The Effect of Copayment on Medical Aid Beneficiaries in Korea

PURPOSE: This study was to ascertain whether there are differences in health care utilization and expenditure for Type I Medical Aid Beneficiaries before and after applying Copayment. METHODS: This study was one-group pretest posttest design study using secondary data analysis. Data for pretest group were collected from claims data of the Korea National Health Insurance Corporation and data for posttest group were collected through door to-door interviews using a structured questionnaire. A total of 1,364 subjects were sampled systematically from medical aid beneficiaries who had applied for copayment during the period from December 12, 2007 to September 25, 2008. RESULTS: There was no negative effect of copayment on accessibility to medical services, medication adherence (p=.94), and quality of life (p=.25). Some of the subjects' health behaviors even increased preferably after applying for copayment including flu prevention (p<.001), health care examination (p=.035), and cancer screening (p=.002). However, significant suppressive effects of copayment were found on outpatient hospital visiting days (p<.001) and outpatient medical expenditure (p<.001). CONCLUSION: Copayment does not seem to be a great influencing factor on beneficiaries'accessibility to medical services and their health behavior even though it has suppressive effects on outpatients' use of health care.

Job Analysis of Medical Care Client Managers based on DACUM / 산업간호학회지

PURPOSE: The purpose of this study is to establish the standards for duty of Medical Care Client Managers and analyze the extent of accomplishment, importance, and difficulty according to the standards. METHODS: The draft for duty of Medical Care Client Managers was formed by the method of developing a curriculum (DACUM) and data were collected from 185 Medical Aid Client Managers in 234 areas to evaluate the actual frequency of accomplishment, importance and difficulty in comparison with the standards for duties. RESULTS: The standard duty draft for Medical Care Client Manager is composed of five separate groups of duties and thirty five tasks. The five duties are Case Management, Extension Approval, External Cause of Injury, Duplicate Claims and Other Administrations. Seven Tasks are allocated to each duty such as Case Management, Extension Approval and External Cause of Injury. Five tasks are allocated to 'Duplicate Claims' duty and nine tasks are allocated to 'Other Administrations' duty. CONCLUSION: From the results of analysis for duties, it was apprehensive about overburdened responsibilities and carelessness in professional duties. It was necessary to establish specific guidelines for duties because of redundent application or regional variation in frequency of accomplishing other administrative duties. It was necessary to relieve a regional disparity of business charge and also was necessary to propose an alternative plan to relieve the overburdened responsibilities.

Development of a Tool for Predicting Nursing Times in Occupational Accident Patients / 산업간호학회지

PURPOSE: This study aims to develop a tool to predict occupational health patients' nursing needs or nursing time. METHOD: A tool was composed based on the materials and opinion of experts, and to verify the reliability and validity of the tool, nursing time of total 311 inpatients in 2 occupational health hospitals were surveyed. RESULTS: The developed tool was total 151 items and composed of physical function, cognitive function, communication, emotional and disturbance behavior, nursing skill, and rehabilitation need. The reliability of the tool was high, showing Cronbach's alpha coefficient of 0.95. But several items should be deleted for low corrected item-total correlation. According to the multiple regression analysis, physical function and rehabilitation need were shown to be the most powerful predictive variables for nursing time. CONCLUSION: The developed tool was appeared to have high reliability and validity. But further refinement of the tool is needed.

Survey on the Occupational Disabled Status using Functional Assessment Tools / 산업간호학회지

PURPOSE: The purpose of this study was to investigate the actual condition of the disabled due to Occupational accidents based on the functional evaluation tool. METHOD: The data were collected from 2 Workers Accident Medical Corporation, 311 subjects between February and August, 2007. The tool comprised of six components including physical function, cognitive function, communication, emotional and disturbing behavior, nursing skills and rehabilitation needs. RESULTS: Among the disabled, the average point of physical function of 5 was found in 61.92% and to express and understand were evaluated as normal in 36.69% and 33.44%, respectively. Also, hearing and vision were evaluated as normal in 53.50% and 37.98%, respectively. 19.01% of the disabled had emotional problems and 13.78% had disturbing behavior. Most disabled were in need of nursing skills with 97.73% ROM and activities. The 78.18% and 76.90% of disabled were in need of rehabilitation because of right and left leg in full movement disorders, respectively. CONCLUSION: The evaluation score for the disabled caused by Occupational accidents was diverse showing 10 to 19 points and 140 to 150 points. The result means the care cost should be determined depending on the care needs of the disabled because there is such a diverse range of care needs for them.

Comparison of Case Management between Tele Care Regions and General Care Regions in Korean Medicaid / 간호행정학회지

PURPOSE: The purpose of the study was to compare recipients' health behavior, attitude to using medicaid, medication compliance, and the changes in hospital cost and visit-day of in-patient and out-patient care between tele-care regions (TCR) and general care regions (GCR) in Korean medicaid. METHOD: The design of the study was ex-post facto comparing recipients in TCR and GCR. The sample included 625 persons in TCR and 410 persons in GCR. To collect materials, the case manager interviewed recipients of medicaid and filled out questionnaires which were analyzed through SAS/PC 9.1. RESULTS: In studying health behavior and medication, compliance was not significant. However, the attitude to using medicaid was significantly more positive in TCR than in GCR. In out-patients, the change of hospital visit-day was not significant between TCR and GCR, but TCR showed a reduction in hospital cost compared to GCR. For in-patient recipients, GCR showed a greater reduction in changes in hospital cost and visit-day compared to TCR. CONCLUSIONS: The results of the study show that attitudes to using medicaid via telephone are positive and results are more effective than hospital visit consultation, and the cost of out-patient care could be reduced.