세계의 일차의료 현황과 발전방향: 미국 (2) —일차의료 변혁의 혁신 모델— = Current Status and Future Directions of Primary Care in the World: Insights from United States (2) —Innovative Models for the Transformation of Primary Care—

다국어 초록 (Multilingual Abstract)

One of the most prominent models for strengthening primary care in the United States is the “Patient-Centered Medical Home (PCMH),” which has led the transformation of primary care over the past 15 years. The PCMH employs a team-based approach to deliver comprehensive, patient-centered primary care services and has evolved to support various innovative payment models. Medicare, a federal health insurance program for individuals aged 65 and older or those with specific chronic conditions, has introduced primary care payment models such as “Comprehensive Primary Care Plus” and “Primary Care First.” These models create a hybrid payment system that integrates traditional fee-for-service with fixed care management fees, per-visit payments, and value-based payments. More recently, the Direct Primary Care model has offered primary care physicians a meaningful alternative to fee-for-service payments by enabling direct contracts with patients. In contrast, the existing “Accountable Care Organization (ACO)” model has had a limited impact on primary care and chronic disease management. To address this limitation, newer models such as “ACO Primary Care Flex” have been introduced, offering additional payments to support primary care services. Meanwhile, Medicaid, which serves low-income and vulnerable populations, aims to increase primary care payment rates to match those of Medicare. To support populations in areas underserved by primary care, the “Health Resources and Services Administration” has implemented various initiatives, with “Federally Qualified Health Centers” and “Rural Health Centers” playing key roles in delivering essential services.