Research in Community and Public Health Nursing

Original Articles

The Effects of the Designated Doctor System on Health Care Utilization of Medical Aid Beneficiaries with Chronic Diseases: Min Jung Kim, Young Ha Cho, Nam Hee Park; J Korean Acad Community Health Nurs. 2015;26(3):278-291. Published online September 30, 2015; DOI: https://doi.org/10.12799/jkachn.2015.26.3.278

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PURPOSE
This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences.
METHODS
Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program.
RESULTS
There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution.
CONCLUSION
These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

Citations

Citations to this article as recorded by

A Two-step Clustering Approach for Measuring Socioeconomic Factors Associated with Cardiovascular Health among Older Adults in South Korea
Chi-Young Lee
Korean Journal of Adult Nursing.2020; 32(6): 551. CrossRef

Effectiveness of Community-based Case Management for Patients with Hypertension: Soon Nyoung Yun, In Sook Lee, Jin Hyun Kim, Young Ko; J Korean Acad Community Health Nurs. 2014;25(3):159-169. Published online September 30, 2014; DOI: https://doi.org/10.12799/jkachn.2014.25.3.159

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Abstract PDF: PURPOSE
The purpose of this study was to evaluate the effectiveness of case management for patients with hypertension on their health status and medical service utilization.
METHODS
This study was a secondary analysis of data collected for a larger study of chronic disease management in 2008 using the National Health Insurance Corporation database. A total of 12,944 patients who received case management for hypertension were included in this analysis. The subjects of case management were classified into subgroups, namely, over-use, under-use, and non-use groups according to the amount of medical service utilization. To compare the medical service utilization, a control group was selected randomly. The data were analyzed through descriptive statistics, McNemar test, and ANOVA.
RESULTS
All the subgroups displayed significant differences in blood pressure, self-management, social support, and their characteristics of medical service utilization. The total medical expense of the under-use and non-use groups increased after case management. However, there was no decrease in the medical expense of the over-use group.
CONCLUSION
This finding suggests that there is a need to re-examine why patients overuse medical services and to supplement specific strategies for encouraging appropriate medical service utilization, and enhancing case management efforts for the over-use group.

The Characteristics and Service Utilization of Home Nursing Care Beneficiaries Under the Korean Long Term Care Insurance: Jung Suk Lee, Eun Jeong Han, Im Ok Kang; J Korean Acad Community Health Nurs. 2011;22(1):33-44. Published online March 31, 2011; DOI: https://doi.org/10.12799/jkachn.2011.22.1.33

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15 Citations

Abstract PDF

PURPOSE
This study examined the characteristics and service utilization of home nursing care beneficiaries under the Korean Long-Term Care Insurance (LTCI).
METHODS
We used assessment data and claim data of National Health Insurance Corporation from July to August 2008. Data were composed of subjects who were the beneficiaries of home nursing care.
RESULTS
A total of 634 subjects were analyzed. Of the subjects, 57.1% were 75 years and over. The average score of nursing care need was only 0.71 and the percentage of those whose nursing care need score was zero was 58.0%. More than half of the subjects had partially dependent musculoskeletal conditions, and 75.5% had two or more comorbidities. A third of them usedonly home nursing care, and another third used both home nursing care and general home care at the same time. Those who needed sore care used the largest home nursing care benefits.
CONCLUSION
Home nursing care of LTCI performs community-based healthcare services under LTCI. Throughout the past two years, however, it has not been active. Understanding the characteristics of its users is important in order to develop effective strategies for activating home nursing care.

