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Kim, Cho, and Park: The Effects of the Designated Doctor System on Health Care Utilization of Medical Aid Beneficiaries with Chronic Diseases
Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(3): 278-291.

Published online: 30 September 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.3.278

The Effects of the Designated Doctor System on Health Care Utilization of Medical Aid Beneficiaries with Chronic Diseases

Min Jung Kim1, Young-Ha Cho2, Nam Hee Park3

1Graduate School, Department of Nursing, Inje University, Busan, Korea.

2Graduate School of Public Health, Inje University, Busan, Korea.

3Department of Nursing, Inje University, Busan, Korea.

Corresponding author: Park, Nam Hee. Department of Nursing, Inje University, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. Tel: +82-51-890-6832, Fax: +82-51-891-6832, parknh@inje.ac.kr

Received 25 June 2015       Revised 14 September 2015       Accepted 23 September 2015

© 2015 Korean Academy of Community Health Nursing

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences.

Methods

Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program.

Results

There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution.

Conclusion

These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

Keywords: Hospital attending physician, Chronic disease, Medicaid, Health care utilization

Figures and Tables

Table 1

General Characteristics of Beneficiaries with Designated Doctor System (N=200)

jkachn-26-278-i001
Characteristics Categories n (%)
Gender Male 70 (35.0)
Female 130 (65.0)
Age (year) <65 67 (33.5)
≥65 133 (66.5)
Medical type 1 189 (94.5)
2 11 (5.5)
Disability No 126 (63.0)
Physical disability 42 (21.0)
Brain lesions 13 (6.5)
Etc 19 (9.5)
Main disease SRID 8 (4.0)
CND 81 (40.5)
Other diseases 111 (55.5)
Number of Chronic disease 1 101 (50.5)
2 49 (24.5)
3 35 (17.5)
≥4 15 (7.5)
Optional designation number of hospitals and clinics 1 162 (81.0)
2 30 (15.0)
≥3 8 (4.0)
Selective sorting Obvious applier 197 (98.5)
Voluntary participants 3 (1.5)

SRID=severe/rare incurable diseases; CND=chronic notified diseases.

Table 2

Characteristics of Designated Doctor System (N=200)

jkachn-26-278-i002
Characteristics Categories n (%)
Type of medical institutions Health institution 4 (2.0)
Clinic 102 (51.0)
Hospital 41 (20.5)
General hospital 41 (20.5)
Senior general hospital 12 (6.0)
Medical department Internal medicine 87 (43.5)
Orthopedic 45 (22.5)
Neurology 24 (12.0)
Others 44 (22.0)
Region Big city 11 (5.5)
Middle city 157 (78.5)
Rural 32 (16.0)
Table 3

A Change in Trend of Health Care Utilisation before and after the Introduction of Designated Doctor System based on the Characteristics of Individual Patient

