Inpatient Service Use by Type of Health Coverage Scheme in South Korea: A Secondary Analysis of National Data
Abstract
Background: Healthcare utilization has progressively increased, especially among Medical Aid (MA) beneficiaries in South Korea. Recently, the focus of MA policy is shifting to long-term inpatient management. We aimed to identify the factors associated with inpatients’ medical service use among MA beneficiaries compared to National Health Insurance (NHI) beneficiaries.
Methods: This secondary data analysis study used raw data collected from 2012 to 2014 by the Korea Health Panel Study, which is a national health survey conducted annually. Data from 3,869 participants were analyzed: 3,621 NHI beneficiaries and 248 MA beneficiaries. Multiple regression analysis and difference and slope difference tests were performed.
Results: Age, education level, marital status, living with family, employment, disability, and unmet medical needs significantly influenced the length of hospital stay. Living with family, employment, disability, chronic illness, and unmet medical needs significantly influenced hospitalization costs. MA beneficiaries had longer hospital stay than did NHI beneficiaries (F=5.99, P=0.003); however, there was no difference in hospitalization costs. Among those with low education, longer hospital stay length was more frequent among MA beneficiaries.
Conclusion: A future intervention model for MA inpatients should consider their service use patterns and characteristics. Most importantly, healthcare education should be provided according to MA patients’ education level to enable patients to make informed health-related decisions. An effort is needed to change the current hospitalization system by encouraging patients to utilize local community care service and by expanding community care and in-home healthcare services.
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6. Lee HJ (2016). Health care utilization and out-of-pocket spending of Medical Aids recipients in South Korea: a propensity score matching with National Health Insurance participants. Korean J Health Econ Pol, 22: 29–49.
7. Kim JH, Kim NR, Park EC (2016). Impact of con-tinuous Medical Aid utilisation on health care utili-sation: unique insight using the 2008–2012 Kore-an Welfare Panel Study (KOWEPS). BMJ Open, 6 (4): e008583.
8. Kim J, Shon C (2018). The effects of health coverage schemes on length of stay and preventable hospi-talization in Seoul. Int J Environ Res Public Health, 15 (4): 772.
9. Andersen RM (1995). Revisiting the behavioral mod-el and access to medical care: does it matter? J Health Soc Behav, 36: 1–10.
10. Yoon J, Shin HW, Noh YH, Yeo N (2015). Does concurrent introduction of small cost-sharing and gatekeeping arrangements reduce health care spending? Evidence from Medical Aid reform in South Korea. Health Soc Welfare Rev, 35 (4): 35–63.
11. Yoo KB, Ahn HU, Park EC, et al (2016). Impact of co-payment for outpatient utilization among Medical Aid beneficiaries in Korea: a 5-year time series study. Health Pol, 120 (8): 960–6.
12. Kim US, Lee JY, Yu WS, et al (2009). The desired direction for optimal medical service use of medical aid beneficiaries–focusing on the long-term admission. Seoul: Human Re-source Development Institute for Health and Welfare. South Korea.
13. Ministry of Health and Welfare (2018). Basic liveli-hood security improvement system to prevent in-appropriate supply and demand. South Korea.
14. Kim JH, Lee TJ, Lee YJ, Seo KM (2013). Mid-long term development measures for Medicaid system. Seoul: Seoul National University and Ministry of Health and Welfare. South Korea.
15. Lee S, Lim JY (2013). The effects of introduction of co-payment system on the Medical Aid benefi-ciaries’ health care usage in Korea. Korean J Health Econ Pol, 19: 23–49.
16. Lee K (2018). Health care perspectives on communi-ty care. J Korean Med Assoc, 61 (1): 586–9.
17. Korea Health Panel Study. Korea Institute for Health and Social Affairs. https://www.khp.re.kr:444/eng/main.do
18. National Academies of Sciences, Engineering, and Medicine (2018). Health-care utilization as a proxy in disability determination. Washington (DC): National Academies Press.
19. Aday LA, Eichhom RL (1972). The utilization of health services: indices and correlates. Bethesda, MD: National Center for Health Services Research and Devel-opment.
20. McCullough K, Dalstrom M (2018). I am insured but how do I use my coverage: Lessons from the front lines of Medicaid reform. Public Health Nurs, 35 (6): 568–73.
21. MacLeod S, Musich S, Gulyas S, et al (2017). The im-pact of inadequate health literacy on patient satis-faction, health care utilization, and expenditures among older adults. Geriatr Nurs, 38: 334–41.
22. Shon CW (2018). Health management and medical service use of Medicaid beneficiaries in Seoul. The Seoul Institute Policy Report, 253: 1–23.
23. Hughes TM, Merath K, Chen Q, et al (2018). Asso-ciation of shared decision-making on patient-reported health outcomes and health care utiliza-tion. Am J Surg, 216 (1): 7–12.
