• Health Policy and Management
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• v.33 no.4
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• pp.400-410
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• 2023

Background: As the government has recently been discussing the expansion of the disaster health expenses support project, we would like to confirm the characteristics of beneficiaries of the support project, particularly those of high-cost beneficiaries. Methods: Using the database of catastrophic health expenditure support project from 2019-2020, this study aims to confirm the characteristics of high-cost beneficiaries focusing on the overlap of the relieved out-of-pocket systems, known as the out-of-pocket ceiling system and the system for rare incurable diseases. Logistic regression analysis is used to examine this issue. Results: In order to analyze the factors influencing high-cost beneficiaries, five models were created and analyzed, including the status of duplicated beneficiaries for relieved out-of-pocket systems, sociodemographic and economic factors, and individual health status as sequential independent variables. All five models were statistically significant, of which economic factors had the greatest impact on the model's predictions. The main results indicated that those who benefited from multiple systems in duplicate were more likely to be high-cost beneficiaries, and there is a higher probability of incurring high health expenses among the underage. In addition, within the beneficiaries of catastrophic health expenditure support project, it was observed that higher health insurance premium percentiles are associated with a higher proportion of high-cost beneficiaries. Conclusion: This study examined the characteristics of high-cost beneficiaries by encompassing reimbursement and non-reimbursement. According to this study, it is expected to be used as basic data for setting priorities and improving the current criteria of catastrophic health expenditure support project, aiming to sequentially expand the program.

• Health Policy and Management
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• v.20 no.1
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• pp.19-36
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• 2010

Fee for long-term care insurance in Korea are determined in proportion to resources utilized according to severity rather than based on categorization of beneficiaries in consideration of the characteristics of resource utilization. This adoption is based on the assumption that as beneficiaries of long-term care insurance, characteristically, demands social services rather than needs medical treatments, the characteristics of beneficiaries and the quality of utilized resources are comparatively homogenous. Therefore, the proposition is that the size of resource consumed by beneficiaries in the same grade is identical. However, even in the same grade, the level of utilized resources is different depending on the characteristic of beneficiaries. In this regard, this study is to examine whether there are differences in the volumes of utilized resources depending on the characteristics of beneficiaries even in the same grade. We analyzed time study data for 2003, 2005, 2006 which conducted by the Korea Institute for Health and Social Affairs. To look at differences in the volumes of utilized resources, we identified characteristics of beneficiaries that influence utilized resource volumes and categorized services provided by facilities into the rehabilitation treatment category, the problematic behavior category, and the physical malfunction category. Then, we examined each service in consideration of service difficulty levels and wage weights. The result of examination showed that differences in utilized resource volumes exist in all three grades depending on the characteristics of beneficiaries. Especially, in the first grade with a high level of seriousness, utilized resource volumes were different for those three service categories and the problematic behaviour category considered dementia was found to consume the largest volume of resources. Moreover, there was the inversion phenomenon of utilized resources volumes between the grades. This result indicates that utilized resource volumes are different even in the same grade depending on the characteristics of beneficiaries and it is required to consider case-mix for reflection of the volumes of utilized resources depending on the characteristics of beneficiaries.

• 한국노년학
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• v.32 no.2
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• pp.593-609
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• 2012

The study was performed to identify the functional status change of beneficiaries of Long-Term Care Insurance and its related factors. We conducted the logistic regression with 17,652 beneficiaries during August and September in 2008. As a result, activities of daily living(ADL), behavioral changes, rehab, instrumental activities of daily living(IADL) and cognitive function, followed by nursing care area were improved in a greater degree. For the institutional service, level-1 beneficiaries was significantly improved in rehab area and level-2 beneficiaries was improved in ADL. For the home-visit care service of in-home services, level-1 beneficiaries was improved in ADL, level-2 beneficiaries was improved in ADL and rehab area, level-3 beneficiaries was improved in ADL, cognitive function and behavioral changes. For the day-and-night care service, level-1 beneficiaries was improved in ADL, IADL, behavioral changes and rehab area, level-2 beneficiaries was improved in behavioral changes, level-3 beneficiaries was improved in cognitive function and behavioral changes. For the short-stay service, level-3 beneficiaries was improved in behavioral changes. By the above results, there was a difference in a functional improvement by level and used services. Therefore, government need to provide the personalized service system based on the objective and comprehensive understanding for health and functional status of beneficiaries.

