Skip Navigation
Skip to contents

J Korean Acad Nurs : Journal of Korean Academy of Nursing

Search
Advanced Search
OPEN ACCESS
mobile search button mobile menu button

Articles

Page Path
HOME > J Korean Acad Nurs > Volume 42(7); 2012 > Article
Original Article
Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea
Yang Heui Ahn1, Ok Kyung Ham2, Soo Hyun Kim2, Chang Gi Park3
Journal of Korean Academy of Nursing 2012;42(7):928-935.
DOI: https://doi.org/10.4040/jkan.2012.42.7.928
Published online: December 12, 2012

1Department of Nursing, Yonsei University Wonju College of Medicine, Wonju, Korea

2Department of Nursing, Inha University, Incheon, Korea

3Office of Global Health Leadership, University of Illinois at Chicago, Illinois, USA

1Department of Nursing, Yonsei University Wonju College of Medicine, Wonju, Korea

2Department of Nursing, Inha University, Incheon, Korea

3Office of Global Health Leadership, University of Illinois at Chicago, Illinois, USA

Address reprint requests to : Ham, Ok Kyung Department of Nursing, Inha University, Inha-ro 100, Nam-gu, Incheon 402-751, Korea Tel: +82-32-860-8211 Fax: +82-32-874-5880 Email: okkyung@inha.ac.kr, okkyung7@hanmail.net
• Received: May 31, 2012   • Revised: June 18, 2012   • Accepted: November 13, 2012

Copyright © 2012 Korean Society of Nursing Science

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.

  • 11 Views
  • 0 Download
  • 6 Scopus
prev next
Full Article

Download PDF Download PDF

  • Purpose
    The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling.
  • Methods
    Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis.
  • Results
    Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization.
  • Conclusion
    The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/ or promotion of community awareness.
  • Keywords: Multilevel analysis; Medical assistance; Health services; Case management
Figure 1.
Theoretical framework of the study based on ecological model.
jkan-42-928f1.jpg
Table 1.
General Characteristics of Medical Aid Beneficiaries (N=15,948)
Individual variable Distribution n (%) M±SD Range
Age (year) 66.93±12.51 11-100
Gender Male 5,667 (35.5)
Female 10,281 (64.5)
Marital status Married/cohabitating 4,460 (28.0)
Single 977 (6.1)
Widowed/divorced/separated 6,171 (38.7)
No response 4,340 (27.2)
Education (n=19,946) None 5,660 (35.5)
≤9 years 6,171 (38.7)
≥10 years 2,243 (14.1)
No response 1,874 (11.7)
Disability Yes 6,702 (42.0)
No 9,246 (58.0)
Beneficiary type Type 1 11,255 (70.6)
Type 2 1,737 (10.9)
Person of national merit 1,358 (8.5)
Othera 1,598 (10.0)
Health care service utilization (days/6 months) 1,235.99±585.99 1–15,872

aIncluded refugees, servicemen, victims of natural disasters etc.

Table 2.
Attributes of Group Level Characteristics according to the 229 Regions (N=15,948)
Group variables Range M±SD
SDI −1.42-1.69 −0.10±0.83
Population 18,221-1,073,149 292,585.34±212,291.33
Number of beneficiaries 468-27,773 10,214.73±6,034.24
Number of case managers 1-10 3.40±2.78

SDI=Social deprivation index.

Table 3.
Multilevel Analysis of Health Care Service Utilization according to the 229 Regions (N=15,948)
Fixed effect Null model
 Model 1
 Model 2
Estimates p Estimates p Estimates p
Individual level
 Intercept 1,209.39 <.001 1,325.70 <.001 1,254.37 <.001
 Age 0.77 .121 0.61 .258
 Gender −1.73 .890 −11.42 .395
 Education −27.06 .099 −19.12 .287
 Marital status 19.21 .114 15.62 .232
 Disability −28.67 .014 −35.98 .005
 Beneficiary type −111.49 <.001 −97.17 <.001
Group level
 SDI −73.17 .044
 Population 0.00 .678
 Number of beneficiaries 0.02 .005
 Number of case managers −47.02 .007
Random effect Variance component p Variance component p Variance component p
Residual 313,859.17 <.001 320,318.59 <.001 285,288.65 <.001
Intercept (variance) 69,267.68 <.001 74,194.58 <.001 62,038.82 <.001
Deviance 247,649.77 165,740.62 124,927.58
χ2 81,909.15 <.001 40,813.04 <.001

SDI=Social deprivation index. Variables: Gender 1=male, 2=female; education 1=less than or equal to 9 years, 2=more than 9 years; marriage1=without spouse (single, divorces, widowed, or separated), 2=with spouse; disability 0=not disabled, 1=disabled; beneficiary type 1=type 1, 2=other (type 2, those for persons of national merit, refugees, servicemen, and victims of natural disasters).