jkachn-26-278-i003
Variables Characteristics Categories Before† (n=200) After‡ (n=200) Difference t (p)
M±SD M±SD M±SD
Total benefit day (day/year) Gender Male 1,049.0±461.93 1,047.4±425.04 1.6±414.03 0.03 (.974)
Female 938.1±340.19 969.0±425.47 -30.9±458.64 -0.77 (.443)
Age (year) <65 984.5±401.43 1,039.1±437.22 -54.6±412.17 -1.09 (.282)
≥65 973.1±385.04 974.9±420.10 -1.8±457.88 -0.05 (.963)
Medical type 1 983.8±397.80 1,010.1±430.44 -26.2±450.95 -0.80 (.425)
2 857.6±172.12 761.9±249.77 95.7±250.08 1.27 (.233)
Disability No 957.8±393.30 1,012.3±427.65 -54.4±379.64 -1.61 (.110)
Physical disablity 1,019.5±337.45 966.0±456.30 53.5±504.09 0.69 (.495)
Brain lesions 1,051.0±406.57 770.4±304.19 280.5±358.64 2.82 (.015)
Etc 958.8±472.80 1,113.4±379.62 -154.5±629.73 -1.07 (.299)
Main disease SRID 911.1±291.34 708.5±221.26 202.6±280.62 2.04 (.080)
CND 1,031.8±432.73 1,088.6±475.00 -56.7±532.33 -0.96 (.340)
Other diseases 941.6±359.53 949.9±382.72 -8.3±372.57 -0.24 (.814)
Outpatient day (day/year) Gender Male 109.0±109.45 111.0±121.27 -2.0±53.83 -0.31 (.757)
Female 106.0±79.56 100.5±87.30 5.5±76.14 0.83 (.407)
Age (year) <65 104.6±92.24 110.0±107.10 -5.4±68.06 -0.66 (.515)
≥65 108.3±90.50 101.2±97.01 7.1±69.50 1.18 (.240)
Medical type 1 109.0±92.47 106.6±102.36 2.4±70.22 0.47 (.638)
2 73.2±47.51 61.7±34.41 11.5±47.44 0.81 (.438)
Disability No 103.3±89.66 106.7±105.59 -3.3±61.64 -0.61 (.541)
Physical disability 116.0±86.37 99.5±70.86 16.5±82.30 1.30 (.201)
Brain lesions 92.6±78.80 63.6±55.24 29.0±57.37 1.83 (.093)
Etc 121.7±116.94 125.2±136.42 -3.4±86.83 -0.17 (.866)
Main disease SRID 84.3±100.95 24.5±19.19 59.8±106.90 1.58 (.157)
CND 92.8±73.71 97.2±89.67 -4.3±70.01 -0.56 (.577)
Other diseases 119.1±100.04 115.0±108.26 4.1±63.80 0.68 (.499)
Medication day (day/year) Gender Male 902.4±419.44 891.6±376.04 10.8±386.28 0.24 (.815)
Female 815.4±301.43 842.6±389.31 -27.1±422.48 -0.73 (.465)
Age (year) <65 842.2±368.47 882.7±397.03 -40.5±45.68 -0.89 (-.378)
≥65 847.7±339.80 848.2±378.99 -0.4±427.15 -0.01 (.991)
Medical type 1 850.4±356.57 869.8±389.31 -19.4±417.60 -0.64 (.524)
2 768.9±152.11 687.5±240.28 81.3±222.48 1.21 (.253)
Disability No 835.1±339.03 872.2±373.38 -37.1±351.72 -1.18 (.239)
Physical disability 880.5±328.26 860.4±425.47 20.0±471.40 0.28 (.784)
Brain lesions 895.5±391.82 595.8±363.74 299.6±356.12 3.03 (.010)
Etc 807.1±437.78 956.4±322.98 -149.3±555.10 -1.17 (.256)
Main disease SRID 784.8±327.22 552.2±319.77 232.6±331.14 1.99 (.087)