• Journal of Korean Academy of Nursing
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• v.42 no.7
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• pp.928-935
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• 2012

Purpose: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. Methods: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. Results: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. Conclusion: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

• Research in Community and Public Health Nursing
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• v.21 no.3
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• pp.321-332
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• 2010

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.

• Journal of Korean Biological Nursing Science
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• v.18 no.3
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• pp.144-152
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• 2016

Purpose: This study compares beneficiaries of Korean Medicaid with those under the National Health Insurance program, seeking to understand how each group utilizes their healthcare. Methods: Data were obtained from a Health Promotion Survey in 2005. Health status was measured by the respondents' perception of health. Health service utilization included the availability of healthcare services, the type of healthcare institution, and intent to revisit. Predisposing and enabling factors, as well as health care needs were used for this study. Results: Compared to National Health Insurance beneficiaries, Medicaid beneficiaries reported lower levels of health status and fewer enabling factors. They had more chronic diseases and disabilities. Education level, existence of chronic diseases, exercise patterns, and disabilities were associated with health status. Conclusion: We found that Medicaid beneficiaries had fewer resources and higher levels of health needs. As Medicaid is reformed, policy makers and administrators should understand healthcare utilization behaviors of Medicaid beneficiaries and the factors hindering access to care.

• Journal of the Korean Dietetic Association
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• v.9 no.2
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• pp.114-127
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• 2003

In the process of devising an efficient meal service system for the elderly, 478 elderly were interviewed at 6 different social centers with the elderly meal service program in Seoul area to monitor degree of satisfaction and/or needs of the beneficiaries regarding the program. The survey was conducted during the month of December 2002 by well-trained interviewers using self-developed questionnaire. Results were analyzed statistically using SAS package program. Most of the beneficiaries were low economic class and 76% of them had doctor diagnosed disease(s). Among the beneficiaries of congregate meal service, mean score of 12 aspects of satisfaction was 3.72 out of 5. For most of the questions, female elderly and healthy elderly responded with higher score than male elderly and unhealthy elderly, respectively (p<0.05, p<0.01). On the other hand, beneficiaries of the home-delivered meal service were little bit less satisfied with the service (3.54 out of 5). Compared to the beneficiaries of congregate meal service, larger portion of beneficiaries of home-delivered meal service wanted more meats (28.5 % vs. 17.1 %) and vegetables (23.2 % vs. 12.3 %) as side dishes. On the other hand, the most preferred type of cooking and/or seasoning was stewing for both cases. Based on these findings, it is suggested that more fresh foods should be used than processed foods in the preparation of meals for the elderly and, more fish-, meat- and vegetable- dishes should be served to come up to the needs of the elderly. Onto this, mainly Korean style meals with some intermittent Western, Japanese or Chinese style meals served at the right temperature would suffice most of the elderly needs.

• Journal of Yeungnam Medical Science
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• v.8 no.2
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• pp.185-201
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• 1991

