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Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study.

Bähler C, Huber CA, Brüngger B, Reich O - BMC Health Serv Res (2015)

Bottom Line: Strong positive associations with utilization and costs were also found for nursing dependency.Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient.Strategies for a better coordination of multimorbid patients are urgently needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland. caroline.baehler-baumgartner@helsana.ch.

ABSTRACT

Background: Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors.

Methods: The study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency.

Results: Prevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient.

Conclusions: Multimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed.

No MeSH data available.


Related in: MedlinePlus

The number of consultations per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green boxplots: Total number of consultations; red boxplots: Number of consultations by primary care physicians; blue boxplots: Number of consultations by specialists.
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Fig1: The number of consultations per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green boxplots: Total number of consultations; red boxplots: Number of consultations by primary care physicians; blue boxplots: Number of consultations by specialists.

Mentions: The mean number of consultations per year amounted to 15.7 (median: 10) in the multimorbid-sample compared to 4.4 (median: 2) in the non-multimorbid-sample (Table 3). In women, the corresponding figures were slightly higher than in men (16.0 and 4.6 versus 15.3 and 4.1; results not shown). Moreover, we found an increase of 3.2 consultations per each additional chronic condition. The increase in the number (and distribution) of consultations per each additional chronic condition is illustrated in Figure 1. An increase can be seen in primary care physicians as well as in specialists, even though to a lesser extent in the latter (Figure 1).Table 3


Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study.

Bähler C, Huber CA, Brüngger B, Reich O - BMC Health Serv Res (2015)

The number of consultations per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green boxplots: Total number of consultations; red boxplots: Number of consultations by primary care physicians; blue boxplots: Number of consultations by specialists.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307623&req=5

Fig1: The number of consultations per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green boxplots: Total number of consultations; red boxplots: Number of consultations by primary care physicians; blue boxplots: Number of consultations by specialists.
Mentions: The mean number of consultations per year amounted to 15.7 (median: 10) in the multimorbid-sample compared to 4.4 (median: 2) in the non-multimorbid-sample (Table 3). In women, the corresponding figures were slightly higher than in men (16.0 and 4.6 versus 15.3 and 4.1; results not shown). Moreover, we found an increase of 3.2 consultations per each additional chronic condition. The increase in the number (and distribution) of consultations per each additional chronic condition is illustrated in Figure 1. An increase can be seen in primary care physicians as well as in specialists, even though to a lesser extent in the latter (Figure 1).Table 3

Bottom Line: Strong positive associations with utilization and costs were also found for nursing dependency.Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient.Strategies for a better coordination of multimorbid patients are urgently needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland. caroline.baehler-baumgartner@helsana.ch.

ABSTRACT

Background: Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors.

Methods: The study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency.

Results: Prevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient.

Conclusions: Multimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed.

No MeSH data available.


Related in: MedlinePlus