• Journal of Korean Academy of Nursing Administration
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• v.16 no.4
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• pp.381-388
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• 2010

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.

• Research in Community and Public Health Nursing
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• v.21 no.3
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• pp.321-332
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• 2010

Purpose: This study examined change in healthcare utilization by disease severity after case management (CM) for Medicaid. Methods: Data were extracted from survey data on "Healthcare utilization and health status of Medicaid beneficiaries" conducted in 2007 and 2008 by the Ministry for Health, Welfare and Family Affairs. This study was designed to compare change in healthcare utilization between the CM group and the non-CM group. The subjects were 528 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006. Results: In beneficiaries having fewer than 3 among the 11 notified diseases, the CM group showed a significantly larger decrease in outpatient day, outpatient expense, medication day, and medication expense than the non-CM group. In beneficiaries having 3 or more among the 11 notified diseases, however, there was no significant difference in healthcare utilization between the CM group and the non-CM group. Conclusion: CM worked effectively on Medicaid beneficiaries outpatient healthcare utilization for mild diseases. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, a future study is needed to develope strategies to reduce hospitalization and care for Medicaid beneficiaries with severe diseases.

• Journal of Korean Public Health Nursing
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• v.17 no.2
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• pp.287-298
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• 2003

This study was conducted to identify the health care utilization, health care costs, and potential health care demands of the disabled in the Medicaid Aid beneficiaries. This study focused on the heath care costs not included in the medical aid allowance such as transportation, informal nursing costs, and ambulatory aids etc. Participants were the 864 subjects who were beneficiaries of the National Medical Aid program living in 10 district of Korea. A questionnaires were distributed to the disabled in the Medical Aid beneficiaries during August to September, 2001 through public offices. Data were collected through a home visiting by social workers working in public offices. Direct and indirect medical costs expended for one month by the participating disabled were examined. They expended 110.748 won $({\$}100)$ for heath care costs, which was not included in the medical aid allowance during the month. The disabled with cerebral diseases or who have level 4 disability expended more health care costs compare to those with other diseases. Gradual expansion of medical aid allowance for the disabled is recommended to alleviate economic burden of the disabled and their family.

• Research in Community and Public Health Nursing
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• v.23 no.4
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• pp.438-445
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• 2012

Purpose: Medical Aid Beneficiaries were surveyed to identify differences in health behaviors, adherence to drug regimen, and quality of life between those people in the Designated Doctor System and those who are not. Methods: A total of 1,327 study subjects were separated into three groups: those in the Designated Doctor System for 2 years, those in for 1 year, and those not in the system. Results: After the introduction of the Designated Doctor System, 55.8% and 67.9%, respectively, of the subjects in the Designated Doctor System complained of inconvenience in relation to hospital use and the patient referral process. Also, the rate of emergency room use or hospitalization guided by the Designated Doctor System was only 8.7% and 6.5%, respectively. There were no significant differences in health behaviors and adherence to drug regimens between those in the Designated Doctor System and those who are not. Conclusion: This study was carried out early in the introduction of the system. Therefore, it is necessary to monitor the positive and negative effects of the Designated Doctor System for a full reflection of its impact.

• Journal of Korean Public Health Nursing
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• v.29 no.3
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• pp.412-425
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• 2015

Purpose: This study was conducted to understand the trend in research by analyzing previous studies related to the case management of Medicaid and to explore the direction of future research. Methods: Thirty three studies conducted from January 2003 to June 2015 were analyzed according to characteristics of researchers and subjects, research methods, measurable variables, and key words. Results: Of the studies analyzed, 69.7% were conducted on Medicaid beneficiaries, and 65.6% were conducted on the group of high risk for over medical utilization. The mainly used research design was a survey study design, which was 51.5% of them, followed by experimental (24.2%), and qualitative (12.1%) study design. Most frequently measured variables were medical utilization (62.5%), needs for case management (41.7%), and health status (25.0%). The topics most frequently studied were related to medical utilization, effect of case management, self-care, and program development in Medicaid beneficiaries and job and socio-psychological factors in case managers. Conclusion: The future direction of nursing research in Medicaid case management is to be vitalized through the expansion of the research population, and concretization and diversification of the research topics. In addition, conduct of further studies on intervention strategies and contents for improving quality of case management program is also needed.

