Change in Healthcare Utilization by Disease Severity after Case Management for Medicaid

Seung Joo Lim

doi:10.12799/jkachn.2010.21.3.321

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Original Article
Change in Healthcare Utilization by Disease Severity after Case Management for Medicaid: Seung Joo Lim; Journal of Korean Academy of Community Health Nursing 2010;21(3):321-332.
DOI: https://doi.org/10.12799/jkachn.2010.21.3.321
Published online: April 4, 2014

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

• Received: July 31, 2010 • Revised: September 13, 2010 • Accepted: September 16, 2010

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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Abstract

Abstract

Purpose
This study examined change in healthcare utilization by disease severity after case management (CM) for Medicaid.
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 change in healthcare utilization between the CM group and the non-CM group. The subjects were 528 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006.
Results
In beneficiaries having fewer than 3 among the 11 notified diseases, the CM group showed a significantly larger decrease in outpatient day, outpatient expense, medication day, and medication expense than the non-CM group. In beneficiaries having 3 or more among the 11 notified diseases, however, there was no significant difference in healthcare utilization between the CM group and the non-CM group.
Conclusion
CM worked effectively on Medicaid beneficiaries outpatient healthcare utilization for mild diseases. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, a future study is needed to develope strategies to reduce hospitalization and care for Medicaid beneficiaries with severe diseases.
Key Words: Medicaid; Case management; Chronic disease; Utilization

Table 1

General Characteristics of Beneficiaries having Fewer than 3 and Those having 3 or More among the 11 Notified Diseases (Unit: person)

CM=case management; ES=elementary school; MS=middle school; HS=high school.

Table 2

Disease Characteristics of Beneficiaries having Fewer than 3 and Those having 3 or More among the 11 Notified Diseases (Unit: person)

CM=case management; BDs=behavioral disorders; COPD=chronic obstructive pulmonary disease.

Table 3

Comparison of Healthcare Utilization between the CM Group and the Non-CM Group in Beneficiaries having Fewer 3 among the 11 Notified Diseases (N=230)

CM=case management (n=67); Non-CM=non-case management (n=163).

^†The first six months of the year 2006 per person; ^‡The first six months of the year 2008 per person; ^§Outpatient expense+medication expense+inpatient expense.

Table 4

Comparison of Healthcare Utilization between the CM Group and the Non-CM Group in Beneficiaries having 3 or More among the 11 Notified Diseases (N=298)

CM=case management (n=128); Non-CM=non-case management (n=170).

^†The first six months of the year 2006 per person; ^‡The first six months of the year 2008 per person; ^§Outpatient expense+medication expense+inpatient expense.

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Change in Healthcare Utilization by Disease Severity after Case Management for Medicaid

Table 1 General Characteristics of Beneficiaries having Fewer than 3 and Those having 3 or More among the 11 Notified Diseases (Unit: person)

CM=case management; ES=elementary school; MS=middle school; HS=high school.

Table 2 Disease Characteristics of Beneficiaries having Fewer than 3 and Those having 3 or More among the 11 Notified Diseases (Unit: person)

CM=case management; BDs=behavioral disorders; COPD=chronic obstructive pulmonary disease.

Table 3 Comparison of Healthcare Utilization between the CM Group and the Non-CM Group in Beneficiaries having Fewer 3 among the 11 Notified Diseases (N=230)

CM=case management (n=67); Non-CM=non-case management (n=163).

^†The first six months of the year 2006 per person; ^‡The first six months of the year 2008 per person; ^§Outpatient expense+medication expense+inpatient expense.

Table 4 Comparison of Healthcare Utilization between the CM Group and the Non-CM Group in Beneficiaries having 3 or More among the 11 Notified Diseases (N=298)

CM=case management (n=128); Non-CM=non-case management (n=170).

^†The first six months of the year 2006 per person; ^‡The first six months of the year 2008 per person; ^§Outpatient expense+medication expense+inpatient expense.