Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Self-perception of the Amount of Medical Aid Use of Outpatient Overusers in Korea

의료급여 외래 과다이용자의 의료이용량에 대한 자기인식

  • Shin, Sun-Mi (Office of Global health Leadership, University of Illinois at Chicago) ;
  • Kim, Eui-Sook (Institute of Case Management) ;
  • Lee, Hee-Woo (Seoul Education Research Information Institute)
  • 신선미 (시카고소재 일리노이주립대학교 국제보건리더쉽센터) ;
  • 김의숙 (한국보건복지인력개발원 의료급여사례관리사업지원단) ;
  • 이희우 (서울특별시교육연구정보원)
  • Published : 2009.06.30
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Abstract

Limited studies examined Medical Aid recipients' perception for amount of medical use. This study aimed to identify self-perception(optimal, under and overutilization) for amount, and real amount of medical use, and to determine factors associated with the perception. Subjects were 2,489 Medical Aid recipients among top 2% overusers in 2005. 200 case managers(CM) managing them conducted survey. CM interviewed them using 2005 medical claiming data from the Health Insurance Review & Assessment Service and structured questionnaire. Despite of overusers, perception of overutilization was only 26.9% and 23.6% in Class I and Class II, and that of underutilization was 21.4% and 18.7% respectively. In Class I, monthly total outpatient cost per capita of overutilization perception in 2006 was 206 thousand won higher than 150 thousand won of optimal utilization. Amounts of outpatient visit-days and prescribed cases of overutilization perception were higher than those of optimal and underutilization(p <0.0001). In Class II, overutilization perception had more prescribed cases(p 0.004). After adjustment of confounding factors including age and sex, the associated factors(odds ratio) with overutilization perception were hypertension(1.25), arthritis(1.32), depression(1.66), visit of multi medical institutions(3.09), and those of the underutilization were female(1.34), disabled(1.27), no family support(1.49), living in medium and small city(1.48), experience of unabled-visit to medical institution(2.54), frequent visit-recommendation from physician (1.36). In conclusion, education and consult are needed for subjects to improve the reasonable decision of medical use, and the self-care ability to manage diseases and symptoms. We suggest reinforcing the alternative service in community instead of costly medical institution.

Keywords

References

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