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Open AccessArticle

How to Reduce Excessive Use of the Health Care Service in Medical Aid Beneficiaries: Effectiveness of Community-Based Case Management

by Myung Ja Kim 1 and Eunhee Lee 2,*
1
Department of Resident Welfare, Hwacheon County office, Hwacheon-gun, Ganwon-do 24125, Korea
2
School of Nursing/Research Institute of Nursing Science, Hallym University, Chuncheon, Gangwon-do 24252, Korea
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(7), 2503; https://doi.org/10.3390/ijerph17072503
Received: 6 March 2020 / Revised: 2 April 2020 / Accepted: 3 April 2020 / Published: 6 April 2020
Community-based case management for medical aid beneficiaries was implemented in Korea to promote the rational use of medical care and stabilize the financial system. This study investigated the economic impact of community-based case management on reductions in healthcare utilization and costs. This was a program study using a national database to evaluate the effectiveness of community-based case management in changing not only healthcare utilization and costs but also client-centered outcomes using the NHI database and 198 regional databases. A total of 1741 case management clients were included in this study. The case management clients were categorized into three targeted groups and were provided individualized services according to the groups. Client-centered outcomes, such as health-related quality of life (QOL), self-care ability, and having a support system, increased after case management. Healthcare utilization and costs decreased significantly after case management. However, there was no significant difference in the decrease between the groups. An increase in healthcare utilization among medical aid beneficiaries has been observed due to the aging population and an increase in the number of recipients. To reduce healthcare utilization and costs while maintaining the health status of the beneficiaries, it is necessary to expand targeted case management. View Full-Text
Keywords: case management; medical aid program; health care utilization; health care cost case management; medical aid program; health care utilization; health care cost
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Kim, M.J.; Lee, E. How to Reduce Excessive Use of the Health Care Service in Medical Aid Beneficiaries: Effectiveness of Community-Based Case Management. Int. J. Environ. Res. Public Health 2020, 17, 2503.

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