Limits...
Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis.

Lee JT, Hamid F, Pati S, Atun R, Millett C - PLoS ONE (2015)

Bottom Line: Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0.56, 95% CI = 0.46, 0.66), a higher likelihood of being hospitalised in India (AOR = 1.59, 95% CI = 1.45, 1.75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia.Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries.Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.

ABSTRACT

Background: The burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa.

Methods: Secondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007-2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models.

Results: The prevalence of multimorbidity in the adult population varied from 3.9% in Ghana to 33.6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0.56, 95% CI = 0.46, 0.66), a higher likelihood of being hospitalised in India (AOR = 1.59, 95% CI = 1.45, 1.75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88.3% for outpatient, 55.9% for inpatient visit in China) in most countries.

Conclusion: Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.

No MeSH data available.


Related in: MedlinePlus

Association between number of NCDs and healthcare utilisation- any outpatient utilisation (Fig 2a); Association between number of NCDs and healthcare utilisation- number of outpatient visits (Fig 2b).Figures in the last column are coefficients and 95% CI for the variable “number of NCD” from regression models adjusting for all covariates. Logistic model is used to estimate any visit for outpatient/inpatient service, and negative binomial model is used for number of visit/ hospitalisation days outcome.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4496037&req=5

pone.0127199.g002: Association between number of NCDs and healthcare utilisation- any outpatient utilisation (Fig 2a); Association between number of NCDs and healthcare utilisation- number of outpatient visits (Fig 2b).Figures in the last column are coefficients and 95% CI for the variable “number of NCD” from regression models adjusting for all covariates. Logistic model is used to estimate any visit for outpatient/inpatient service, and negative binomial model is used for number of visit/ hospitalisation days outcome.

Mentions: An increased number of NCDs was associated with a higher likelihood of having an outpatient visit in the last year (Table 2, Fig 2). For example, in China, the percentage of respondents having any outpatient visits in the past year increased from 46% for those without any NCDs to 63% for those with more than three NCDs (AOR = 1.50, 95% CI = 1.32,1.72). In South Africa, the percentage of respondents having any outpatient visits increased from 26% for those without any NCD to 81% for those with multimorbidity (AOR = 2.12, 95% CI = 1.59, 2.84). In the pooled analysis, the percentage of respondents having an outpatient visit increased from 51% for those without any NCD to 72% for those with multimorbidity (AOR = 1.51, 95% CI = 1.40, 1.64).


Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis.

Lee JT, Hamid F, Pati S, Atun R, Millett C - PLoS ONE (2015)

Association between number of NCDs and healthcare utilisation- any outpatient utilisation (Fig 2a); Association between number of NCDs and healthcare utilisation- number of outpatient visits (Fig 2b).Figures in the last column are coefficients and 95% CI for the variable “number of NCD” from regression models adjusting for all covariates. Logistic model is used to estimate any visit for outpatient/inpatient service, and negative binomial model is used for number of visit/ hospitalisation days outcome.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496037&req=5

pone.0127199.g002: Association between number of NCDs and healthcare utilisation- any outpatient utilisation (Fig 2a); Association between number of NCDs and healthcare utilisation- number of outpatient visits (Fig 2b).Figures in the last column are coefficients and 95% CI for the variable “number of NCD” from regression models adjusting for all covariates. Logistic model is used to estimate any visit for outpatient/inpatient service, and negative binomial model is used for number of visit/ hospitalisation days outcome.
Mentions: An increased number of NCDs was associated with a higher likelihood of having an outpatient visit in the last year (Table 2, Fig 2). For example, in China, the percentage of respondents having any outpatient visits in the past year increased from 46% for those without any NCDs to 63% for those with more than three NCDs (AOR = 1.50, 95% CI = 1.32,1.72). In South Africa, the percentage of respondents having any outpatient visits increased from 26% for those without any NCD to 81% for those with multimorbidity (AOR = 2.12, 95% CI = 1.59, 2.84). In the pooled analysis, the percentage of respondents having an outpatient visit increased from 51% for those without any NCD to 72% for those with multimorbidity (AOR = 1.51, 95% CI = 1.40, 1.64).

Bottom Line: Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0.56, 95% CI = 0.46, 0.66), a higher likelihood of being hospitalised in India (AOR = 1.59, 95% CI = 1.45, 1.75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia.Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries.Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.

ABSTRACT

Background: The burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa.

Methods: Secondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007-2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models.

Results: The prevalence of multimorbidity in the adult population varied from 3.9% in Ghana to 33.6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0.56, 95% CI = 0.46, 0.66), a higher likelihood of being hospitalised in India (AOR = 1.59, 95% CI = 1.45, 1.75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88.3% for outpatient, 55.9% for inpatient visit in China) in most countries.

Conclusion: Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.

No MeSH data available.


Related in: MedlinePlus