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Impact of Changes in Medical Aid Status on Health Care Utilization

보건행정학회지 2019년 29권 4호 p.513 ~ 522
김우림 ( Kim Woo-Rim ) - National Cancer Center National Cancer Control Institute Division of Cancer Control & Policy

남정모 ( Nam Chung-Mo ) - National Cancer Center National Cancer Control Institute Division of Cancer Control & Policy
이상규 ( Lee Sang-Gyu ) - Yonsei University Institute of Health Services Research
박소희 ( Park So-Hee ) - Yonsei University Institute of Health Services Research
김태현 ( Kim Tae-Hyun ) - Yonsei University Institute of Health Services Research
박은철 ( Park Eun-Cheol ) - Yonsei University College of Medicine Department of Preventive Medicine

Abstract


Background: South Korea operates a Medical Aid (MA) program targeting selected low-income individuals to ensure medical service delivery to the disadvantaged while enhancing self-sufficiency of work-capable beneficiaries. However, as reasons behind welfare exits are diverse and do not always infer poverty relief or the provision of appropriate levels of health care services, this study aimed to investigate the association between changes in MA status and health care utilization.

Methods: This study used the 2006 to 2015 National Health Insurance claims data. The impact of changes in annual MA status on health care utilization (yearly number of outpatient visits, inpatient visits, length of stay, and emergency department [ED] visits) was investigated using the generalized estimating equation model.

Results: In 117,943 adult subjects aged 20 to 64, compared to the ‘MA to MA’ group, the ‘MA to MA exit’ group showed general decreases in utilization (outpatient visits: β=-3.93, p<0.0001; hospital admissions: relative risk [RR], 0.87; 95% confidence interval [CI], 0.83?0.91; length of stay: β=-3.64, p<0.0001; ED visits: RR, 0.83; 95% CI, 0.77?0.90). Similar patterns were found in the ‘MA exit to MA exit’ group (outpatient visits: β=-5.72, p<0.0001; admissions: RR, 0.91; 95% CI, 0.87?0.94; length of stay: β=-5.87; p<0.0001; ED visits: RR, 0.81; 95% CI, 0.75?0.88). Likewise, in 74,747 older adult subjects aged 65 or above, the ‘MA to MA exit’ group showed reduced levels of utilization (outpatient visits: β=-1.51; p=0.0020), as well as the ‘MA exit to MA exit’ group (admissions: RR, 0.92; 95% CI, 0.89?0.95; length of stay: β, -5.45; p<0.0001; ED visits: RR, 0.90; 95% CI, 0.83?0.97).

Conclusion: MA exit was associated with general decreases in health care utilization. Utilization patterns of individuals with experiences of receiving MA benefits should be monitored to promote the ideal use of health care services while preventing potential financial barriers present in accessing medical care.

키워드

Medical Aid; Medical Aid alteration status; Welfare exit; Health care utilization; Medical utilization
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