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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

Health care costs per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green lines: Total health care costs; red lines: Health care costs by primary care physicians; blue lines: Health care costs by specialists. Straight lines = linear regression lines; Dashed lines = LOESS smoother.
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Related In: Results  -  Collection

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Fig2: Health care costs per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green lines: Total health care costs; red lines: Health care costs by primary care physicians; blue lines: Health care costs by specialists. Straight lines = linear regression lines; Dashed lines = LOESS smoother.

Mentions: Mean total health care costs were 5.5 times higher in the multimorbid patients compared to those with none or only one chronic condition (Table 5). Considerable mean higher costs in multimorbid patients were found for both subgroups: for inpatient and outpatient costs. As far as inpatient costs are concerned, the differences in costs were highest in acute hospitals compared to psychiatric or other hospital settings (e.g. rehabilitations). As for the outpatient costs, relative differences were notably found for home care nursing services and hospital outpatient visits. Relative differences in mean costs between multimorbid versus non-multimorbid individuals were higher for primary care physicians compared to specialists, even though the mean costs for specialists were almost twice as high in both samples. Each additional chronic condition was associated with increased costs of CHF 2222 (US$ 2383) per year. Figure 2 illustrates the log-transformed total health care costs, the costs by primary care physicians and the costs by specialists per year according to the number of chronic conditions. While the costs seem to increase almost linearly in individuals suffering from four to six chronic conditions, the LOESS smoother show lower than expected costs in individuals with no chronic condition and in those with seven or more chronic conditions.Table 5


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)

Health care costs per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green lines: Total health care costs; red lines: Health care costs by primary care physicians; blue lines: Health care costs by specialists. Straight lines = linear regression lines; Dashed lines = LOESS smoother.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Health care costs per year according to the number of chronic conditions in an elderly population (≥65 years of age) in Switzerland, 2013. Green lines: Total health care costs; red lines: Health care costs by primary care physicians; blue lines: Health care costs by specialists. Straight lines = linear regression lines; Dashed lines = LOESS smoother.
Mentions: Mean total health care costs were 5.5 times higher in the multimorbid patients compared to those with none or only one chronic condition (Table 5). Considerable mean higher costs in multimorbid patients were found for both subgroups: for inpatient and outpatient costs. As far as inpatient costs are concerned, the differences in costs were highest in acute hospitals compared to psychiatric or other hospital settings (e.g. rehabilitations). As for the outpatient costs, relative differences were notably found for home care nursing services and hospital outpatient visits. Relative differences in mean costs between multimorbid versus non-multimorbid individuals were higher for primary care physicians compared to specialists, even though the mean costs for specialists were almost twice as high in both samples. Each additional chronic condition was associated with increased costs of CHF 2222 (US$ 2383) per year. Figure 2 illustrates the log-transformed total health care costs, the costs by primary care physicians and the costs by specialists per year according to the number of chronic conditions. While the costs seem to increase almost linearly in individuals suffering from four to six chronic conditions, the LOESS smoother show lower than expected costs in individuals with no chronic condition and in those with seven or more chronic conditions.Table 5

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