24. Okunrintemi V, Spatz ES, Di Capua P, et al (2017). Patient-provider communication and health out-comes among individuals with atherosclerotic cardiovascular disease in the United States: Medi-cal Expenditure Panel Survey 2010 to 2013. Circ Cardiovasc Qual Outcomes, 10 (4): e003635.
25. Agosti P, Tettamanti M, Vella FS, et al (2018). Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients. Eur J Intern Med, 57: 25–31.
26. Lage DE, Jernigan MC, Chang Y, et al (2017). Living alone and discharge to skilled nursing facility care after hospitalization in older adults. J Am Geriatr Soc, 66 (1): 100–5.
27. Pilotto A, Sancarlo D, Pellegrini F, et al (2016). The multidimensional prognostic index predicts in-hospital length of stay in older patients: a multicen-tre prospective study. Age Ageing, 45 (1): 90–6.
28. Anderson ME,Glasheen JJ,Anoff D, Pierce R, Capp R, Jones CD (2015). Understanding predictors of prolonged hospitalizations among general medi-cine patients: A guide and preliminary analysis. J Hosp Med, 10 (9): 623–6.
29. Toh HJ, Lim ZY, Yap P, Tang T (2017). Factors as-sociated with prolonged length of stay in older patients. Singapore Med J, 58 (3): 134–8.
30. Cheng SH, Chiang TL (1997). The effect of universal health insurance on health care utilization in Tai-wan: results from a natural experiment. JAMA, 278 (2): 89–93.
31. MacArthur H, Phillips C, Simpson H (2012). Im-proving quality reduces costs – quality as the busi-ness strategy. http://www.1000livesplus.wales.nhs.uk/opendoc/190781
32. Cho J, Jeong K, Kim S, Kim H (2019). Exploring the health care seeking behavior of medical aid bene-ficiaries who overutilize health care services: a quali-tative descriptive study. Int J Environ Res Public Health, 16 (14): 2485.
33. Cho KH, Chung Y, Roh YK, Cho B, Kim CH, Lee HS (2004). Health care for older persons: a coun-try profile—Korea. Int Health Aff, 52 (7): 1199–204.
34. Tappenden P, Campbell F, Rawdin A, Wong R, Kalita N (2012). The clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review. Health Technol Assess, 16 (20): 1–72.
35. Feinglass J, Norman G, Golden RL, Muramatsu N, Gelder M, Cornwell T (2018). Integrating social services and home-based primary care for high-risk patients. Popul Health Manag, 21 (2): 96–101.
2. Ministry of Health and Welfare (2018). Guideline for Medicaid Program in 2018. Sejong: Ministry of Health and Welfare. South Korea.
3. National Health Insurance Service (2018). 2017 Na-tional Health Insurance Statistical Yearbook. http://www.nhis.or.kr/menu/boardRetriveMenuSet.xx?menuId=F3322/
4. Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W (2011). Addressing access barriers to health services: an analytical framework for selecting ap-propriate interventions in low-income Asian countries. Health Pol Plan, 27 (4): 288–300.
5. Kim JH, Lee KS, Yoo KB, Park EC (2015). The dif-ferences in health care utilization between Medical Aid and health insurance: a longitudinal study us-ing propensity score matching. PLoS ONE, 10 (3): e0119939.
6. Lee HJ (2016). Health care utilization and out-of-pocket spending of Medical Aids recipients in South Korea: a propensity score matching with National Health Insurance participants. Korean J Health Econ Pol, 22: 29–49.
7. Kim JH, Kim NR, Park EC (2016). Impact of con-tinuous Medical Aid utilisation on health care utili-sation: unique insight using the 2008–2012 Kore-an Welfare Panel Study (KOWEPS). BMJ Open, 6 (4): e008583.
8. Kim J, Shon C (2018). The effects of health coverage schemes on length of stay and preventable hospi-talization in Seoul. Int J Environ Res Public Health, 15 (4): 772.
9. Andersen RM (1995). Revisiting the behavioral mod-el and access to medical care: does it matter? J Health Soc Behav, 36: 1–10.
10. Yoon J, Shin HW, Noh YH, Yeo N (2015). Does concurrent introduction of small cost-sharing and gatekeeping arrangements reduce health care spending? Evidence from Medical Aid reform in South Korea. Health Soc Welfare Rev, 35 (4): 35–63.
11. Yoo KB, Ahn HU, Park EC, et al (2016). Impact of co-payment for outpatient utilization among Medical Aid beneficiaries in Korea: a 5-year time series study. Health Pol, 120 (8): 960–6.
12. Kim US, Lee JY, Yu WS, et al (2009). The desired direction for optimal medical service use of medical aid beneficiaries–focusing on the long-term admission. Seoul: Human Re-source Development Institute for Health and Welfare. South Korea.
