scholarly journals How to reduce excessive use of health care service in medical aid beneficiaries: an economic impact of community-based case management

2019 ◽  
Author(s):  
Myung Ja Kim ◽  
Eunhee Lee
Keyword(s):  
Health Care ◽  
Case Management ◽  
Health Care Utilization ◽  
Economic Impact ◽  
Care Service ◽  
Health Care Service ◽  
Care Utilization ◽  
Community Based ◽  
Medical Aid ◽  
Use Of Health Care

Abstract Background Community based case management for medical aid beneficiaries was implemented in Korea to induce rational use of medical care among the beneficiaries and stabilize the financial system. This study investigated the economic impact of community based case management on health care utilization and cost. Methods This study is a quantitative policy evaluation study to evaluate the impact of case management on excessive use of health care service in medical aid beneficiaries using national database. Results Total 1,741 medical aid beneficiaries with case management included in this study. Case management was provided to three target group, high-risk, long-term inpatient, and intensive care group. An increase in health-related quality of life (QOL) and the ability to use appropriate health care and a reduction in health care utilization and cost were observed for case management. There was no significant difference in the reduction in the total number of visiting days and the cost between the groups. Conclusions An increase in the health care utilization among medical aid beneficiaries has been observed due to the aging population and increase in the number of recipients. To reduce health care costs while maintaining the health status of the beneficiaries, it is necessitated to expand the targeted management.

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

2020 ◽  
Vol 17 (7) ◽  
pp. 2503
Author(s):  
Myung Ja Kim ◽  
Eunhee Lee
Keyword(s):  
Case Management ◽  
Healthcare Utilization ◽  
Care Service ◽  
Health Care Service ◽  
National Database ◽  
Community Based ◽  
Medical Aid ◽  
Significant Difference ◽  
Related Quality ◽  
Health Related

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.

scholarly journals THE CORRELATION BETWEEN DEMAND FACTORS AND HEALTH CARE SERVICE UTILIZATION BY CONTRIBUTION BENEFICIARY PATIENTS

2019 ◽  
Vol 7 (2) ◽  
pp. 185
Author(s):  
Leli Rachmawati ◽  
Isma Faridatus Sholihah
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
General Hospital ◽  
Health Care Services ◽  
Care Service ◽  
Health Care Service ◽  
Care Utilization ◽  
Care Services ◽  
Outpatient Unit ◽  
Health Care Service Utilization

Background: National Health Insurance is the government's effort to increase public access to health care services. As the implementer of the National Health Insurance, the Outpatient Unit of Haji General Hospital, Surabaya has undergone the decrease of contribution beneficiaries’ visits from 2010-2013. This condition indicates a decrease in health care utilization by the low-income community.Aim: This study aims to identify the correlation between health care demands and health care utilization by the contribution beneficiary patients.Method: The study was an observational analytic using a cross-sectional design. A systematic random sampling technique was used to determine the sample of the study. The respondents were 74 contribution beneficiary patients who possessed a district government free care scheme and had ever utilized the health care services at the Outpatient Unit of Haji General Hospital, Surabaya, and at least 13 years old. The data were collected through questionnaires and analyzed with Spearman and Chi-Square tests (α =0.05).Results: Health status, insurance needs, additional costs, gender, ethnicity, education, and income did not have a significant correlation with the health care service utilization by the contribution beneficiary patients at the Outpatient Unit of Haji General Hospital. It was identified that the older the people are, the higher the frequency of health care utilization is. Besides, service time was proven to be the determinants of health care utilization (p = 0.006).Conclusion: The most influential factors in utilizing the health care services by contribution beneficiary patients are service time and age. Based on those factors, the Haji General Hospital requires to improve its services and service timeliness for the elderly contribution beneficiary patients.Keywords: demand, contribution beneficiary patients, utilization.

Cultural Mistrust and Health Care Utilization: The Effects of a Culturally Responsive Cognitive Intervention

2017 ◽  
Vol 48 (8) ◽  
pp. 816-834 ◽  
Author(s):  
Randolph T. Brooks ◽  
Reginald Hopkins
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Service Utilization ◽  
Culturally Responsive ◽  
Care Service ◽  
Health Care Service ◽  
Cognitive Intervention ◽  
Cultural Mistrust ◽  
Care Utilization ◽  
Health Care Service Utilization

Cultural mistrust is a critical factor underlying the racial/ethnic disparity in mental health care service utilization. It was hypothesized that there would be a difference in utilization attitudes and intentions before and after exposure to a culturally responsive intervention among individuals with moderate to high levels of cultural mistrust. Two Hundred Thirty-Six students from a predominately Black university participated in this study. This experiment employed a Solomon Four Groups design to assess the effectiveness of a culturally responsive cognitive intervention to neutralize the effects of cultural mistrust on health care attitudes and health care service utilization intentions. The results showed that the intervention was effective in neutralizing cultural mistrust and improving posttest utilization attitudes and intentions among individuals who had high levels of cultural mistrust. It was also found that health care utilization attitudes and intentions were enhanced for individuals with high levels of cultural mistrust.

