Na Young-Kyoon, Lee Daho, Lee Kyounga
Department of Health & Welfare, Paichai University, Daejeon 35345, Republic of Korea.
Health Insurance Research Institute, National Health Insurance Service, Wonju 26464, Republic of Korea.
Healthcare (Basel). 2025 Apr 28;13(9):1015. doi: 10.3390/healthcare13091015.
South Korea implemented a case management program for Medical Aid (MA) beneficiaries in 2003. This study evaluates the effect of case management on healthcare utilization among MA beneficiaries, with a focus on both outpatients and inpatients. This retrospective comparative study was conducted using the 2023 full dataset of MA beneficiaries. The propensity score matching method was used to match the case management group with the non-case management group, and differences in healthcare utilization were analyzed using a difference-in-differences analysis. The case management group exhibited characteristics of a medically vulnerable population, with greater healthcare needs than those of the non-case management group. Case management interventions reduced outpatient days by 4.7 and outpatient medical costs by USD 327 per person annually. For long-term inpatients, it reduced inpatient days by 13.6 and medical costs by USD 2261 per person annually ( < 0.001). MA case management effectively reduced both outpatient/inpatient days and medical costs. As the effects may vary depending on the type of case management, developing diverse and detailed case management programs is necessary.
韩国于2003年为医疗救助（MA）受益人实施了一项病例管理计划。本研究评估了病例管理对MA受益人医疗服务利用的影响，重点关注门诊患者和住院患者。这项回顾性比较研究使用了2023年MA受益人的完整数据集。采用倾向得分匹配法将病例管理组与非病例管理组进行匹配，并使用双重差分分析来分析医疗服务利用的差异。病例管理组表现出医疗弱势群体的特征，其医疗需求比非病例管理组更大。病例管理干预措施使门诊天数每年减少4.7天，人均门诊医疗费用减少327美元。对于长期住院患者，住院天数每年减少13.6天，医疗费用每人每年减少2261美元（<0.001）。MA病例管理有效地减少了门诊/住院天数和医疗费用。由于效果可能因病例管理类型而异，因此有必要制定多样化和详细的病例管理计划。
