- Volume 16 Issue 8
The purpose of this study is to investigate the effect of Medicaid case management (CM) performed by Medicaid case managers on health management and to examine the overall health care utilization with high risk Medicaid beneficiaries. The subjects involved in this research were 113 Medicaid beneficiaries who were recipients CM in Y-gu between October 1st, 2012 and March 31th, 2013. The results show that there were significant differences in 'recognition of own disease', 'understanding of Medicaid policy', 'medication' and 'healthy lifestyle'. Also there were significant differences in 'appropriateness of health utilization', 'number of medical institutions', 'level of social isolation' and 'general health status'. In addition, significant differences were found in Medicaid days, outpatient days, medication days and Medicaid costs. It was found that the Medicaid CM had a positive effect on health care utilization. The study suggests the need of strengthening and diversifying Medicaid CM as well as supporting the management and monitoring after the termination of Medicaid CM.
Medicaid;Case Management;Medicaid Case Manager;Medical Use
- Ministry of Health & Welfare, 2013 Guideline of medicaid management, Ministry of Health & Welfare. 2013.
- Y. S. Shin, "Direction to go for medical aid", Health and Welfare Policy Forum, 167, pp, 28-38, 2010.
- J. M. Choi, J. J. Oh, "The effects of the designated doctor system on the health of medical aid beneficiaries", Journal of Korean Academy of Community Health Nursing, 23(4), pp.438-445, 2012. DOI: http://dx.doi.org/10.12799/jkachn.2012.23.4.438 https://doi.org/10.12799/jkachn.2012.23.4.438
- Y. S. Shin, H. W. Shin, D. K. Hwang, Case management and it's the effectiveness in Korean Medicaid I, Korea Institute for Health and Social Affairs, 2007.
- Center for Medicaid in Korea. History of medicaid management [Internet]. Seoul: Center for Medicaid, c2013 [cited 2013 Jan 03], Available From: https://www.macmc.or.kr/page.do?pgmid =macm020503. (accessed January 03, 2013)
- S. J. Lim, Effects of case management for medicaid on healthcare utilization, Unpublished doctoral thesis, Seoul National University, 2010.
- Rossi, PA. Case management in health care (2nd ed.), Saunders. 2003.
- Frankel AJ, Gelman S. Case Management: An Introduction to Concepts and Skills, Lyceum Books, 2012.
- American Case Management Association. Definition of case management [Internet]. Arkansas (AR): American Case Management Association. c2013[cited 2013 Jan 03], Available from: http://www.acmaweb.org/section. asp?sid=4 &mn=mn1&sn=sn1&wpg=mh. (accessed January 03, 2013)
- Y. H. Ahn, E. S. Kim, I. S. Ko, "The effects of tele-care case management services for medical aid beneficiaries", Journal of Korean Academy Community Health Nursing, 21(3), pp.351-361, 2010. DOI: http://dx.doi.org/10.12799/jkachn.2010.21.3.351 https://doi.org/10.12799/jkachn.2010.21.3.351
- Y. H. Ahn, "Effects of medicaid case management program and its policy directions", Korean Journal of Care Management, 5, pp.67-84, 2010.
- Y. S. Shin, H. W. Shin, D. K. Hwan, I. C. Rho, Monitoring for medicaid financial efficiency, Korea Institute for Health and Social Affairs, 2006.
- Y. S. Shin, H. W. Shin, D. K. Hwang, Case management and it's the effectiveness in Korean Medicaid II, Korea Institute for Health and Social Affairs, 2008.
- W. H. Lee, "Developing a case management strategies program for Korean medical aid clients", Unpublished doctoral thesis, Hanyang University, 2006.
- E. S. Kim, I. S. Ko, G. S. Kim, M. Y. Kim, J. J. Nam, S. M. Shin, I. S. Yang, S. H. Lee, D. M. Lee, J. S. Choi, "A study for improving the over users of the out-patient of the hospital in korea medicaid". Ministry of Health, Welfare, and Family & Yonsei University College of Nursing, Institute of Nursing Policy, 2007.
- E. S. Kim, Y. H. Ahn, I. S. Ko, K. O. Lee, J. S. Ko, Planning and development of guide for medical aid case management services. Ministry of Health, Welfare, and Family & Yonsei University College of Nursing, Institute of Nursing Policy, 2008.
- Y. A. Shin, H. C. Shin, H. W. Shin, E. J. Park, S. W. Hong, S. M. Shin. Health services use and health status of medicaid beneficiaries according to medicaid policy change. Ministry of health, welfare and family affaires, Korea human resource development institute for health and welfare, & Institute of case management for medicaid, 2008.
- S. A. Kim, Effect of case management intervention by medical aid case manager: centered on medical aid recipients with chronic disease, Unpublished master's thesis, Hanyang University, 2012.
- S. J. Lim, "Change in healthcare utilization by disease severity after case management for Medicaid". Journal of Korean Academy of Community Health Nursing, 21(3), pp.321-332, 2010. DOI: http://dx.doi.org/10.12799/jkachn.2010.21.3.321 https://doi.org/10.12799/jkachn.2010.21.3.321
- J. S. Kim, K. J. Lee, "Effectiveness analysis on medicaid case management and its implications", Health and Welfare Policy Forum, 191, pp.50-59.
- S. W. Hong, "Factors influencing health-related quality of life in Korean medicaid beneficiaries", Journal of Korean Academy of Nursing, 39(4), pp.480-489, 2009. DOI: http://dx.doi.org/10.4040/jkan.2009.39.4.480 https://doi.org/10.4040/jkan.2009.39.4.480
- H. J. Lee, J. J. Oh, J. M. Choi, "Comparison of case management between tele care regions and general care regions in Korean medicaid", Journal of Korean Academy of Nursing Administration, 16(4), pp.381-388, 2010. DOI: http://dx.doi.org/10.11111%2Fjkana.2010.16.4.381 https://doi.org/10.11111/jkana.2010.16.4.381
- M. L. Sylvia, M. Griswold, L. Dunbar, C. M. Boyd, M. Park, C. Boult. "Guided care: Cost and utilization outcomes in a pilot study". Disease Management. 11(1). pp.29-36, 2008. https://doi.org/10.1089/dis.2008.111723
- S. J. Lim. "The effects of case management for Medicaid healthcare utilization by the Medicaid system", Journal of Korean Academy of Community Health Nursing, 21(4), pp.375-385, 2010. DOI: http://dx.doi.org/10.1089/dis.2008.111723 https://doi.org/10.12799/jkachn.2010.21.4.375
- Social Network, Self-Care Agency and Quality of Life of High-risk Beneficiaries in Case Management of Medicaid vol.28, pp.4, 2017, https://doi.org/10.12799/jkachn.2017.28.4.421