Health care utilization in chronic pain—A population based study

2013 ◽  
Vol 4 (4) ◽  
pp. 255 ◽  
Author(s):  
Thorbjörg Jonsdottir ◽  
Helga Jonsdottir ◽  
Sigridur Gunnarsdottir ◽  
Eirikur Lindal
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care Utilization ◽  
Care Service ◽  
Health Care Service ◽  
Care Utilization ◽  
Sociodemographic Characteristics ◽  
Older Individuals ◽  
Cross Sectional ◽  
Significant Difference

AbstractAimsTo investigate health care utilization in relation to chronic pain.MethodsIn this cross-sectional study postal questionnaires, measuring sociodemographic characteristics, pain, health related quality of life (HRQoL), attitudes to pain and health care utilization past six months, were sent to 4500 individuals aged 20–70 years, randomly drawn from the Icelandic National Registry.ResultsTotal response rate was 36.9% (n = 1589) and was higher among older individuals and women. Nearly one half of respondents (47.5%, n = 754) reported chronic pain (≥3 months) with mean duration of 9.3 years (median = 6.0 years, SD = 10.0) and 57.5% of them had consulted health care service for their pain past six months. Use of pain related health care was significantly related to attitudes towards pain and individuals with pain in chest, upper extremities, hips and lower extremities consulted health care for their pain significantly more often than people with other pain locations. Pain related health care utilization was not significantly related to sociodemographic characteristics. There was a significant difference in both Physical (PCS) and Mental (MCS) component HRQoL scales as well as nature of pain (severity, interference, spread and pattern), between individuals who had consulted health care for their pain and those who had not. However, when these relationships were tested by using logistic regression models, only PCS and pain interference remained significant in this relationship.ConclusionsChronic pain related health care utilization is related to several pain characteristics and its influence on daily life, where interference and physical components of HRQoL are most important.

scholarly journals Effectiveness of Public and Co-operative Health Insurance Models in Nepal: A Concurrent Mixed Study

2016 ◽  
Author(s):  
Chhabi Ranabhat ◽  
Chun-Bae Kim ◽  
Myung-Bae Park
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Health Care Service ◽  
Large Population ◽  
High Income ◽  
Care Utilization ◽  
Utilization Rate ◽  
Religious Minority ◽  
Mixed Study

Background: Health insurance (HI) run by government is providing health care service to large population. Due to poor accountability, participation and sustainability, cooperative health insurance is becoming more popular and effective in low and middle income and some high-income countries too. In Nepal, there are public and cooperative HI is in practice. The aim of this study is to compare the effectiveness of public (government) and cooperative HI in relation to benefit packages, population coverage, inclusiveness, health care utilization, and promptness for treatment in these two health insurance models in Nepal. Method: This is an institution based concurrent mixed study consists of qualitative and quantitative variables from public and cooperative groups. We included all public HI operated by government hospitals and cooperatives groups those purchased hospital service in contract. Two separate study tools were applied to access the effectiveness of insurance models. The key questions were asked for the representatives of government and private health insurance. The numeric information consisted of in quantitative data and subjective response was included in qualitative approach. Descriptive statistics and Mean Whitney U test was applied in numeric data and qualitative information were analyzed by inductive approach Results: The study revealed that new enrolment was not increased, health care utilization rate was increased and the benefit package was almost same in both groups. The overall inclusiveness was higher for the government HI, but enrolment from the religious minority, proportion of negotiated amount during treatment were significantly higher (p<0.05). During illness, the response time to reach hospital was significantly faster in cooperative health insurance than government health insurance. Qualitative findings showed that level of participation, accountability, transparency and recording system was better in cooperative health insurance than public. Conclusion: Cooperative HI could be more sustainable and accountable to the community for all; low, middle and high-income countries.

scholarly journals Chronic conditions and use of health care service among German centenarians

2017 ◽  
Vol 46 (6) ◽  
pp. 939-945 ◽  
Author(s):  
Petra von Berenberg ◽  
Dagmar Dräger ◽  
Thomas Zahn ◽  
Julia Neuwirth ◽  
Adelheid Kuhlmey ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Conditions ◽  
Care Service ◽  
Health Care Service ◽  
Use Of Health Care

scholarly journals Use of health care services 6 months following major trauma

2007 ◽  
Vol 31 (4) ◽  
pp. 628 ◽  
Author(s):  
Belinda J Gabbe ◽  
Ann M Sutherland ◽  
Owen D Williamson ◽  
Peter A Cameron
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Service Use ◽  
Major Trauma ◽  
Injury Severity ◽  
Care Service ◽  
Health Care Service ◽  
Trauma Patients ◽  
Care Services ◽  
Use Of Health Care

To establish the use of health care services 6 months following major trauma, 243 blunt major trauma patients were recruited during their acute hospital stay and followed up by telephone interview at 6 months post-injury. Data collected at 6 months included health care service usage and their level of disability according to the Glasgow Outcome Scale ? Extended (GOSE). Ninety-four percent of patients were living in the community at 6 months, and most (69%) reported continued use of health care services. Of those with ongoing disability, non-compensable patients were significantly more likely (OR 3.7; 95% CI, 1.6?8.6) to have ceased health care service use than compensable patients, independent of injury severity.

scholarly journals A Community-Based Intervention Improves Preventive Health Care Utilization and Immunization Rates for a High Risk DC Population

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 123A-123A
Author(s):  
Ayman El-Mohandes ◽  
Michal Young ◽  
Lawrence Grylack ◽  
M Nabil El-Khorazaty ◽  
Kathy Katz ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
Health Care Utilization ◽  
Preventive Health Care ◽  
Preventive Health ◽  
Care Utilization ◽  
Community Based ◽  
Immunization Rates
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