  • Cho S.H. 2003;Using multilevel analysis in patient and organizational outcomes research. Nursing Research. 52(1):61–65.ArticlePubMed
  • Eun S. J., Hong J. Y., Lee J. Y., Lee J. S., Kim Y., Kim Y. I., et al. 2006;Differences in medical care utilization rates of the disabled and the non- disabled with ambulatory care sensitive conditions. Journal of Preventive Medicine and Public Health. 39(5):411–418.PubMed
  • Ahn Y. H., Kim E. S., Ham O. K., Kim S. H., Hwang S. S., Chun S. H., et al. 2011;Factors associated with the overuse or underuse of health care services among medical aid beneficiaries in Korea. Journal of Community Health Nursing. 28:190–203. http://dx.doi.org/10.1080/07370016.2011.614837ArticlePubMed
  • Bae S. S., Jo H. S., Kim D. H., Choi Y. J., Lee H.J., Lee T. J., et al. 2008;Factors associated with gastric cancer screening of Koreans: Based on a socio-ecological model. Journal of Preventive Medicine & Public Health. 41(2):100–106.Article
  • Berben L., Dobbels F., Engberg S., Hill M. N., de Geest, S. 2012;An ecological perspective on medication adherence. Western Journal of Nursing Research. 34(5):635–653. http://dx.doi.org/10.1177/0193945911434518ArticlePubMedPDF
  • Chang, Y. 2012.Determinants of gastric cancer screening attendance in Korea: A multi-level analysis. Unpublished master’s thesis. Seoul National University; Seoul.
  • Cho S.H. 2003;Using multilevel analysis in patient and organizational outcomes research. Nursing Research. 52(1):61–65.ArticlePubMed
  • Eun S. J., Hong J. Y., Lee J. Y., Lee J. S., Kim Y., Kim Y. I., et al. 2006;Differences in medical care utilization rates of the disabled and the non- disabled with ambulatory care sensitive conditions. Journal of Preventive Medicine and Public Health. 39(5):411–418.PubMed
  • Hanlon P., Walsh D., Whyte B. W., Scott S. N., Lightbody P., Gilhooly M. L.M. 1998;Hospital use by an ageing cohort: An investigation into the association between biological, behavioural, and social risk markers and subsequent hospital utilization. Journal of Public Health Medicine. 20(4):467–476.ArticlePubMed
  • Kim E. Y., Nam E. S., Chae Y. R., Lee H.K. 2008;Factors affecting the elderly’s preference for utilization of long-term care services based on Andersen’s Behavioral Model. Journal of the Korean Gerontological Society. 28(3):585–602.
  • Kim S.A. 2012.The effect of case management intervention by medical aid case manager: Centered on medical aid recipients with chronic disease. Unpublished master’s thesis. Hanyang University; Seoul.
  • Korea Ministry of Health & Welfare. 2010.2010 medical aid program guide. Seoul: Author.
  • Lake E.T. 2006;Multilevel models in health outcomes research part II: Statistical and analytic issues. Applied Nursing Research. 19(2):113–115. http://dx.doi.org/10.1016/j.apnr.2006.01.001ArticlePubMed
  • Lee H. J., Oh J. J., Choi J.M. 2010;Comparison of case management between tele care regions and general care regions in Korean Medicaid. Journal of Korean Academy of Nursing Administration. 16(4):381–388.Article
  • Lee S.H. 2009;Multi-level analysis of factors related to quality of service in long-term care hospitals. Journal of Korean Academy of Nursing. 39(3):409–421. http://dx.doi.org/10.4040/jkan.2009.39.3.409PubMed
  • Lim S.J. 2010;Change in healthcare utilization by disease severity after case management for Medicaid. Journal of Korean Academy of Community Health Nursing. 21(3):321–332.Article
  • Medlensky L., Esplen M. J., Gallinger S., McLaughlin J. R., Goel, V. 2003;Relatives of colorectal cancer patients: Factors associated with screening behavior. American Journal of Preventive Medicine. 25(3):187–194. http://dx.doi.org/10.1016/S0749-3797(03)00202-2ArticlePubMed
  • Park J. H., Lee J. S., Lee J. Y., Hong J. Y., Kim S. Y., Kim S. O., et al. 2006;Factors affecting national health insurance mass screening participation in the disabled. Journal of Preventive Medicine and Public Health. 39(6):511–519.PubMed
  • Park S., Lake E.T. 2005;Multilevel modeling of a clustered continuous outcome. Nursing Research. 54(6):406–413. http://dx.doi.org/10.1097/00006199-200511000-00007ArticlePubMedPMC
  • Sallis J. F., Owen N., Fisher E.B. 2008.Ecological models of health behavior. In: Glanz K., Rimer B.K., Viswanath K., editors. Health behavior and health education: theory, research, and practice. 4th ed.San Fransisco: Jossey-Bass.
  • Shin S. M., Kim E. S., Park C. K., Lee H.W. 2010a;The medical use of the disabled among overusers of medical aid in Korea. Journal of Preventive Medicine and Public Health. 43(1):35–41. http://dx.doi.org/10.3961/jpmph.2010.43.1.35ArticlePubMed
  • Shin S. M., Kim M. J., Kim E. S., Lee H. W., Park C. G., Kim H.K. 2010b;Medical aid service overuse assessed by case managers in Korea. Journal of Advanced Nursing. 66(10):2257–2265. http://dx.doi.org/10.1111/j.1365-2648.2010.05364.xArticlePubMed
  • Shin Y. J., Yoon T. H., Kim M. H., Cho H. J., Kim M. K., Yoo W. S., et al. 2009.Health promotion strategies and programs development for health inequalities alleviation. Seoul: Industry-University Cooperation Foundation Hanyang University·Korea Health Promotion Foundation.
  • Song M.K. 2011.Factors related to competencies of medical aid case managers. Unpublished master’s thesis. Hanyang University; Seoul.
  • Statistics Korea. 2009;Database. Retrieved December 15, 2011, from. http://kostat.go.kr/portal/korea/index.action
  • World Health Organization. 2002;World report on violence and health. Retrieved May 16, 2012, from. http://www.emro.who.int/violence-injuries-disabilities/health-topics/

