Korea’s medical service delivery system has not been working well. As a result, many patients use outpatients’ medical services in general hospitals. The objective of this study was 1) to compare between outpatients’ medical services use in clinics and those in general hospitals among hypertension or diabetes patients and 2) to examine the status of disease treatment and management for hypertension or diabetes patients. In addition, we examined the policies on chronic disease management and surveyed the knowledge and attitudes of patients for these polices.

Nearly 80% of hypertension patients and about 70% of diabetics used ambulatory care at clinics. The Korean government applied in October 2011 a differential co-payment system for prescription drugs that distinguishes between general hospitals and clinics. We analyzed National Health Insurance claims data and found that the proportion of patients with hypertension or diabetes who used ambulatory care at clinics increased after
the implementation of the differential co-payment system.

Among patients with hypertension, the likelihood of shifting from a general hospital to a clinic was higher for women of younger ages with low-severity. Patients with hypertension or diabetes who visited clinics instead of general hospitals visited doctors more frequently, but they paid less OOP(Out-of-Pocket) medical expenditures.

We surveyed 501 patients with hypertension or diabetes using face-to-face interview and conducted Focus Group Interview (FGI) for 24 patients. Patients used medical services at general hospitals because they thought that doctors were well trained and general hospitals had a good equipment. In contrast, patients who used medical services at clinics answered that they did because clinics were located near their
homes. Only 60% of patients knew the graded out-of-pocket (OOP) expenditures of prescription drug between of general hospital and of clinic and 23.5% knew the support for chronic disease management in clinics by government.

The results of our study suggest that the use of medical service in clinics increase by the improvement of disease management in clinics as well as by lower OOP expenditures burden of patients.