CND 897.8±394.47 945.6±440.94 -47.8±484.34 -0.89 (.377)
Other diseases 812.4±310.91 819.2±324.89 -6.8±347.28 -0.21 (.836)
Inpatient day (day/year) Gender Male 37.5±93.71 44.7±96.27 -7.2±43.22 -1.39 (.168)
Female 16.4±39.90 32.8±85.30 -16.3±76.42 -2.44 (.016)
Age (year) <65 36.3±87.61 46.3±100.55 -10.0±64.74 -1.27 (.209)
≥65 17.5±48.40 32.3±82.96 -14.7±67.89 -2.50 (.014)
Medical type 1 24.3±65.86 38.4±91.37 -14.0±68.45 -2.83 (.005)
2 15.4±38.77 12.6±28.02 2.8±15.05 0.62 (.549)
Disability No 17.1±56.64 33.1±83.90 -16.0±71.48 -2.52 (.013)
Physical disability 29.6±60.54 27.8±63.18 1.8±51.66 0.23 (.819)
Brain lesions 62.7±103.36 111.0±167.61 -48.2±89.84 -1.94 (.077)
Etc 28.9±83.20 32.1±83.95 -3.2±26.54 -0.53 (.605)
Main disease SRID 81.0±131.55 131.7±178.60 -50.7±97.18 -1.47 (.183)
CND 37.3±86.75 57.8±115.55 -20.4±89.88 -2.05 (.043)
Other diseases 9.8±20.36 14.9±34.66 -5.1±37.03 -1.45 (.149)
The number of utilizing hospital (a place/year) Gender Male 17.5±11.18 16.3±12.26 1.1±10.17 0.96 (.339)
Female 17.6±10.41 15.0±9.80 2.6±9.95 3.00 (.003)
Age (year) <65 18.2±11.97 16.8±11.74 1.4±10.39 1.11 (.273)
≥65 17.2±9.95 14.8±10.13 2.4±9.86 2.88 (.005)
Medical type 1 17.7±10.76 15.6±10.92 2.0±10.15 2.79 (.006)
2 15.1±8.54 12.1±5.07 3.0±7.89 1.26 (.236)
Disability No 17.4±10.23 15.7±10.37 1.6±9.93 1.89 (.061)
Physical disability 18.5±9.34 14.9±7.86 3.5±8.65 2.64 (.012)
Brain lesions 18.0±15.37 11.5±9.85 6.4±10.02 2.33 (.038)
Etc 16.7±12.98 17.8±17.24 -1.1±12.58 -0.38 (.706)
Main disease SRID 9.8±5.74 8.8±7.79 1.0±2.72 1.04 (.334)
CND 17.4±10.22 16.4±10.89 1.0±10.65 0.90 (.373)
Other diseases 18.2±11.06 15.3±10.66 2.9±9.86 3.16 (.002)
Medical expense (1,000 won) Gender Male 7,534±6,909 8,831±7,237 -1,297±5,118 -2.12 (.038)
Female 5,994±4,518 7,215±6,599 -1,220±6,392 -2.18 (.031)
Age (year) <65 6,972±6,045 8,070±6,891 -1,097±5,497 -1.64 (.107)
≥65 6,312±5,225 7,635±6,858 -1,323±6,205 -2.46 (.015)
Medical type 1 6,633±5,610 7,998±6,964 -1,364±6,097 -3.08 (.002)
2 4,816±2,902 4,056±2,651 760±2,053 1.23 (.247)
Disability No 5,602±4,682 7,199±6,421 -1,596±5,752 -3.12 (.002)
Physical disability 7,448±4,888 7,522±5,635 -74±6,620 -0.07 (.943)
Brain lesions 1,140±8,077 1,317±1,196 -177±6,960 -0.92 (.378)
Etc 7,350±7,699 8,523±6,421 -1,173±5,207 -0.98 (.339)
Main disease SRID 9,673±8,746 12,433±1,324 -2,810±8,675 -0.92 (.390)
CND 8,155±6,956 9,523±7,652 -1,368±7,124 -1.73 (.088)
Other diseases 5,123±3,184 6,170±4,980 -1,047±4,735 -2.33 (.022)

