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HOME > J Korean Acad Community Health Nurs > Volume 21(3); 2010 > Article
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

© 2013 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 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.
Table 1
General Characteristics of Beneficiaries having Fewer than 3 and Those having 3 or More among the 11 Notified Diseases (Unit: person)
jkachn-21-321-i001.jpg

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)
jkachn-21-321-i002.jpg

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)
jkachn-21-321-i003.jpg

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)
jkachn-21-321-i004.jpg

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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References

    Citations

    Citations to this article as recorded by  
    • The Effect of Case Management Services for High-risk Medicaid Beneficiaries
      Young Jin Ahn, Yun-Kyoung Choi
      Journal of the Korea Academia-Industrial cooperation Society.2015; 16(8): 5430.     CrossRef
    • Comparing the Needs of Case Management between Medical Aid Beneficiaries with Simple and Multiple Chronic Diseases
      Yang Heui Ahn, Yeonok Suh, Ok Kyung Ham, Hee Kyung Kim
      The Korean Journal of Rehabilitation Nursing.2015; 18(2): 98.     CrossRef
    • Case Management for Medical Aid Beneficiaries in Korea: Findings from Case-control Study
      Hee-Sun Shin, Jin-Joo Oh
      Asian Nursing Research.2014; 8(4): 274.     CrossRef
    • Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea
      Yang Heui Ahn, Ok Kyung Ham, Soo Hyun Kim, Chang Gi Park
      Journal of Korean Academy of Nursing.2012; 42(7): 928.     CrossRef

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


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