Understanding North Korea’s healthcare system requires looking beyond headline figures to how conditions evolve and what field evidence can reveal. Since Kim Jong Un assumed power, hospital construction and modernization have been central to rebuilding the system, with the push extending to local hospitals after 2025 was designated the inaugural year of the public health revolution. Institutional reform has moved alongside this expansion: the 2026 constitutional revision removed provisions on free medical care, while the “Health Insurance Fund” has been broadened as part of a wider restructuring of healthcare provision. Digitalization is also intended to link central and local institutions and spread medical expertise more widely. Whether these reforms endure, however, will depend on staffing, medicines, equipment, and sustainable financing. Future inter-Korean cooperation will therefore need to move beyond material assistance toward strengthening institutional and operational capacity.