Reorganization strategies to enhance healthcare professionalism in the health and medical administration system
Article information
Abstract
Purpose
This study aims to identify current structural and operational challenges within Korea’s Ministry of Health and Welfare (MOHW), review the organization of health and medical administrative systems in other countries, and propose reorganization strategies to enhance professional expertise in health policy and governance.
Current Concepts
The main challenges facing the MOHW include weak coordination between health and welfare functions, a declining proportion of the health budget, and a shortage of health-sector professionals. Among 148 countries analyzed, 114 (77.0%) operate a Ministry of Health structure, 18 (12.2%) a Ministry of Health and Welfare, seven (4.7%) a Ministry of Health and Other Affairs, five (3.4%) a Ministry of Health, Welfare, and Other Affairs, and four (2.7%) other types of administrative structures. Many countries have recently reorganized their administrative systems to address emerging health issues such as substance abuse, digital health transformation, medical innovation, and infectious disease preparedness. In addition, several have established dedicated units for communication, coordination, and integrated management.
Discussion and Conclusion
To strengthen professionalism in Korea’s Health and Medical Administration System, two structural strategies are proposed: (1) establishing an independent Ministry of Health, or (2) expanding the second vice-ministerial office within the existing MOHW framework. Given the rapid evolution of the healthcare environment and the increasing complexity of global crises, an evidence-based and rational reorganization is urgently needed. Building broad consensus with healthcare professionals will be essential to reinforce expertise and ensure effective leadership in national health administration.
Introduction
Since the early 2000s, the world has witnessed a series of pandemics, including severe acute respiratory syndrome, influenza A (H1N1), and Middle East respiratory syndrome (MERS). Korea has made various institutional improvements throughout these successive pandemics. However, persistent criticism has continued to target the inadequate responses of the relevant authorities. These critiques have highlighted the need to reorganize public health administration to support more effective and timely policy formulation and implementation [1]. During the coronavirus disease 2019 (COVID-19) pandemic in particular, several structural limitations of Korea’s health administration became especially apparent, such as inconsistencies in infectious disease control policies, administrative disconnection between central and local governments, and weakened coordination capacity within the public health system [2].
The Ministry of Health and Welfare (MOHW) of Korea has undergone more frequent restructuring, division, and mergers than any other central administrative agency. The ministry adopted its current name in 2010 and, for the past 15 years, has been responsible for national health and welfare policy formulation and administration [3]. However, the nature of the tasks within the health and welfare sectors differs substantially, and the scale of each field is vast, making it extremely difficult to manage both comprehensively and efficiently within a single ministry. Historically, the MOHW has allocated more resources and administrative capacity to welfare rather than health policy, leading to criticism that it was unable to respond promptly and professionally as the lead ministry during the COVID-19 pandemic [4]. The medical community has therefore consistently argued for establishing an independent Ministry of Health to enhance policy expertise and crisis response capacity [5]. Nevertheless, no government has recently proposed a reorganization plan for the MOHW [6,7].
Health policy exerts an exceptionally broad impact and is directly linked to the public’s right to life. Therefore, the ministry responsible must possess a high degree of expertise in health and medical affairs. Even if such reform is not prioritized in the national policy agenda, its importance and necessity are comparable to those of other governmental reorganizations. For this reason, following the election of President Lee Jae-myung, the medical community identified the “establishment of a Ministry of Health” as its foremost policy proposal to restore the coherence and expertise of national health policy [8].
Although the need for reform in Korea’s health administration has long been acknowledged, the volume of relevant research remains limited. Existing studies have primarily focused on advocating for the separation of the health ministry, without addressing feasible structural reform measures within the current system. However, given the rapid transformation of future health environments, it is essential to explore not only the possibility of creating an independent health ministry but also practical reorganization strategies within the existing structure. Therefore, this study aims to identify and summarize the problems inherent in the current structure of the MOHW, examine international models of health administration, and propose organizational reform strategies that could strengthen professional capacity and policy coherence in Korea’s health and medical administration.
Problems in Korea’s Health and Medical Administration Structure
1. Insufficient integration between health and welfare functions
The MOHW was originally designed to manage both health and welfare services, reflecting the intrinsic connection between these 2 areas. In certain contexts, separating health and welfare functions would indeed be inefficient or even infeasible. For example, programs such as the Medical Aid Program, disability rehabilitation hospitals, assistive device support, public health management for persons with disabilities, operation of child-abuse response hospitals, the long-term care insurance program for older adults, and community-based integrated care pilots rely on both health and welfare services to operate effectively [9].
