Department of Nursing, Munkyung College, Mungyeong, Korea.
J Adv Nurs. 2010 Oct;66(10):2257-65. doi: 10.1111/j.1365-2648.2010.05364.x. Epub 2010 Jul 2.
This paper is a report of a study conducted to describe characteristics of overusers of the Medical Aid service, assess appropriateness of overusers' medical service use, and determine contributing factors to medical aid overuse in Korea.
Medical Aid use in Korea has increased in recent years, but no systematic studies reported the characteristics of overusers and appropriateness of their medical service use.
In a cross-sectional study, case managers conducted interviews, evaluated participants' insurance claim data, and determined overusers by the case managers' determination of the appropriateness of their medical service use and their expenditures during the year of 2006. Descriptive statistics, chi-square analysis, analysis of variance, and multiple logistic regression were used for data analysis.
Most heavy users were elderly, female, less educated, and had stress, lower perceived health status and multiple clinic visits. Twenty-five per cent of inpatients and 63.9% of outpatients were classified as overusers. The average total cost per capita of an overuser was 43.3% higher than that of an optimal user. Age, education, stress, arthritis, multiple clinic visits and frequent clinic visit recommendations by providers were statistically significant contributing factors to the overuse.
Preventive measures are needed to decrease the overuse of Medical Aid in Korea; such measures should focus on characteristics contributing to overuse, including the provider-induced demand for more clinic visits. Case managers could play an important role as gatekeepers, managers, and educators for optimal use of Medical Aid in Korea and elsewhere in the world that faces similar problems.
本文是一项研究报告，旨在描述医疗援助过度使用者的特征，评估过度使用者医疗服务使用的适宜性，并确定韩国医疗援助过度使用的促成因素。
近年来，韩国的医疗援助使用有所增加，但没有系统研究报告过度使用者的特征和其医疗服务使用的适宜性。
在一项横断面研究中，个案管理员进行了访谈，评估了参与者的保险索赔数据，并通过个案管理员确定医疗服务使用的适宜性及其在 2006 年的支出来确定过度使用者。采用描述性统计、卡方分析、方差分析和多因素逻辑回归进行数据分析。
大多数重度使用者为老年人、女性、受教育程度较低，存在压力、较低的健康感知和多次就诊。25%的住院患者和 63.9%的门诊患者被归类为过度使用者。每位过度使用者的人均总费用比最优使用者高出 43.3%。年龄、教育程度、压力、关节炎、多次就诊以及提供者频繁就诊建议是过度使用的统计学显著促成因素。
需要采取预防措施来减少韩国医疗援助的过度使用；这些措施应针对导致过度使用的特征，包括提供者对更多就诊的需求。个案管理员可以在韩国乃至世界其他面临类似问题的地区，作为医疗援助最佳使用的把关者、管理者和教育者发挥重要作用。
