42 key informants, including policy makers, legal experts, researchers, and clinicians, identified design priorities using the 5P framework (Purpose, Population, People, Process, and Patterns). Second, policy documents and implementation guidelines from Phases 1-4 were reviewed to trace the program's evolution.

Results: Stakeholders emphasized that the primary objectives of HBPC should be to support aging in place, preserve functional ability, and reduce avoidable medical expenditures. Stakeholders supported gradually expanding the target population. However, a central point of contention involved whether to lower provider eligibility thresholds to increase scalability or raise them to ensure service quality. Document analysis revealed that revisions across Phases 1-4 expanded eligibility for recipients and providers and reduced coinsurance rates, thereby improving accessibility. Nonetheless, interdisciplinary training and a comprehensive performance evaluation framework remain in early stages.

Discussion and implications: Integrating stakeholder perspectives into policy design grounds HBPC development in practical experience. These findings underscore HBPC's potential in supporting aging in place among high-need, vulnerable populations and inform the development of inclusive, adaptable community-based care models.