However, despite the theoretical rationale for integration, the internal operations of the MOHW reveal persistent fragmentation. The ministry is divided into 2 deputy minister offices, the First Vice Minister and the Second Vice Minister. Although the Minister is expected to coordinate between these divisions, this function is often limited because the Minister typically lacks professional experience in medicine or public health. As a result, the ministry functions more like 2 separate bureaucratic entities than an integrated organization [10].
2. Declining budgetary share for the health sector
The ministry’s total budget for 2025 is 125.49 trillion Korean Won (KRW), representing a 7.2% increase from the previous year’s 117.04 trillion KRW and accounting for 18.6% of the total national budget. However, the share of social welfare spending increased from 79.3% in 2012 to 85.4% in 2025, while the proportion of health expenditure declined from 20.7% to 14.6% during the same period. Thus, the apparent budget growth primarily reflects increases in welfare spending [11].
Since the 2000s, recurring outbreaks of emerging infectious diseases have shown that such crises impose enormous economic and societal burdens. The COVID-19 pandemic further demonstrated that responding to new infectious threats requires substantial fiscal investment. Despite this, the proportion of health spending continues to decline, thereby weakening national preparedness for future health crises.
3. Shortage of health and medical experts
Healthcare is an inherently specialized field that requires high levels of professional expertise. Without an adequate understanding of medical practice, health policy planning can become detached from real-world conditions, increasing the risk of policy failures and resistance from healthcare providers. This gap between administrative decisions and frontline practice has repeatedly surfaced—for example, during the 2000 separation of prescribing and dispensing, the 2014 telemedicine initiative, the 2020 Four Major Health Reforms, and the 2023 medical school quota increase [9].
As of 2022, only 20.2% (188 out of 931 employees) of MOHW staff were engaged in health-related positions, and fewer than 10% of these were physicians—only 14 medical doctors in total (2 bureau directors, 3 division directors, and 9 lower-level officers) [12]. Moreover, since the tenure of the 35th Minister (Ju Yang-ja, March–April 1998), only one physician has been appointed as Minister. Throughout the COVID-19 pandemic, the Minister was a career bureaucrat rather than a medical expert. As a result, policy decisions frequently lacked practical insight from the healthcare field. Even after the position of Second Vice Minister (responsible for health affairs) was introduced in 2020, only one of the 4 individuals appointed had an academic background in public health, whereas the remaining 3 were general civil servants [13]. This persistent shortage of medical professionals in leadership positions has repeatedly weakened Korea’s capacity to respond effectively to health emergencies such as MERS and COVID-19 [14]. In contrast, other countries with similar ministerial structures ensure that medical professionals hold key decision-making roles. In the United Kingdom, the Department of Health and Social Care (DHSC) includes 2 Ministers of State and 2 Parliamentary Under Secretaries of State, most of whom oversee healthcare. The department’s Permanent Secretary concurrently serves as the Chief Medical Officer, exercising substantial authority over health policy decisions [15]. Similarly, in the United States, the Deputy Secretary of Health and Human Services (HHS) is a healthcare expert who advises both the Secretary and the President. Among the 19 Assistant Secretaries within HHS, 6 are healthcare professionals [16]. In comparison, Korea’s Second Vice Minister is not a medical professional.
Health Administration Structures in Foreign Countries
1. Global overview of health administration systems in 148 countries
This study classified the organizational structures of health administration in 148 countries for which public information was available1. The classification was based on the scope of authority and administrative function. First, countries were categorized according to their principal area of responsibility: ministries primarily responsible for “health” were classified as Ministries of Health. Ministries overseeing both “health and welfare” were classified as Ministries of Health and Welfare. Ministries that combined “health” with other unrelated sectors were classified as Health-Other Ministries. Ministries managing “health, welfare, and additional sectors” were classified as Health-Welfare-Other Ministries. Lastly, entities not organized as ministries were categorized as Other Types. Second, even when a ministry’s official name did not include the word “health,” it was classified as a Ministry of Health if its primary responsibility was health administration and welfare was managed separately by another governmental body. Conversely, any ministry whose core responsibilities covered both health and welfare was categorized as a Ministry of Health and Welfare, regardless of its English title.