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  

      • Cite
        CITE
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea
        J Korean Acad Nurs. 2012;42(7):928-935.   Published online December 12, 2012
        DOI: https://doi.org/10.4040/jkan.2012.42.7.928
        Close
      • XML DownloadXML Download
      Figure
      • 0
      We recommend
      Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea
      Image
      Figure 1. Theoretical framework of the study based on ecological model.

      Figure 1.

      Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea
      Individual variable Distribution n (%) M±SD Range
      Age (year) 66.93±12.51 11-100
      Gender Male 5,667 (35.5)
      Female 10,281 (64.5)
      Marital status Married/cohabitating 4,460 (28.0)
      Single 977 (6.1)
      Widowed/divorced/separated 6,171 (38.7)
      No response 4,340 (27.2)
      Education (n=19,946) None 5,660 (35.5)
      ≤9 years 6,171 (38.7)
      ≥10 years 2,243 (14.1)
      No response 1,874 (11.7)
      Disability Yes 6,702 (42.0)
      No 9,246 (58.0)
      Beneficiary type Type 1 11,255 (70.6)
      Type 2 1,737 (10.9)
      Person of national merit 1,358 (8.5)
      Othera 1,598 (10.0)
      Health care service utilization (days/6 months) 1,235.99±585.99 1–15,872
      Group variables Range M±SD
      SDI −1.42-1.69 −0.10±0.83
      Population 18,221-1,073,149 292,585.34±212,291.33
      Number of beneficiaries 468-27,773 10,214.73±6,034.24
      Number of case managers 1-10 3.40±2.78
      Fixed effect Null model
      		 Model 1
      		 Model 2
      Estimates p Estimates p Estimates p
      Individual level
       Intercept 1,209.39 <.001 1,325.70 <.001 1,254.37 <.001
       Age 0.77 .121 0.61 .258
       Gender −1.73 .890 −11.42 .395
       Education −27.06 .099 −19.12 .287
       Marital status 19.21 .114 15.62 .232
       Disability −28.67 .014 −35.98 .005
       Beneficiary type −111.49 <.001 −97.17 <.001
      Group level
       SDI −73.17 .044
       Population 0.00 .678
       Number of beneficiaries 0.02 .005
       Number of case managers −47.02 .007
      Random effect Variance component p Variance component p Variance component p
      Residual 313,859.17 <.001 320,318.59 <.001 285,288.65 <.001
      Intercept (variance) 69,267.68 <.001 74,194.58 <.001 62,038.82 <.001
      Deviance 247,649.77 165,740.62 124,927.58
      χ2 81,909.15 <.001 40,813.04 <.001
      Table 1. General Characteristics of Medical Aid Beneficiaries (N=15,948)

      Included refugees, servicemen, victims of natural disasters etc.

      Table 2. Attributes of Group Level Characteristics according to the 229 Regions (N=15,948)

      SDI=Social deprivation index.

      Table 3. Multilevel Analysis of Health Care Service Utilization according to the 229 Regions (N=15,948)

      SDI=Social deprivation index. Variables: Gender 1=male, 2=female; education 1=less than or equal to 9 years, 2=more than 9 years; marriage1=without spouse (single, divorces, widowed, or separated), 2=with spouse; disability 0=not disabled, 1=disabled; beneficiary type 1=type 1, 2=other (type 2, those for persons of national merit, refugees, servicemen, and victims of natural disasters).

      Table 1.

      Table 2.

      Table 3.

      J Korean Acad Nurs : Journal of Korean Academy of Nursing
      © Korean Society of Nursing Science.
      Close layer
      TOP