The Seoul Institute, 57 Nambusunhwan-ro, 340-gil, Seocho-gu, Seoul 06756, Korea.
Int J Environ Res Public Health. 2018 Apr 17;15(4):772. doi: 10.3390/ijerph15040772.
The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care.
医疗救助计划是政府为保障低收入韩国家庭的最低生活和医疗服务而设立的医疗福利计划。在首尔，医疗救助计划的受益人数不断增加，导致住院时间（LOS）和医疗费用增加。到目前为止，研究主要集中在 LOS 等数量指标上，但只有少数研究关注服务质量。我们调查了 LOS 和可预防住院（PH）率，作为衡量首尔医疗救助计划提供的服务数量和质量的替代指标。为了了解该计划的影响，我们提取了医疗救助计划受益人和国民健康保险（NHI）参保者中排名后 20%的数据，进行倾向评分匹配（PSM），并控制了与疾病严重程度相关的变量。使用多层分析估计了医疗救助计划受益人和 NHI 参保者之间的差异。医疗救助计划受益人的 LOS 更长，可预防住院（PH）率也高于 NHI 参保者。这意味着尽管这些受益人服务利用率高，但他们并没有得到及时和充分的医疗保健服务。因此，应将与 PH 相关的患者就诊和筛查等指标纳入管理政策，以改善初级保健。
