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This study aimed to review the history of national chronic diseases management, outcomes, and limitations of major chronic disease management programs in South Korea, and discuss emerging challenges. South Korea is one of many countries that implement national chronic disease management programs. “A pilot program for the registration and management of cardiocerebrovascular high-risk groups” in 2007, “A pilot program for community primary medical care” in 2014, and “A pilot program for chronic care charges” in 2016. Although these programs showed positive outcomes with respect to various indicators, a common limitation has been observed: the implementation of a systematic and comprehensive program at the national level is difficult. The Korean government has launched the development of an integrated program at the national level that complements the shortcomings and maximizes the strengths of existing pilot programs. Such an integrated model comprehensively manages diseases and health problems centered on patients by increasing consistency and continuity of medical treatment and institutionalizing care coordinator positions through local clinic-based patient management structures for chronic disease management. For establishing and implementing policies to strengthen chronic care management in primary medical care, a virtuous cycle, in which experiences in various programs that have been conducted are monitored and achievements are accumulated in aid of policy development, is important. That is, objective evaluation indices and systems should be designed as programs are carried forward, and program quality should be improved through the disclosure of evaluation results and feedback.
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