Citations

Citations to this article as recorded by

Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community
Soyoung Seo, Soong-nang Jang
Journal of Korean Academy of Nursing.2022; 52(1): 105. CrossRef
Emergencies in Long-Term Care Services for the Elderly in Korea: A Mixed-Methods Study
Soon Ok Kim, Sun Hee Bae
International Journal of Environmental Research and Public Health.2019; 17(1): 66. CrossRef
Powerlessness, Family Support and Health Promoting Behavior in Elders Using Home Service under Korean Long-term Care Insurance
Yanghee Pang, Oksoo Kim
Journal of Korean Gerontological Nursing.2017; 19(3): 184. CrossRef
Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study
Yeong Jun Ju, Hyo Jung Lee, Woorim Kim, Sang Ah Lee, Kyu-Tae Han, Eun-Cheol Park
International Journal of Nursing Studies.2017; 75: 93. CrossRef
Effects of Visiting Nursing Services in Long-term Care Insurance on Utilization of Health Care
Sangjin Lee, Chanyeong Kwak
Journal of Korean Academy of Community Health Nursing.2016; 27(3): 272. CrossRef
Economic Effect of Home Health Care Services for Community-dwelling Vulnerable Populations
Eunhee Lee, Jinhyun Kim
Journal of Korean Academy of Nursing.2016; 46(4): 562. CrossRef
Regional Comparison of Home Visiting Care Service Satisfaction among Elder Beneficiaries of the Long Term Care Insurance
Chanyeong Kwak
Journal of Korean Academy of Community Health Nursing.2016; 27(2): 114. CrossRef
The Barriers and Solution of Providing Long-term Care Services at Home for the Beneficiaries with Mild Dementia: A Focus Group Interview
Mi Sook Song, Kyung Sook Lim
Journal of Korean Public Health Nursing.2016; 30(2): 259. CrossRef
Policy Implications for Home-Visit Nursing(HVN) of the Korean Long Term Care Insurance through the implications of the Japanese HVN
Hosihn Ryu, Kumi Arita
Journal of Korean Public Health Nursing.2015; 29(3): 403. CrossRef
Plan for Invigoration of Visiting Nursing Center in Long-Term Care Insurance for the Elderly - Through SWOT Analysis -
Do Hwa Byeon
Journal of Korean Public Health Nursing.2015; 29(2): 203. CrossRef
The Effects of Visiting Nursing Services in Long-term Care Insurance: A Difference-in-Difference Analysis
Jieun Kim, Insook Lee
Journal of Korean Academy of Community Health Nursing.2015; 26(2): 89. CrossRef
The Relationship between Home-Visit Nursing Services and Health Care Utilization among Nursing Service Recommended Beneficiaries of the Public Long-Term Care Insurance
Sae Bom Kang, Hongsoo Kim
Health Policy and Management.2014; 24(3): 283. CrossRef
Importance and Performances of Visiting Nurse Services Provided under the Long Term Care Insurance System for the Elderly
Do Hwa Byeon, Hye Jin Hyun
Journal of Korean Academy of Community Health Nursing.2013; 24(3): 332. CrossRef
The Experiences of Family Caregivers under the Long-term Care Insurance
Eun-Young Kim, Ga Eon Lee, Sam-Sook Kim, Chun Yee Lee
Journal of Korean Academy of Community Health Nursing.2012; 23(4): 347. CrossRef
Trends in Home-visit Nursing Care by Agencies' Characteristics under the National Long-term Care Insurance System
Jung Suk Lee, Rah Il Hwang, Eun Jeong Han
Journal of Korean Academy of Community Health Nursing.2012; 23(4): 415. CrossRef

The Effects of Case Management for Medicaid on Healthcare Utilization by the Medicaid System: Seung Joo Lim; J Korean Acad Community Health Nurs. 2010;21(4):375-385. Published online December 31, 2010; DOI: https://doi.org/10.12799/jkachn.2010.21.4.375

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5 Citations

Abstract PDF

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.

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
The Effects of the Designated Doctor System on Health Care Utilization of Medical Aid Beneficiaries with Chronic Diseases
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

The Effects of Tele-care Case Management Services for Medical Aid Beneficiaries: Yang Heui Ahn, Eui Sook Kim, Il Sun Ko; J Korean Acad Community Health Nurs. 2010;21(3):351-361. Published online September 30, 2010; DOI: https://doi.org/10.12799/jkachn.2010.21.3.351

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4 Citations

Abstract PDF

PURPOSE
This study was done to analyze the effects of tele-care case management services using secondary data.
METHODS
A descriptive research design was utilized, and the participants were 134 medical aid beneficiaries who were in either the high-risk group or the preventive group. Case management services were delivered by 8 care managers. Data were analyzed using PAWS Statistics 17 through descriptive statistics and paired t-test.
RESULTS
After the case management intervention, the participants' health quality of life, self-care competency, and reasonable medical care utilization increased significantly for the high-risk group. However there were no significant changes in the preventive group.
CONCLUSION
The results showed that the tele-care case management services were effective for high-risk medical aid beneficiaries. Further studies with controls for constitutional variables and a comparison group are required to validate the robustness of the effectiveness of the case management program in the present study.

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
A study on the Effectiveness of Case Management in Elderly Medicaid Beneficiaries by Geographic Location
Jeong-Hyun Cho, Soon-Ock Kim, Myeong-Kyeong Song, Eun-Shil Yim
Journal of Korean Public Health Nursing.2012; 26(2): 289. CrossRef
Validation of a Needs Assessment Tool for Case Management in Korean Medical Aid Beneficiaries
Yang Heui Ahn, Eui Sook Kim, Ok Kyung Ham, Soo Hyun Kim, Soon Ok Kim, Myung Kyung Song
Journal of Korean Academy of Nursing.2012; 42(4): 549. CrossRef

Change in Healthcare Utilization by Disease Severity after Case Management for Medicaid: Seung Joo Lim; J Korean Acad Community Health Nurs. 2010;21(3):321-332. Published online September 30, 2010; DOI: https://doi.org/10.12799/jkachn.2010.21.3.321

379 View
2 Download
4 Citations

Abstract PDF

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.

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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