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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

Percentage of out-of-pocket spending for each type of outpatient service in persons with multimorbidity (Fig 5a); Percentage of out-of-pocket spending for each type of inpatient service in persons with multimorbidity (Fig 5b).Estimates presented here are based on respondent’s healthcare visit that was not free of charge.
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pone.0127199.g005: Percentage of out-of-pocket spending for each type of outpatient service in persons with multimorbidity (Fig 5a); Percentage of out-of-pocket spending for each type of inpatient service in persons with multimorbidity (Fig 5b).Estimates presented here are based on respondent’s healthcare visit that was not free of charge.

Mentions: Patterns of out-of-pocket spending by type of service for persons with multimorbidity are presented in Fig 5 and Tables E and F within S1 File. For outpatient services, medicines constituted the highest proportion of out-of-pocket expenditures for persons with multimorbidity in China (83.5%) and India (61.0%). The proportion of out-of-pocket expenditure for healthcare providers varied greatly between countries, ranging from 4.2% in Russia to 65.9% in South Africa. Transport cost constituted a substantial proportion of spending in Ghana (38.5%), South Africa (20.1%), and Mexico (18.8%). For inpatient services, medicines constituted the highest proportion of out-of-pocket expenditures in China (60.6% of total out-of-pocket expenditures) and India (49.2%). The proportion spent on inpatient healthcare provider fees varied greatly in each country; from 73.2% in South Africa to 3.2% in Russia.


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)

Percentage of out-of-pocket spending for each type of outpatient service in persons with multimorbidity (Fig 5a); Percentage of out-of-pocket spending for each type of inpatient service in persons with multimorbidity (Fig 5b).Estimates presented here are based on respondent’s healthcare visit that was not free of charge.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0127199.g005: Percentage of out-of-pocket spending for each type of outpatient service in persons with multimorbidity (Fig 5a); Percentage of out-of-pocket spending for each type of inpatient service in persons with multimorbidity (Fig 5b).Estimates presented here are based on respondent’s healthcare visit that was not free of charge.
Mentions: Patterns of out-of-pocket spending by type of service for persons with multimorbidity are presented in Fig 5 and Tables E and F within S1 File. For outpatient services, medicines constituted the highest proportion of out-of-pocket expenditures for persons with multimorbidity in China (83.5%) and India (61.0%). The proportion of out-of-pocket expenditure for healthcare providers varied greatly between countries, ranging from 4.2% in Russia to 65.9% in South Africa. Transport cost constituted a substantial proportion of spending in Ghana (38.5%), South Africa (20.1%), and Mexico (18.8%). For inpatient services, medicines constituted the highest proportion of out-of-pocket expenditures in China (60.6% of total out-of-pocket expenditures) and India (49.2%). The proportion spent on inpatient healthcare provider fees varied greatly in each country; from 73.2% in South Africa to 3.2% in Russia.

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