PURPOSE: This study investigates the social network, self-care agency, and quality of life of high-risk beneficiaries in case management of Medicaid and the correlations between these variables. It also identifies influencing factors on their quality of life. METHODS: The subjects included 187 individuals chosen from the high-risk beneficiaries in case management of Medicaid in D Metropolitan City. Data was collected through direct interviews based on a structured questionnaire on home visits. RESULTS: The perceived health status was the most influential factor in their quality of life, followed by self-care agency, mutual support network, and natural support network in order. These factors explained 40.6% of their quality of life. CONCLUSION: These findings raise a need to develop a nursing intervention program to increase the self-care agency of the high-risk beneficiaries in case management of Medicaid.
Case Management* ; House Calls ; Medicaid* ; Nursing ; Quality of Life* ; Self Care*

PURPOSE: This study was done to analyze the effects of tele-care case management services using secondary data. METHODS: A descriptive research design was utilized, and the participants were 134 medical aid beneficiaries who were in either the high-risk group or the preventive group. Case management services were delivered by 8 care managers. Data were analyzed using PAWS Statistics 17 through descriptive statistics and paired t-test. RESULTS: After the case management intervention, the participants' health quality of life, self-care competency, and reasonable medical care utilization increased significantly for the high-risk group. However there were no significant changes in the preventive group. CONCLUSION: The results showed that the tele-care case management services were effective for high-risk medical aid beneficiaries. Further studies with controls for constitutional variables and a comparison group are required to validate the robustness of the effectiveness of the case management program in the present study.
Case Management* ; Medicaid ; Quality of Life ; Research Design ; Self Care

PURPOSE: In the present study, the difference in patients' nursing demands and nursing performance as perceived by the patients was examined. METHODS: The participants were 272 patients on maintenance hemodialysis at five university hospitals. Nursing need and nursing performance were measured using the tool developed by Lee for this study. RESULTS: The mean score for nursing demand was 3.35 points out of 4. The scores were higher for participants with middle school graduation or less, those not professing religion, and those whose medical insurance was of the medicaid type. The mean score for perceived nursing performance was 3.22 points out of 4. Nursing performance as perceived by hemodialysis patients was lower than nursing demand for 22 of 28 items. The item with the largest difference between nursing performance and nursing demand was 'Give a pain-free injection', followed by 'Explain about insurance benefits and supports' and 'Maintain quiet environment in the hemodialysis unit enabling rest during hemodialysis'. CONCLUSION: The results show that nursing performance as perceived by hemodialysis patients was lower than nursing demand. This result indicates a need to develop appropriate strategies to enhance nursing performance, especially for items that showed low nursing performance.
Hospitals, University ; Humans ; Insurance ; Insurance Benefits ; Medicaid ; Oxalates ; Renal Dialysis

BACKGROUND: This study is designed to estimate the factors that affect the level of three different performance (publicity, efficiency, profitability) among regional public hospitals. METHODS: The units of analysis are the regional 30 hospitals, which have the operating data during 22 years (from 1933 to 2014). The research method is used by fixed panel analysis. The publicity is measured by medicaid outpatient proportion and medicaid inpatient proportion. The efficiency is measured by two types of efficient score by DEA (data envelopment analysis). The profitability is measured by medical income to medical revenue and ROA (return on total asset). RESULTS: At first, the increase of bed gives negative affect to the publicity but give positive effect to the efficiency and profitability. Because it means the increase of the region population, it gives more profitability compare to hospital with small number of beds. The more the operating period is the higher effect to the publicity and efficiency because of it's refutation. The debt ratio gives negative effect to publicity, but positive effect to profitability. It is the normal belief that there is inverse relationship between publicity and profitability. The turnover rate of bed gives the negative affect to the publicity, but positive affect to the efficiency and profitability. That give us the implication that type of the inpatient make different effect the hospital performance. The ratio of labor cost give negative effect to all kind of performance. That means that the higher labor cost don't mean the higher publicity and labor cost control is very important factors to hospital performance. So the region hospital have to focus the labor factors more to make higher performance. CONCLUSION: As the conclusion, the independent variables give similar effect to the efficiency and the profitability, but give inverse effect to the publicity. That means that if an region hospital want to make the more publicity, it loss the higher efficiency and profitability. Specially publicity is higher negative relation with the profitability.
Cost Control ; Hospitals, Public ; Humans ; Inpatients ; Medicaid ; Methods ; Outpatients

PURPOSE: This study was conducted to identify effects of Medicaid Case Manager's communication competence and stress on their job satisfaction. METHODS: The current work is descriptive research, and the participants were 154 medicaid case managers. Data were collected between May and July, 2017 through Embrain, a specialized research organization. The data were analyzed using independent t-test, ANOVA, and multiple regression. RESULTS: The mean communication competence of the medicaid case managers was 3.61, stress 1.76, and their job satisfaction 2.74. Age and average monthly compensation brought significant differences in their job satisfaction. Their communication competence was correlated with stress (r=−.35, p<.001), but not with their job satisfaction. The stress was the most influential factor in job satisfaction (β=−.45). CONCLUSION: The results of this work show that the medicaid case managers' communication competence was not an influence factor of their job satisfaction, which is different from implications from the previous studies and needs confirmation through future research. In addition the results of this study also suggest that stress management can be a useful approach to the improvement of medicaid case managers' job satisfaction.
Compensation and Redress ; Job Satisfaction ; Medicaid ; Mental Competency ; Stress, Psychological

