The objectives of this study were to evaluate the current state of governance structure and management of the health system to achieve the goals of the health system in South Korea, and to propose reform plan. This study drew implications from the governance of United Kingdom, Germany, and Netherlands, based on the principle of health system proposed by World Health Organization. The presidency and the health ministry should make macroscopic decision-making. The government has to decentralize the enforcement by municipality to operate public health and national health insurance (NHI), and to distribute the centralized NHI fund by municipality. The front line health centers and community centers should provide integrated health and social services. The government has to establish diversified regulatory bodies to enhance both the patient-centered care and the efficiency and equity of health care, and to provide mechanisms for ensuring autonomy of providers. The governance of the health system should be composed of the centralization of macro decision-making, the decentralization of implementation by municipality, the integration of health and social services on the front line, and the well-balanced regulation and autonomy on both consumers and suppliers.