SRID=severe/rare incurable diseases; CND=Chronic notified diseases; †One year before the introdution of designated doctor system; ‡One year after the introdution of designated doctor system.

Table 4

A Change in Trend of Health Care Utilisation before and after the Introduction of Designated Doctor System based on the Characteristics of Health Care Facilities

jkachn-26-278-i004
Variables Characteristics Categories Before† (n=200) After‡ (n=200) Difference t (p)
M±SD M±SD M±SD
Total benefit day (day/year) Type of medical institutions Health institution 726.2±426.16 724.2±69.86 2.0±420.92 0.01 (.993)
Clinic 972.2±373.14 1,005.2±394.31 -33.7±400.26 -0.84 (.406)
Hospital 911.6±370.67 913.2±373.20 -1.5±505.30 -0.02 (.984)
General hospital 1,032.6±451.44 1,077.9±554.52 -45.3±500.14 -0.58 (.565)
Senior general hospital 1,133.5±317.13 1,018.2±386.18 115.2±404.60 0.99 (.345)
Medical department Internal medicine 946.2±363.07 953.6±412.63 -7.3±445.99 -0.15 (.878)
Orthopedic 930.4±341.32 993.9±367.31 -63.4±435.07 -0.98 (.333)
Neurology 1,171.6±498.72 1,127.4±634.92 44.2±545.01 0.40 (.695)
Others 978.9±401.72 1,012.3±362.89 -33.3±389.94 -0.57 (.573)
Region Big city 1,338.9±582.63 1,219.9±568.38 119.0±526.29 0.75 (.471)
Middle city 939.1±364.03 967.0±413.82 -27.9±434.11 -0.81 (.421)
Rural 1,037.9±375.00 1,063.8±414.30 -25.9±462.10 -0.32 (.753)
Outpatient day (day/year) Type of medical institutions Health institution 80.0±73.38 84.2±27.48 -4.2±68.88 -0.12 (.910)
Clinic 125.8±108.06 128.4±116.40 -2.5±71.27 -0.36 (.717)
Hospital 93.6±71.56 72.3±56.37 21.2±71.71 1.90 (.065)
General hospital 81.8±57.28 89.5±92.72 -7.7±67.39 -0.74 (.467)
Senior general hospital 89.2±56.87 63.7±51.96 25.5±26.84 3.29 (.007)
Medical department Internal medicine 95.2±74.37 84.9±73.04 10.2±67.10 1.43 (.157)
Orthopedic 132.5±106.97 141.2±116.78 -8.7±80.33 -0.73 (.471)
Neurology 107.0±77.31 109.4±112.88 -2.4±74.86 -0.16 (.876)
Others 104.6±106.23 101.4±113.71 3.1±56.82 0.37 (.714)
Region Big city 82.0±73.67 80.9±62.22 1.0±40.73 0.09 (.931)
Middle city 101.3±84.13 94.7±93.61 6.5±71.02 1.16 (.248)
Rural 144.2±117.58 158.6±124.69 -14.4±66.04 -1.24 (.226)
Medication day (day/year) Type of medical institutions Health institution 631.7±393.68 591.5±93.02 40.2±383.83 0.21 (.847)
Clinic 830.8±312.07 862.2±325.26 -31.4±347.14 -0.91 (.363)
Hospital 770.5±343.35 758.8±387.24 11.7±500.55 0.15 (.881)
General hospital 930.4±421.09 970.3±488.63 -39.9±456.55 -0.56 (.578)
Senior general hospital 1,014.5±304.65 895.5±419.26 119.0±437.31 0.94 (.366)
Medical department Internal medicine 831.8±325.92 845.7±367.95 -13.8±408.38 -0.32 (.752)
Orthopedic 779.0±295.22 825.9±312.32 -46.8±387.31 -0.81 (.421)
Neurology 1,027.4±477.28 936.8±642.33 90.5±542.71 0.82 (.422)
Others 843.0±340.47 880.0±295.81 -37.0±352.20 -0.70 (.489)
Region Big city 1,195.5±545.47 1,070.5±553.07 125.0±507.43 0.82 (.433)
Middle city 813.5±323.17 833.8±378.08 -20.2±402.90 -0.63 (.529)
Rural 884.5±330.12 914.6±329.61 -30.0±411.93 -0.41 (.683)
Inpatient day (day/year) Type of medical institutions Health institution 14.5±28.33 48.5±74.40 -34.0±82.51 -0.82 (.470)
Clinic 12.5±39.44 24.3±67.72 -11.7±61.81 -1.92 (.058)
Hospital 54.6±111.65 80.1±136.58 -25.4±92.78 -1.76 (.086)
General hospital 20.3±38.28 18.0±37.95 2.3±31.45 0.48 (.633)
Senior general hospital 29.7±74.84 59.0±130.50 -29.2±82.37 -1.23 (.244)
Medical department Internal medicine 21.1±54.94 33.3±77.20 -12.1±62.12 -1.83 (.071)
Orthopedic 14.7±36.02 26.8±67.25 -12.0±71.31 -1.13 (.264)
Neurology 37.1±80.18 81.1±144.12 -43.9±97.16 -2.22 (.037)
Others 31.2±90.96 30.8±89.03 0.4±43.72 0.07 (.943)
Region Big city 61.3±123.37 68.4±139.52 -7.0±34.42 -0.68 (.510)
Middle city 24.4±64.49 37.9±92.12 -13.4±72.50 -2.33 (.021)
Rural 8.1±14.94 21.8±39.23 -13.6±41.65 -1.86 (.073)
The number of utilizing hospital (a place/year) Type of medical institutions Health institution 12.7±7.67 9.0±4.08 3.7±7.04 1.07 (.365)
Clinic 18.6±11.24 17.0±11.57 1.5±10.57 1.52 (.132)
Hospital 16.4±11.39 14.1±10.85 2.3±10.75 1.39 (.171)
General hospital 16.7±8.81 14.4±9.10 2.2±9.09 1.58 (.122)
Senior general hospital 17.5±9.87 12.7±7.39 4.7±6.83 2.41 (.035)
Medical department Internal medicine 17.4±10.82 15.8±10.70 1.5±9.46 1.58 (.119)
Orthopedic 19.7±11.22 16.3±12.03 3.4±10.78 2.13 (.039)
Neurology 15.8±9.13 12.9±9.53 2.9±8.52 1.68 (.107)
Others 16.7±10.50 15.4±10.03 1.3±11.18 0.80 (.431)
Region Big city 15.1±9.33 16.2±11.05 -1.0±8.27 -0.44 (.971)
Middle city 17.5±10.64 15.0±10.81 2.5±10.37 3.02 (.003)
Rural 18.8±11.24 17.5±10.16 1.2±8.74 0.83 (.414)
Medical expense (1,000 won) Type of medical institutions Health institution 4,217±2,954 7,643±8,973 -3,425±9,016 -0.76 (.503)
Clinic 5,437±3,704 6,897±5,613 -1,460±5,650 -2.61 (.010)
Hospital 7,991±7,741 10,489±8,765 -2,497±6,864 -2.33 (.025)
General hospital 6,841±4,636 6,433±4,267 408±4,676 0.56 (.580)
Senior general hospital 10,590±9,216 10,686±11,944 -95±7,603 -0.04 (.966)
Medical department Internal medicine 5,993±4,441 6,965±5,734 -972±6,182 -1.47 (.146)
Orthopedic 5,695±4,198 7,941±6,440 -2,246±6,028 -2.50 (.016)
Neurology 10,076±7,882 12,815±9,986 -2,739±6,929 -1.94 (.065)
Others 6,526±6,427 6,483±6,218 42±4,603 0.06 (.951)
Region Big city 11,063±9,958 11,625±10,724 -562±3,039 -0.61 (.553)
Middle city 6,328±5,284 7,388±6,673 -1,060±5,971 -2.23 (.028)
Rural 5,981±3,792 8,384±5,832 -2,402±6,650 -2.04 (.050)

