Shin Sun Mi, Kim Eui Sook, Park Chang Ki, Lee Hee Woo
Office of Global Health Leadership, University of Illinois, Chicago, Illinois, USA.
J Prev Med Public Health. 2010 Jan;43(1):35-41. doi: 10.3961/jpmph.2010.43.1.35.
In Korea, the top 10% of Medical Aid recipients represent nearly 60% of total payment, with the costs for those disabled for over 365 days representing approximately 30% of total payment. The purpose of this study was to compare Medical Aid use of the disabled with non-disabled recipients, and to identify contributing factors to the total payment in the top 2% of recipients identified as Medical Aid overusers.
Subjects (n=2,211) selected were > or =18-years-of-age and received >1000 days of co-payment-free type I Medical Aid. Case managers (n=200) conducted interviews in December 2006, and collected data from Health Insurance Review & Assessment Service. Amounts over the 9 months from January September 2006 were analyzed descriptively and using Chi-square, ANCOVA, and robust multiple linear regression.
Disabled individuals (mean age 61.3 years) composed 36.6% of subjects; 44.8% of the disabled were male. On a monthly basis per capita, the disabled group averaged 10.5 outpatient days, total payment of 523,000 Korean Won(), inpatient payment of 359,000, and outpatient payment of 183,000. All values exceeded the monthly average for non-disabled individuals. Contributing factors were identified as male gender (82,000), elementary school or lower educational level (64,000), residence in a small city (82,000), lack of family support (61,000), kidney disability (673,000), intellectual disability (151,000), and multiple disabilities (119,000).
The identification of contributing factors to Medical Aid use by those defined as disabled supports the adoption of comprehensive alternative policies such as strengthening of education and consultation services, provision of alternative facilities, and promotion of self-care.
在韩国，医疗救助受助者中排名前10%的人群占总支付金额的近60%，其中残疾超过365天的人群的费用约占总支付金额的30%。本研究的目的是比较残疾受助者和非残疾受助者的医疗救助使用情况，并确定被认定为医疗救助过度使用者的前2%受助者总支付金额的影响因素。
选取年龄≥18岁且接受过1000天以上无自付费用的I类医疗救助的受试者（n=2211）。200名个案管理员于2006年12月进行访谈，并从健康保险审查与评估服务机构收集数据。对2006年1月至9月这9个月的费用金额进行描述性分析，并使用卡方检验、协方差分析和稳健多元线性回归进行分析。
残疾个体（平均年龄61.3岁）占受试者的36.6%；44.8%的残疾人为男性。每月人均方面，残疾组平均门诊天数为10.5天，总支付金额为523,000韩元（），住院支付为359,000韩元，门诊支付为183,000韩元。所有数值均超过非残疾个体的月平均值。确定的影响因素包括男性（82,000韩元）、小学及以下教育水平（64,000韩元）、居住在小城市（82,000韩元）、缺乏家庭支持（61,000韩元）、肾脏残疾（673,000韩元）、智力残疾（151,000韩元）和多重残疾（119,000韩元）。
确定残疾人群体医疗救助使用的影响因素，有助于采取全面的替代政策，如加强教育和咨询服务、提供替代设施以及促进自我护理。
