Medical Aid service overuse assessed by case managers in Korea

Journal of Advanced Nursing

Volumn 66, Issue 10, 2010, Pages 2257-2265

  Shin, Sun Mi ^a   Kim, Mi Ja ^b   Kim, Eui Sook ^c   Lee, Hee Woo ^d   Park, Chang Gi ^b   Kim, Hyun Kyung ^e  

^a Mun Kyung College   (South Korea)

^b UNIVERSITY OF ILLINOIS AT CHICAGO   (United States)

^c Ministry for Health Welfare and Family Affairs   (South Korea)

^d Seoul Education Research Information Institute   (South Korea)

^e Chonbuk National University   (South Korea)

Author keywords

Case managers; Costs; Healthcare services; Korea; Medical aid; Nursing; Overuse

Indexed keywords

AGED; ARTICLE; CASE MANAGEMENT; CHRONIC DISEASE; CROSS-SECTIONAL STUDY; ECONOMICS; FEMALE; HEALTH CARE COST; HEALTH SERVICE; HEALTH STATUS; HUMAN; KOREA; MALE; MEDICAL CARE; MEDICAL FEE; MENTAL STRESS; ORGANIZATION AND MANAGEMENT; PATIENT ATTITUDE; SOCIOECONOMICS; STATISTICS; UTILIZATION REVIEW;

AGED; CASE MANAGEMENT; CHRONIC DISEASE; CROSS-SECTIONAL STUDIES; FEE-FOR-SERVICE PLANS; FEMALE; HEALTH CARE COSTS; HEALTH EXPENDITURES; HEALTH SERVICES MISUSE; HEALTH STATUS; HUMANS; KOREA; MALE; MEDICAL ASSISTANCE; PATIENT ACCEPTANCE OF HEALTH CARE; SOCIOECONOMIC FACTORS; STRESS, PSYCHOLOGICAL;

EID: 77956292996     PISSN: 03092402     EISSN: 13652648     Source Type: Journal    
DOI: 10.1111/j.1365-2648.2010.05364.x     Document Type: Article

References (48)