A household survey was conducted to compare the patterns of morbidity and medical care utilization between medical aid beneficiaries and medical insurance beneficiaries. The study population included 285 medical aid beneficiaries that were completely surveyed and 386 medical insurance benficiaries selected by simple random sampling from a Dong(Township) in Taegu. Well-trained surveyers mainly interviewed housewives with a structured questionnaire. The morbidity rates of acute illness during the 15-day period, were 63 per 1,000 medical aid beneficiaries and 62 per 1,000 medical insurance beneficiaries. The rates for chronic illness were 123 per 1,000 medical aid beneficiaries and 73 per 1,000 medical insurance beneficiaries. The most common type of acute illness in medical aid and medical insurance beneficiaries was respiratory disease. In medical aid beneficiaries, musculoskeletal disease was most common, but in medical insurance beneficiaries, gastrointestinal disease was most common. The mean duration of acute illness of medical aid beneficiaries was 3.8 days and that of medical insurance beneficiaries was 6.8 days. During the one year period, mean duration of medical aid beneficiaries chronic illnesses was 11.5 months which was almost twice as long compared to medical insurance beneficiaries. Pharmacy was most preferrable facility among the acute illness patient in medical aid beneficiaries, but acute cases of medical insurance beneficiaries visited the clinic most commonly. Chronic cases of both groups visited the clinic most frequently. There were some findings suggesting that much unmet need existed among the medical aid beneficiaries. In acute cases, the average number of days of medical aid users utilized medical facilities was less than medical insurance users. On the other hand, the length of medical care utilization of chronic cases was reversed. Geographical accessibility was the most important factors in utilization of medical facilities. Almost half of the study population answered the questions about source of funds on medical security correctly. Most respondents considered that the objective of medical security was afford ability. The chief complaint on hospital utilization was the complicated administrative procedures. These findings suggest that there were some problems in the medical aid system, especially in the referral system.

• The Journal of the Korea Contents Association
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• v.16 no.5
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• pp.477-487
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• 2016

This study attempts to comprehensively evaluate differences in sociodemographic characteristics, health behavior, disease morbidity, medical care and health-related quality of life of medical aid beneficiaries and health insurance beneficiaries. To achieve this, this study analyzes primitive data of community health survey that each health center had recently conducted in 2013. Study socioeconomic characteristics, health behavior, disease morbidity, medical care showed that various factors affecting health-related quality of life. It was found that medical aid beneficiaries showed lower health related-quality of life than health insurance beneficiaries because not good socioeconomic characteristics, health behavior, disease morbidity, and medical care and even as a comparative result after controlling socioeconomic characteristics, it was found that medical aid beneficiaries health-related quality of life was lower because of not good health behavior, disease morbidity, and medical care. Therefore, to improve health-related quality of life in medical aid beneficiaries as effectively as possible, improving mental health including managing chronic disease and stress and depression and daily living activities is above all important and our national concern with developing systematic program and policies focusing on health promotion behaviors such as moderate drinking habits and regular exercise and eating habits is required.

• Journal of Korean Academy of Nursing
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• v.39 no.4
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• pp.480-489
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• 2009

Purpose: The purpose of this study was to identify the factors which influence health-related quality of life (HRQoL) in Korean Medicaid beneficiaries. The relationships among sociodemographic factors, health status, health behavior, and HRQoL were analyzed. Methods: Data from the 2007 survey on Health Services Use and Health Status of Medicaid Beneficiaries conducted by the Ministry for Health Welfare and Family Affairs were examined. To analyze the sample survey data, descriptive statistics, correlation and hierarchical multiple survey regression analysis with SAS 9.1.3 package were used with SURVEYMEANS and SURVEYREG procedures, which incorporate the sample design into the analyses in order to make statistically valid inference for the whole Medicaid population. Results: The HRQoL correlated with limitations in Activities of Daily Living (ADL) (r=-.509, p<.001), stress (r=-.387, p<.001), depression (r=-.385, p<.001), alcohol consumption (r=.216, p<.001), and exercise (r=.293, p<.001). Significant factors that affect HRQoL of Medicaid beneficiaries were gender, region, limitations in ADL, stress, depression, alcohol consumption, and regular exercise. These variables explained 44.6% of HRQoL (F= 215.00, p<.001). Conclusion: The results indicate that to improve the HRQoL of Medicaid beneficiaries it is important to develop nursing intervention programs that focus on psychological health and health behavior and to give consideration to differences in gender and region.