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http://dx.doi.org/10.14371/QIH.2020.26.2.95

A Study on the Applicability of the Population-Based Health Care Model: Focusing on Social Cooperative-type Medical Clinics in a Local Area  

Lee, Keun-Jung (HIRA Research Institute, Health Insurance Review & Assessment Service)
Oh, Ju-Yeon (HIRA Research Institute, Health Insurance Review & Assessment Service)
Lee, Da-Hee (HIRA Research Institute, Health Insurance Review & Assessment Service)
Hahm, Myung-Il (Department of Health Administration and Management, College of Medical Science, Soonchunhyang University)
Lee, Jin-Yong (HIRA Research Institute, Health Insurance Review & Assessment Service)
Publication Information
Quality Improvement in Health Care / v.26, no.2, 2020 , pp. 95-103 More about this Journal
Abstract
Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.
Keywords
Population health management; Disease management; Cost control;
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