1. Aboderin I, Kalache A, Ben-Shlomo Y, Lynch JW, Yajnik CS, Kuh D, Yach D. Life Course Perspectives on Coronary Heart Disease, Stroke and Diabetes: Key Issues and Implications for Policy and Research 2002, World Health Organization, Geneva
2. Ackermann RT, Cheadle A, Sandhu N, Madsen L, Wagner EH, LoGerfo JP. Community exercise program use and changes in healthcare costs for older adults. American Journal of Preventive Medicine 2003, 25(3):232-237.
3. Afifi AA, Morisky DE, Kominski GF, Kotlerman JB. Impact of disease management on health care utilization: evidence from the " Florida: a Healthy State (FAHS)" Medicaid Program. Preventive Medicine 2007, 44(6):547-553.
4. Andersen AS, Laake P. A causal model for physician utilization: analysis of Norwegian data. Medical Care 1983, 21(3):266-278.
5. Anderson JG, Bartkus DE. Choice of medical care: a behavioral model of health and illness behavior. Journal of Health and Social Behavior 1973, 14(4):348-362.
6. Bailey JE, Van Brunt DL, Mirvis DM, McDaniel S, Spears CR, Chang CF, Schaberg DR. Academic managed care organization and adverse selection under Medicaid managed care in Tennessee. JAMA 1999, 282(11):1067-1072.
7. Bodenheimer T. Disease management-promises and pitfalls. The New England Journal of Medicine 1999, 340(15):1202-1205.
8. Byun YC, Yoon SY, Bae HO, Kang DU, Kweon MI, Kweon SJ, Kim YH. A Study on the Introduction Plan of the Pension for the Disabled 2004, Korea Institute for Health and Social Affairs & Korea Institute for Health and Social Affairs, Seoul
9. National Health Interview 2001, http://www.cdc.gov/nchs/nhis/ques_data_related_1997_forward.htm, Centers for Disease Control and Prevention, Retrieved from on 10 July 2006
10. Chang VW, Lauderdale DS. Income disparities in body mass index and obesity in the United States, 1971-2002. Archives of Internal Medicine 2005, 165(18):2122-2128.
11. Health Survey for England 2001, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_4008058, Department of Health, Retrieved from on 10 July 2006
12. Actual Report on the Financial Outlook for Medicaid 2008, http://www.cms.gov/ActuarialStudies/downloads/MedicaidReport 2008.pdf, Department of Health & Human Services, Retrieved from on 1 April 2010
13. Ellrodt G, Cook DJ, Lee J, Cho M, Hunt D, Weingarten S. Evidence-based disease management. JAMA 1997, 278(20):1687-1692.
14. Gabbay RA, Lendel I, Saleem TM, Shaeffer G, Adelman AM, Mauger DT, Collins M, Polomano RC. Nurse case management improves blood pressure, emotional distress and diabetes complication screening. Diabetes Research and Clinical Practice 2006, 71(1):28-35.
15. Garrett B, Zuckerman S. National estimates of the effects of mandatory Medicaid managed care programs on health care access and use, 1997-1999. Medical Care 2005, 43(7):649-657.
16. Guo JJ, Gibson JT, Gropper DM, Oswald SL, Barker KN. Empiric investigation on direct costs-of-illness and healthcare utilization of Medicaid patients with diabetes mellitus. American Journal of Managed Care 1998, 4(10):1433-1446.
17. Hadley J, Holahan J. Is health care spending higher under Medicaid or private insurance? Inquiry 2003, 40(4):323-342.
18. Medicaid Case Management Services by State 2009, http://www.hrsa.gov/reimbursement/TA/webcast-Sept1-Case-Mgmt-by-State-040825.htm, Health Resources and Services Administration, Retrieved from on 1 March 2009
19. Jonsson PM, Schmidt I, Sparring V, Tomson G. Gender equity in health care in Sweden-minor improvements since the 1990s. Health Policy 2006, 77(1):24-36.
20. Khang YH. Lifecourse approaches to socioeconomic health inequalities. Journal of Preventive Medicine and Public Health 2005, 38(3):267-275.
21. Kim HJ. How much should the poor pay for their health care services under the national health insurance system? Korean Journal of Social Welfare 2004, 56(3):113-133.
22. Kim ES, Kim MY, Ko IS, Lee DM, Kim KS, Choi JS, Shin SM. The Current Situation of Medical Aid Utilization and Improvement Direction in Long Term Utilizers, Ministry for Health, Welfare and Family Affairs. The Nursing Policy Research Institute 2007, Yonsei University, Seoul
23. 2004 Korea National Health and Nutrition Examination Survey: Survey and Sample Design 2003, Korea Institute for Health and Social Affairs, Korea Institute for Health and Social Affairs, Seoul
24. The third Korea National Health and Nutrition Examination Survey (KNHANES) - Illness of Adults 2005a, Korea Institute for Health and Social Affairs, Korea Institute for Health and Social Affairs, Seoul