13. Ministry of Health and Welfare (2018). Basic liveli-hood security improvement system to prevent in-appropriate supply and demand. South Korea.
14. Kim JH, Lee TJ, Lee YJ, Seo KM (2013). Mid-long term development measures for Medicaid system. Seoul: Seoul National University and Ministry of Health and Welfare. South Korea.
15. Lee S, Lim JY (2013). The effects of introduction of co-payment system on the Medical Aid benefi-ciaries’ health care usage in Korea. Korean J Health Econ Pol, 19: 23–49.
16. Lee K (2018). Health care perspectives on communi-ty care. J Korean Med Assoc, 61 (1): 586–9.
17. Korea Health Panel Study. Korea Institute for Health and Social Affairs. https://www.khp.re.kr:444/eng/main.do
18. National Academies of Sciences, Engineering, and Medicine (2018). Health-care utilization as a proxy in disability determination. Washington (DC): National Academies Press.
19. Aday LA, Eichhom RL (1972). The utilization of health services: indices and correlates. Bethesda, MD: National Center for Health Services Research and Devel-opment.
20. McCullough K, Dalstrom M (2018). I am insured but how do I use my coverage: Lessons from the front lines of Medicaid reform. Public Health Nurs, 35 (6): 568–73.
21. MacLeod S, Musich S, Gulyas S, et al (2017). The im-pact of inadequate health literacy on patient satis-faction, health care utilization, and expenditures among older adults. Geriatr Nurs, 38: 334–41.
22. Shon CW (2018). Health management and medical service use of Medicaid beneficiaries in Seoul. The Seoul Institute Policy Report, 253: 1–23.
23. Hughes TM, Merath K, Chen Q, et al (2018). Asso-ciation of shared decision-making on patient-reported health outcomes and health care utiliza-tion. Am J Surg, 216 (1): 7–12.
24. Okunrintemi V, Spatz ES, Di Capua P, et al (2017). Patient-provider communication and health out-comes among individuals with atherosclerotic cardiovascular disease in the United States: Medi-cal Expenditure Panel Survey 2010 to 2013. Circ Cardiovasc Qual Outcomes, 10 (4): e003635.
25. Agosti P, Tettamanti M, Vella FS, et al (2018). Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients. Eur J Intern Med, 57: 25–31.
26. Lage DE, Jernigan MC, Chang Y, et al (2017). Living alone and discharge to skilled nursing facility care after hospitalization in older adults. J Am Geriatr Soc, 66 (1): 100–5.
27. Pilotto A, Sancarlo D, Pellegrini F, et al (2016). The multidimensional prognostic index predicts in-hospital length of stay in older patients: a multicen-tre prospective study. Age Ageing, 45 (1): 90–6.
28. Anderson ME,Glasheen JJ,Anoff D, Pierce R, Capp R, Jones CD (2015). Understanding predictors of prolonged hospitalizations among general medi-cine patients: A guide and preliminary analysis. J Hosp Med, 10 (9): 623–6.
29. Toh HJ, Lim ZY, Yap P, Tang T (2017). Factors as-sociated with prolonged length of stay in older patients. Singapore Med J, 58 (3): 134–8.
30. Cheng SH, Chiang TL (1997). The effect of universal health insurance on health care utilization in Tai-wan: results from a natural experiment. JAMA, 278 (2): 89–93.
31. MacArthur H, Phillips C, Simpson H (2012). Im-proving quality reduces costs – quality as the busi-ness strategy. http://www.1000livesplus.wales.nhs.uk/opendoc/190781
32. Cho J, Jeong K, Kim S, Kim H (2019). Exploring the health care seeking behavior of medical aid bene-ficiaries who overutilize health care services: a quali-tative descriptive study. Int J Environ Res Public Health, 16 (14): 2485.
33. Cho KH, Chung Y, Roh YK, Cho B, Kim CH, Lee HS (2004). Health care for older persons: a coun-try profile—Korea. Int Health Aff, 52 (7): 1199–204.
34. Tappenden P, Campbell F, Rawdin A, Wong R, Kalita N (2012). The clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review. Health Technol Assess, 16 (20): 1–72.
35. Feinglass J, Norman G, Golden RL, Muramatsu N, Gelder M, Cornwell T (2018). Integrating social services and home-based primary care for high-risk patients. Popul Health Manag, 21 (2): 96–101.
| Files | ||
| Issue | Vol 49 No 6 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v49i6.3365 | |
| Keywords | ||
| Health insurance; Medical aid; Hospitalization; Length of stay; Healthcare costs | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
CHO J, LEE E. Inpatient Service Use by Type of Health Coverage Scheme in South Korea: A Secondary Analysis of National Data. Iran J Public Health. 2020;49(6):1129-1137.
