Abstract

With institutional changes, such as an increase in Medical Aid’s coverage, expansion of covered stays and little out-of-pocket spending (OOP), caused Medical Aid’s beneficiaries to use more healthcare services. Therefore the quantity of healthcare services used and the cost to Medical Aid increased dramatically. It seems that Medical Aid’s policy has grown significantly due to expansion of covered services and healthcare costs. There has been little interest or concern regarding usual health behaviors and quality of healthcare services that Medical Aid’s beneficiaries receive. Studies related to Medical Aid’s policies have been focused on moral laxity of Medical Aid’s beneficiaries. This is exemplified by healthcare services shopping by Medical Aid beneficiaries, consideration of the propriety of Medical Aid’s beneficiaries utilization of health care resources is a major factor. Against the backdrop of this situation, this study aims to investigate healthcare utilization and usual health behaviors of Medical Aid’s beneficiaries by evaluating the quality of healthcare services which Medical Aids beneficiaries receive in Seoul. Frequency analysis and multi-level analysis were used as research methods and these analyses were conducted for comparison amongst Medical Aid’s beneficiaries, overall National Health Insurance participants and 20% of National Health Insurance participants based on health insurance premiums. First of all, health behaviors such as high risk drinking, walking, perceived health status and mental health status were worse than overall National Health Insurance participants. From the aspect of healthcare utilization, especially for Medical Aid outpatients, outpatient visits and total healthcare costs were decreased. However, OOP spending was increased. For inpatients overall healthcare utilization such as length of stays, total healthcare costs and OOP spending were increased. Lastly, for quality of healthcare services, the preventable hospitalizations of Medical Aid’s beneficiaries were statistically higher than 20% of National Health Insurance participants. However, emergency visits of Medical Aid’s beneficiaries were statistically lower than that of 20% of National Health Insurance participants. In addition this study found that changes in health behaviors and mental health were significantly related to decreases in healthcare costs and outpatient visits.

Based on this study’s results it proposes three policy suggestions. First, expansion of ‘Seoul Citizen Health Point’ program is needed to improve health behavior. Secondly we need to construct and connect dispersed resources in the community The third change proposed is to improve the quality of healthcare services from the aspect of healthcare service providers, such as incentive program to control quality.

 

Contents

01 Introduction

1_Background and Purpose of the Study

2_Main Contents and Research Methods

 

02 Outline and Preceding Studies Related to Medical Aid Program

1_Outline of Medical Aid Program

2_Preceding Studies Related to Medical Aid Program

 

03 Health Behavior and Health Needs of Medical Aid Beneficiaries in Seoul

1_Preventive Health Care

2_Health Needs

3_Conclusion

 

04 Healthcare Utilization and Health Outcome of Medical Aid Beneficiaries in Seoul

1_Healthcare Utilization

2_Health Outcome

3_Conclusion

 

05 Challenges of Medical Aid Program and Policy Suggestions

1_Challenges of Medical Aid Program of Seoul

2_Policy Suggestions