How to reduce excessive use of health care service in medical aid beneficiaries: an economic impact of community-based case management

Abstract

Background Community based case management for medical aid beneficiaries was implemented in Korea to induce rational use of medical care among the beneficiaries and stabilize the financial system. This study investigated the economic impact of community based case management on health care utilization and cost. Methods This study is a quantitative policy evaluation study to evaluate the impact of case management on excessive use of health care service in medical aid beneficiaries using national database. Results Total 1,741 medical aid beneficiaries with case management included in this study. Case management was provided to three target group, high-risk, long-term inpatient, and intensive care group. An increase in health-related quality of life (QOL) and the ability to use appropriate health care and a reduction in health care utilization and cost were observed for case management. There was no significant difference in the reduction in the total number of visiting days and the cost between the groups. Conclusions An increase in the health care utilization among medical aid beneficiaries has been observed due to the aging population and increase in the number of recipients. To reduce health care costs while maintaining the health status of the beneficiaries, it is necessitated to expand the targeted management.