J Korean Acad Community Health Nurs.  2010 Dec;21(4):375-385. 10.12799/jkachn.2010.21.4.375.

The Effects of Case Management for Medicaid on Healthcare Utilization by the Medicaid System

• Lim SJ

• KMID: 2292868
• DOI: http://doi.org/10.12799/jkachn.2010.21.4.375

Abstract

PURPOSE
This study examined the effects of case management (CM) for Medicaid on healthcare utilization considering the Medicaid system.
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 the effects on healthcare utilization between the CM group and the non-CM group. The subjects were 535 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006.
RESULTS
The outpatient days and medication days of the CM group decreased significantly more than those of the non-CM group with the copayment system. There were no significant differences of healthcare utilization between the CM group and the non-CM group with the designated doctor system.
CONCLUSION
CM worked effectively on Medicaid beneficiaries' outpatient healthcare utilization with the copayment system. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, future studies are needed to develop strategies to reduce hospitalization and Medicaid beneficiaries' outpatient healthcare utilization with the designated doctor system.

Keyword

Medicaid; Case management; Cost sharing; Physician; Utilization

MeSH Terms

Case Management*
Cost Sharing
Delivery of Health Care*
Hospitalization
Humans
Medicaid*
Outpatients

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