Health Policy Manag.  2019 Dec;29(4):513-522. 10.4332/KJHPA.2019.29.4.513.

Impact of Changes in Medical Aid Status on Health Care Utilization

• Kim W
• Nam CM
• Lee SG
• Park S
• Kim TH
• Park EC

• KMID: 2470458
• DOI: http://doi.org/10.4332/KJHPA.2019.29.4.513

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.

Keyword

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

MeSH Terms

Adult
Delivery of Health Care*
Emergency Service, Hospital
Humans
Inpatients
Korea
Length of Stay
National Health Programs
Outpatients
Patient Acceptance of Health Care*
Poverty
Vulnerable Populations