25. The third Korea National Health and Nutrition Examination Survey (KNHANES) - Activity Limitation and Health-Related Quality of Life 2005b, Korea Institute for Health and Social Affairs, Korea Institute for Health and Social Affairs, Seoul
26. The third Korea National Health and Nutrition Examination Survey (KNHANES) - Health Behaviors of Adults 2005c, Korea Institute for Health and Social Affairs, Korea Institute for Health and Social Affairs, Seoul
27. The third Korea National Health and Nutrition Examination Survey (KNHANES) - Health Service Utilization 2005d, Korea Institute for Health and Social Affairs, Korea Institute for Health and Social Affairs, Seoul
28. Health Survey for Public Servants and School Personnel 2000, Korea National Health Insurance Corporation, Korea National Health Insurance Corporation, Seoul
29. Kronick R, David R. Is Medicaid Sustainable? Spending Projections for the Program's Second Forty Years 2007, http://www.kaisernetwork.org/health_cast/uploaded_files/Kronick-Rousseau%20slides.pdf, Retrieved from on 1 April 2010
30. Lafferty WE, Downey L, Shields AW, Holan CM, Lind A. Adolescent enrollees in Medicaid managed care: the provision of well care and sexual health assessment. Journal of Adolescent Health 2001, 28(6):497-508.
31. Linden A, Berg GD, Wadhwa S. Evaluation of a Medicaid asthma disease management program. Disease Management 2007, 10(5):266-272.
32. Lorig KR, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, Gonzalez VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Medical Care 1999, 37(1):5-14.
33. McColl MA. Disability studies at the population level: issues of health service utilization. The American Journal of Occupational Therapy 2005, 59(5):516-526.
34. Medical Aid Law of and its Implementing Ordinances. 2009, http://www.law.go.kr/LSW/LsTrmSc.do?menuId=0&query=%EC%9D%98%EB%A3%8C%EA%B8%89%EC%97%AC%EB%B2%95&x=0&y=0#liBgcolor1, Ministry of Government Legislation, Retrieved from http://www.law.go.kr/LSW/LsTrmSc.do?menuId=0&query=%EC%9D%98%EB%A3%8C%EA%B8%89%EC%97%AC%EB%B2%95&x=0&y=0#liBgcolor1 on 11 March 2009
35. Analysis on Government Expenditure Trend: Analysis on Government Expenditure Trend of Medical Aid Cost 2006, 25-50. Park IH. National Assembly Budget Office, In: Director, Social Budget Analysis Team, NABO, ed, The National Assembly of the Republic of Korea, Seoul, pp
36. Ray GT, Lieu T, Weinick RM, Cohen JW, Fireman B, Newacheck P. Comparing the medical expenses of children with Medicaid and commercial insurance in an HMO. American Journal of Managed Care 2000, 6(7):753-760.
37. Rossiter LF, Whitehurst-Cook MY, Small RE, Shasky C, Bovbjerg VE, Penberthy L, Okasha A, Green J, Ibrahim IA, Yang S, Lee K. The impact of disease management on outcomes and cost of care: a study of low-income asthma patients. Inquiry 2000, 37(2):188-202.
38. Shaikh BT, Hatcher J. Health seeking behaviour and health services utilization trends in national health survey of Pakistan: what needs to be done? Journal of the Pakistan Medical Association 2007, 57(8):411-414.
39. Shen C, Sambamoorthi U, Rust G. Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness. Disease Management 2008, 11(3):153-160.
40. Shin YS, Lee HJ, Lee YH, Shin YO, Jung HS, Yoon SJ. Survey on the Medical Needs in Near Poverty Group and Strategies for Increasing Medical Payment 2004, Korea Institute for Health and Social Affairs, Seoul
41. Shin YS, Choi BH, Shin HY, Hwang DK, Yun SJ. A Policy Report for the Current Situation of Medical Aid Expenditure and Improvement Direction 2005, Korea Institute for Health and Social Affairs, Seoul
42. Smith JE. Case management: a literature review. Canadian Journal of Nursing Administration 1998, 11(2):93-109.
43. Smith DG, Moore JD. Medicaid Politics and Policy 1965-2007 2008, Transaction Publishers, New Brunswick, NJ, USA
44. Sommers A, Cohen M. Medicaid's high cost enrollees: how much do they drive program spending? 2006, http://www.kff.org/medicaid/upload/7490.pdf, Retrieved from on 11 March 2009
45. Spitz B. A national survey of Medicaid case-management programs. Health Affairs 1987, 6(1):61-70.
46. 2005 Population and Housing Census 2005, Statistics Korea, Statistics Korea, Seoul
47. 2001 National Health Interview Survey in Taiwan 2002, http://www.bhp.doh.gov.tw/bhpnet/English/file/ontent File/200803271042419375/National%20health%20interview%20survey01.pdf, Taiwan Bureau of Health Promotion, Retrieved from on 10 July 2006
48. Wheeler JR, Janz NK, Dodge JA. Can a disease self-management program reduce health care costs?: the case of older women with heart disease. Medical Care 2003, 41(6):706-715.