• Journal of Korean Academy of Nursing Administration
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• v.15 no.1
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• pp.136-146
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• 2009

Purpose: The purpose of this study was to investigate the effects of copayments for doctor visits and prescription drugs on health services utilization in the Type I Medicaid beneficiaries in Korea. Method: This study examined data from the 2007 survey on Health Services Use and Health Status of Medicaid Beneficiaries performed by the Ministry for Health Welfare and Family Affairs. To analyze these sample survey data, the SURVEYFREQ, SURVEYMEANS, and SURVEYREG procedures which incorporate the sample design into the analyses were used. Results: Findings of this study indicate that copayments for doctor visits and prescription drugs of Medicaid Type I beneficiaries have cut overall medical costs. However, although results should be interpreted very carefully because of the relatively low $R^2$, copayments have cut more health services utilization of people who need more health services because of their complex diseases and disability. In addition, besides copayment, several factors are affecting differences in health services utilization before and after copayments implementation. Conclusion: These results highlight the need to examine the effects of copayments more thoroughly according to the kinds of disease, the severity of disease, and the level of copayment.

• Journal of Korean Academy of Nursing
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• v.53 no.5
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• pp.556-569
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• 2023

Purpose: This phenomenological study tried to understand the essence of the transitional care experience of medicaid case managers and its structural meaning. In addition, it was attempted to establish a system of transitional care and seek support measures for medicaid case managers. Methods: The participants of this study were 7 medicaid case managers who had spent more than 1 year and 6 months in medicaid pilot project. Data were collected with individual in-depth interviews from June to December 2021. The data were analyzed by Giorgi's phenomenological analysis method. Results: The seven constituents derived from the results of this study were 'struggle to establish a living environment', 'dedication to supporting independent living', 'anxiety about safety', 'pressure on care responsibilities', 'distress in building the pilot project', 'pride in role', and 'expectation for improvement'. Conclusion: The study results provide a comprehensive understanding of the transition care reality for medicaid case managers. They also shed light on managers' perceptions and attitudes. These findings can serve as fundamental information for establishing support measures for medicaid case managers and transitional care systems.

• Journal of Korean Public Health Nursing
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• v.24 no.1
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• pp.61-70
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• 2010

Purpose: This study analyzed outcomes of a Telecare case management service pilot project for Korean Medicaid Program Clients in Seoul. Outcome data for provided services and medical aid cost data were analyzed. Methods: Case management services were delivered by 10 medical aid managers. The period of the project was from July to December 2007. Results: The total number of the objects was 9714, representing 43.4% of the total medical aid clients in the area. The average number of consults was 2.58. Consults were most frequently via letter and telephone, with in- person visits being least common. Of the total, 213 cases were referred to community services, 87.8% were transacted successfully. The medical expenditure was less than that from January-June, 2007. Conclusion: Telecare service via mail or telephone allows contact with many clients in a short time which can enable the discover and monitoring of high risk clients. This can be accomplished at a cost savings to the Korean Medicaid Program.

• Korean Journal of Occupational Health Nursing
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• v.18 no.1
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• pp.84-97
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• 2009

Purpose: The purpose of this phenomenological study was to understand the job experiences of the medical aid client managers Method: The data were collected through an in-depth interview from twelve medical aid client managers. It was analyzed using the phenomenological method proposed by Colaizzi (1978). Their feedback was categorized into five items such as 'settlement in the unknown place,' 'exhaustion from work,' 'difficulties in dealing with people,' 'achievement of professionalism and accomplishment,' and 'vision on the new aspect.' Conclusion: Medical aid client managers played diverse roles and they had a role conflict due to unstable position amid feeling proud with new vision on their roles. The results of this study suggested that systematic development of job training programs and description on the duty are needed. Moreover, appropriate legal basis for the duty of medical aid client managers is to be established. Finally, based on this research, more acknowledgement from the Korean nursing society is needed for the new emerging professional job.

• Journal of Digital Convergence
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• v.12 no.3
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• pp.289-297
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• 2014

This study is meaningful by offering basic data that is able to enhance satisfaction with the use of medical services by the qualified recipients of medical aid and to promote health consistently while looking into their satisfaction with the use of medical services, using independent variables for the period after the introduction of the selected medical center system. The study period from August 16, 2013 was 23 August, In conclusion, with a view to enhancing satisfaction with the use of medical services by qualified recipients of medical aid after the execution of the selected medical center system, it is most important to identify with greater sufficiency and accuracy the effect of medical services by qualified recipients of medical services and any unsatisfied desire for medical services. Also, in pursuit of the use of appropriate medical services, there is a need to prepare active cooperation between medical centers and various political alternatives of the government for the effective discovery of accessibility to medical services, overcome inefficiencies in administrative procedures, establish a reasonable medical service delivery system with the guarantee of appropriate medical treatment, and improve health management.