Change in Healthcare Utilization by Disease Severity after Case Management for Medicaid

Abstract

Purpose:Thisstudy examinedchangeinhealthcareutilization bydisease severityafter casemanagement (CM) for Medicaid. Methods: Data were extracted from survey data on Healthcare utilization and health status of Medicaid conducted in 2007 and 2008 by theMinistry for Health, Welfare and Family Affairs. This study was designed to compare change in healthcare utilization between the CM group and the non-CM group. The subjects were 528 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006. Results:Inbeneficiarieshavingfewerthan3amongthe11notifieddiseases, theCMgroup showedasignificantly larger decrease inoutpatient day,outpatient expense, medicationday,andmedication expense than thenon-CM group. In beneficiaries having 3 or more among the 11 notified diseases, however, there was no significant difference in healthcare utilization between the CM group and the non-CM group. Conclusion: CM worked effectively on Medicaid beneficiaries outpatient healthcare utilization for mild diseases. However, its effects on hospitalization,whichisa major cause increasing thetotal expense, were not observed. Therefore, afuturestudy is needed to develope strategies to reduce hospitalization and care for Medicaid beneficiaries with severe diseases.