According to this classification, among the 148 countries analyzed, 114 countries (77.0%) operated Ministries of Health, 18 (12.2%) operated Ministries of Health and Welfare, 7 (4.7%) had Health-Other Ministries, 5 (3.4%) operated Health-Welfare-Other Ministries, and 4 (2.7%) maintained other organizational structures (Tables 1, 2).
Classification of health administration organizational types across 148 countries
Categorization of countries by health ministry type
Among the 38 member states of the Organisation for Economic Co-operation and Development (OECD), 25 countries (65.8%) have a Ministry of Health, 5 (13.2%) operate a Ministry of Health and Welfare, 1 (2.6%) has a Health-Other Ministry, 5 (13.2%) maintain a Health-Welfare-Other Ministry, and 2 countries (5.3%) fall into the Other Types category (Table 3).
Classification of health administration organizational types in OECD member countries
2. Case studies of major countries
1) Germany
Germany’s Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) is responsible for the overall planning, policy development, implementation, and supervision of national health, prevention, and long-term care systems. The BMG is led by a Minister who is a medical doctor and is supported by 4 Parliamentary State Secretaries. Since 2022, the ministry has been organized into 7 directorates. A new Federal Commissioner for Addiction and Drug Issues (Beauftragter der Bundesregierung für Sucht- und Drogenfragen) was established in 2022 to strengthen coordination on addiction and substance abuse policies. Directorate Z oversees ministry management, European and international health policy, and infrastructure development. Directorate 1 manages pharmaceuticals, pharmacies, narcotics, medical devices, and biotechnology. Directorate 2 oversees healthcare delivery systems, health insurance, and hospital administration. Directorate 3 is responsible for health protection, disease control, and biological and medical law. Directorate 4 manages long-term care and preventive services. Directorate 5, established in April 2019, advances the digital transformation and innovation of the German health system, including digital health strategies, electronic health records, and telemedicine expansion. Directorate 6 focuses on public health programs and community health management [17].
2) Canada
Health Canada (HC), the federal ministry of Canada, provides financial support to provincial and territorial governments while ensuring compliance with the principles and standards outlined in the Canada Health Act. Although healthcare delivery and health insurance administration fall under provincial and territorial authority, HC functions as the overarching coordinating body for national health governance. The ministry is led by the Minister of Health, the Minister of Mental Health and Addictions and the Associate Minister of Health, and supported by the Deputy Minister and Associate Deputy Minister. Major divisions include the Audit and Evaluation Branch, Chief Financial Officer, Communications and Public Affairs, Therapeutic Products Directorate, Operations Services Branch, Executive and Corporate Services, General Directorate of Digital Transformation, Health Products and Food Branch, Healthy Environments and Consumer Safety Branch, Legal Services, the Opioid Response Team, Pest Management Regulatory Agency, Regulatory Operations and Enforcement Branch, and Strategic Policy Branch [18].
3) United States
The U.S. Department of HHS promotes continuous advancement in medicine, public health, and social welfare to protect the health of the American people and provide essential services. Under the Secretary of HHS, the Immediate Office of the Secretary manages coordination and advisory functions, while the Office of Intergovernmental and External Affairs facilitates communication with intergovernmental and nongovernmental partners. The HHS comprises 13 operating divisions that oversee public health programs across multiple domains. The Assistant Secretary for Health directs national health policies and programs related to disease prevention and health promotion, coordinates major public health initiatives, and supervises agencies such as the National Institutes of Health, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and the Administration for Strategic Preparedness and Response. These 13 agencies also include the Administration for Community Living, the Agency for Healthcare Research and Quality, the Agency for Toxic Substances and Disease Registry, the Centers for Medicare & Medicaid Services, and the Advanced Research Projects Agency for Health [19].
4) United Kingdom
The United Kingdom’s DHSC does not directly deliver healthcare services. Instead, it formulates policies for public health and adult social care, while the National Health Service provides and manages service delivery. The department includes the Secretary of State, 2 Ministers of State, and 2 Parliamentary Under Secretaries of State. A Permanent Secretary oversees operations, strategy, and implementation while simultaneously serving as the department’s Chief Medical Officer. The DHSC is organized into several directorates, including the Directorate for Primary Care and Prevention, Office of the Chief Medical Officer, Finance Directorate, Adult Social Care Directorate, Secondary Care and Integration Directorate, Strategy Directorate, Second Permanent Secretary’s Office, and International Health Directorate. The Permanent Secretary provides strategic advice to ministers, manages departmental resources, monitors organizational performance, and ensures effective execution of ministerial decisions [20].
