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HOME > J Korean Acad Community Health Nurs > Volume 21(4); 2010 > Article
Original Article
The Effects of Case Management for Medicaid on Healthcare Utilization by the Medicaid System
Seung Joo Lim
Journal of Korean Academy of Community Health Nursing 2014;21(4):375-385.
DOI: https://doi.org/10.12799/jkachn.2010.21.4.375
Published online: April 4, 2014

Part-time Lecturer, College of Nursing, Seoul National University, Korea.

• Received: September 29, 2010   • Revised: November 16, 2010   • Accepted: November 23, 2010

© 2010 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study examined the effects of case management (CM) for Medicaid on healthcare utilization considering the Medicaid system.
  • Methods
    Data were extracted from survey data on "Healthcare utilization and health status of Medicaid beneficiaries" conducted in 2007 and 2008 by the Ministry for Health, Welfare and Family Affairs. This study was designed to compare the effects on healthcare utilization between the CM group and the non-CM group. The subjects were 535 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006.
  • Results
    The outpatient days and medication days of the CM group decreased significantly more than those of the non-CM group with the copayment system. There were no significant differences of healthcare utilization between the CM group and the non-CM group with the designated doctor system.
  • Conclusion
    CM worked effectively on Medicaid beneficiaries' outpatient healthcare utilization with the copayment system. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, future studies are needed to develop strategies to reduce hospitalization and Medicaid beneficiaries' outpatient healthcare utilization with the designated doctor system.
Table 1
General Characteristics of Beneficiaries with Copayment System or Designated Doctor System (Unit: person)
jkachn-21-375-i001.jpg

CM=case management.

Table 2
Disease Characteristics of Beneficiaries with Copayment System or Designated Doctor System (Unit: person)
jkachn-21-375-i002.jpg

CM=case management.

Table 3
Comparison of CM group with Non-CM group of Healthcare Utilization in Beneficiaries with Copayment System and Designated Doctor System (Unit: day, won)
jkachn-21-375-i003.jpg

CM=case management; Non-CM=non-case management.

The first six months of the year 2006 per person; The first six months of the year 2008 per person; §Total expense=outpatient expense+medication expense+inpatient expense.

This article is based on a part of the first author's doctoral thesis from Seoul National University.

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Figure & Data

References

    Citations

    Citations to this article as recorded by  
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      Min Jung Kim, Young-Ha Cho, Nam Hee Park
      Journal of Korean Academy of Community Health Nursing.2015; 26(3): 278.     CrossRef
    • A Study on Influential Factors on Satisfaction with the Use of Medical Services by the Qualified Recipients of Medical Aid(focusing on the period after the introduction of the selected medical center system)
      Jin-Woo Lee, Se-I Yang, Kwang-Hwan Kim
      Journal of Digital Convergence.2014; 12(3): 289.     CrossRef
    • Effectiveness of Community-based Case Management for Patients with Hypertension
      Soon-Nyoung Yun, In-Sook Lee, Jin Hyun Kim, Young Ko
      Journal of Korean Academy of Community Health Nursing.2014; 25(3): 159.     CrossRef
    • The Effects of the Designated Doctor System on the Health of Medical Aid Beneficiaries
      Jeongmyung Choi, Jinjoo Oh
      Journal of Korean Academy of Community Health Nursing.2012; 23(4): 438.     CrossRef

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