†One year before the introdution of designated doctor system; ‡One year after the introdution of designated doctor system.

Table 5

Factors related to Change of Total Beneficial Day and Outpatient Day

jkachn-26-278-i005
Dependent variable Independent variables B SE β t p
Total benefit day Gender (Male=1) 18.01 67.65 .01 0.27 .790
Age 0.37 2.81 .01 0.13 .897
Disability (Existence=1) 102.31 66.09 .11 1.55 .123
Mian disease (Chronic disease=1) -76.12 65.87 -.08 -1.16 .249
Type of medical institutions (Health institution/Clinic=1) -130.06 139.61 -.06 -0.93 .353
Medical department (Internal medicine=1) 38.44 65.56 .04 0.59 .558
Outpatient day Gender (Male=1) -10.01 10.43 -.06 -0.96 .339
Age 0.22 0.43 .03 0.50 .621
Disability (Existence=1) 20.81 10.19 .14 2.04 .043
Mian disease (Chronic disease=1) -17.67 10.16 -.12 -1.74 .084
Type of medical institutions (Health institution/Clinic=1) -9.77 21.53 -.03 -0.45 .651
Medical department (Internal medicine=1) 17.72 10.11 .12 1.75 .081
Total benefit day F=0.77, p=.597, R2=.023, Modified R2=.007
Outpatient day F=1.55, p=.163, R2=.046, Modified R2=.016

Notes

This article is a revision of the first author's master's thesis from Inje University.

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20. Korea Human Resource Development Institute for Health & Welfare. Quarternary period medical aid management experienced job training course. 1st ed. Cheongwon: Korea Human Resource Development Institute for Health & Welfare;2013. p. 129.
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