OBJECTIVES: The aim of the study was to analyze the factors that are related to the illegal dental treatment experience (IDTX), among the Korean adults. METHODS: The raw data for the analysis of IDTX, among the Korean adults, which were aged 17 years and over, were obtained from the dataset of the Korean National Oral Health Survey (KNOHS), which was conducted in 2006. Stratified weighted total 11,808 samples were selected by region and clustered sampling methods. The data of weighted total 11,808 samples were analyzed, using a chi-square test and a logistic regression analysis, by demographic socioeconomic variables of age, gender, area, educational level, occupation, national health insurance, and monthly income. RESULTS: IDTX rate was under 10%, among the adults aged 35~44 years or below the age group. However, it increased to 18.9%, among the adults aged 45~54 years and overtook over 30% among the adults 55 years and over. The age group of high IDTX rate was coincided to the age group of high number of lost teeth. Most of IDTX were presumed to prosthetic treatments. In IDTX rate of samples, aged 45 years and over, odds ratio of females' was 1.3, compared to that of the males'; odds ratio of metropolitan area, 1.2 compared to rural area. IDTX rate was higher among the middle school or below educational level group compared to that of college or over educational level group. IDTX rate of medicaid or not joined to national health insurance group was 31.3%, higher than that of national health insurance group. IDTX rates of low monthly income group, less than 4 million KRW were higher than monthly income group of 4 million KRW or more. CONCLUSIONS: To supply the prosthetic treatments for the population of medicaid and national health insurance is needed to remove illegal dental treatments in Korea.
Adult ; Aged ; Humans ; Korea ; Logistic Models ; Medicaid ; National Health Programs ; Occupations ; Odds Ratio ; Oral Health ; Tooth

PURPOSE: Medical Aid Beneficiaries were surveyed to identify differences in health behaviors, adherence to drug regimen, and quality of life between those people in the Designated Doctor System and those who are not. METHODS: A total of 1,327 study subjects were separated into three groups: those in the Designated Doctor System for 2 years, those in for 1 year, and those not in the system. RESULTS: After the introduction of the Designated Doctor System, 55.8% and 67.9%, respectively, of the subjects in the Designated Doctor System complained of inconvenience in relation to hospital use and the patient referral process. Also, the rate of emergency room use or hospitalization guided by the Designated Doctor System was only 8.7% and 6.5%, respectively. There were no significant differences in health behaviors and adherence to drug regimens between those in the Designated Doctor System and those who are not. CONCLUSION: This study was carried out early in the introduction of the system. Therefore, it is necessary to monitor the positive and negative effects of the Designated Doctor System for a full reflection of its impact.
Emergencies ; Health Behavior ; Hospitalization ; Humans ; Medicaid ; Medical Staff, Hospital ; Organothiophosphorus Compounds ; Quality of Life ; Referral and Consultation

Since Dongboo City Hospital cares patients with medicaid and poor socio-economic status in large percentage, we analized all the newborns delivered at the hospital from 1984 to 1992 by their birth weights, gender, gestational age and their Medical Care System. We found our babies?mean birth weight was lower than National standard mean birth weight of 1975 and 1985 (published by KPA) and also lower than other reported studies. But the fact than mean birth weight has been increasing since 1990 is encouraging.
Birth Weight* ; Gestational Age ; Hospitals, Urban* ; Humans ; Infant, Newborn ; Medicaid ; Parturition*

PURPOSE: This study examined the effects of case management (CM) for Medicaid on healthcare utilization considering the Medicaid system. METHODS: Data were extracted from survey data on "Healthcare utilization and health status of Medicaid beneficiaries" conducted in 2007 and 2008 by the Ministry for Health, Welfare and Family Affairs. This study was designed to compare the effects on healthcare utilization between the CM group and the non-CM group. The subjects were 535 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006. RESULTS: The outpatient days and medication days of the CM group decreased significantly more than those of the non-CM group with the copayment system. There were no significant differences of healthcare utilization between the CM group and the non-CM group with the designated doctor system. CONCLUSION: CM worked effectively on Medicaid beneficiaries' outpatient healthcare utilization with the copayment system. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, future studies are needed to develop strategies to reduce hospitalization and Medicaid beneficiaries' outpatient healthcare utilization with the designated doctor system.
Case Management* ; Cost Sharing ; Delivery of Health Care* ; Hospitalization ; Humans ; Medicaid* ; Outpatients

The main objective of this study to propose an implementation about telemedicine policy in Korea through analyzing current status of state telemedicine policy in the United States. To achieve the result, three types of data sets were used to draw conclusions; 1) status of insured service of telemedicine in each state, 2) physician practice standards related to telemedicine, and 3) licensure. Analyzed results indicated differentiation in insured status of telemedicine service among private insurance parity law, medicaid coverage parity law, and state employee health plan parity in each states. Only two states provide insured service of telemedicine without any limits or certain conditions. Other states have a strict regulation or coverage condition about providing insurance. Each states also apply rigorous standards to telemedicine providers about physician practice standards and licensure. Some states restrict telemedicine itself or provide strict regulation process of telemedicine in Physician-patient encounter. Also, the most strict type 'full state license' and 'consulting exemptions (applied in certain condition)' are applied in most of states. On the basis of study result, environmental and conditional requirement implementation in application of telemedicine policy in Korea is provided in conclusion.
Dataset ; Female ; Insurance ; Jurisprudence ; Korea* ; Licensure ; Medicaid ; Occupational Health ; Parity ; Telemedicine* ; United States*