3. Summary
The analysis of global and national cases yields several key findings. First, among the 148 countries examined, 114 (77.0%) operate a Ministry of Health. Most of these are developing or small states, while advanced economies such as Germany, Canada, Italy, France, Spain, Australia, and Norway also maintain independent health ministries. Notably, several OECD members that currently operate separate Ministries of Health did so only after multiple reorganizations, suggesting that advanced nations often recognize the functional limitations of merged health–welfare systems.
Second, among the 18 countries (12.2%) that integrate health and welfare functions, most adopt a multi–vice-ministerial system. In parliamentary systems such as that of the United Kingdom, ministers and permanent secretaries assume clear divisions of authority and responsibility.
Third, nearly all countries studied have recently undertaken reorganizations to address emerging health challenges. Additionally, every case country maintains specialized departments for communication, inter-agency coordination, and stakeholder engagement. Regardless of whether a country operates a Ministry of Health or a Ministry of Health and Welfare, these examples underscore the critical importance of structured coordination and professional expertise in ensuring the effective functioning of national health administration systems.
Proposals for Strengthening Professional Capacity in Korea’s Health Administration
1. Short-term plan: expansion and empowerment of the Second Vice Minister’s office
This option maintains the existing structure of the MOHW while strengthening professional capacity within the health sector. First, to respond to emerging health issues, several new departments should be established under the Second Vice Minister, including the Division of Addiction and Drug Response, the Division of Digital Health, the Division of Health Workforce and Resource Management, and the Division of Infectious Disease Response. Second, to improve the efficiency and development of health workforce policy, the Bureau of Health Workforce Resources should be created by separating the current Divisions of Medical Workforce Policy and Health Resources Policy, which are presently located within the Bureau of Health Policy. Third, to ensure effective coordination between health and welfare functions, a new Department of Low Fertility and Population Aging should be placed under the direct supervision of the Minister. Fourth, an Office for Policy Coordination and Collaboration should be established under the Minister to enhance communication and interdepartmental cooperation between health and welfare divisions. Fifth, to strengthen professional expertise in health administration, recruitment of medical and public health professionals should be expanded. Lastly, increased budget allocations are necessary to ensure stable operation and development of health policy functions.
2. Mid- to long-term plan: establishment of an independent Ministry of Health
This proposal envisions dividing the existing MOHW into 2 independent ministries and integrating the functions of the Korea Disease Control and Prevention Agency and the Ministry of Food and Drug Safety under a newly established Ministry of Health. First, several national-level bureaus should be established to proactively address evolving health needs and emerging challenges. Second, to facilitate interministerial cooperation, a Policy Coordination Bureau should be created under the direct supervision of the Minister. Third, concerning professional staffing, the Minister of Health should be a medical doctor, and 2 vice ministers should be appointed based on their respective areas of expertise. Fourth, the new Ministry of Health must receive a proportionally larger budget consistent with its expanded national responsibilities.
Conclusion
The MOHW has long faced criticism regarding its inefficiency and lack of specialization. Given the rapidly changing healthcare landscape, the increasing uncertainty surrounding future health crises, and the global expansion of medical technologies, maintaining the current administrative structure will only intensify limitations in professional responsiveness and timely policy delivery. Therefore, a comprehensive, evidence-based reorganization plan is urgently required to ensure that expertise, rationality, and scientific governance are embedded within the health administration system. Such reform should be accompanied by a broad social consensus, including participation from healthcare professionals, welfare experts, public health specialists, and civil society. When deliberations on restructuring are grounded in public agreement and supported by professional evidence, Korea can strengthen both the sustainability of its health administration and public trust in its health policies. Ultimately, the feasibility and necessity of establishing an independent Ministry of Health should be evaluated within this broader framework of societal consensus and administrative effectiveness.
Notes
This analysis was conducted by individually accessing and reviewing the official government websites and health and medical administration system websites of 148 countries
Notes
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Data Availability
Not applicable.