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

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  • John Tayu Lee
  • Fozia Hamid
  • Sanghamitra Pati
  • Rifat Atun
  • Christopher Millett

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.

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  • John Tayu Lee & Fozia Hamid & Sanghamitra Pati & Rifat Atun & Christopher Millett, 2015. "Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-18, July.
    • Handle: RePEc:plo:pone00:0127199
    DOI: 10.1371/journal.pone.0127199
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    7. Glenda Blaser Petarli & Monica Cattafesta & Monike Moreto Sant’Anna & Olívia Maria de Paula Alves Bezerra & Eliana Zandonade & Luciane Bresciani Salaroli, 2019. "Multimorbidity and complex multimorbidity in Brazilian rural workers," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-17, November.
    8. Anupa Rijal & Tara Ballav Adhikari & Jahangir A M Khan & Gabriele Berg-Beckhoff, 2018. "The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-23, November.
    9. Anon Khunakorncharatphong & Nareerut Pudpong & Rapeepong Suphanchaimat & Sataporn Julchoo & Mathudara Phaiyarom & Pigunkaew Sinam, 2021. "Noncommunicable Disease Service Utilization among Expatriate Patients in Thailand: An Analysis of Hospital Service Data, 2014–2018," IJERPH, MDPI, vol. 18(18), pages 1-12, September.
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    11. Kalpana Singh & Albara Alomari & Badriya Lenjawi, 2022. "Prevalence of Multimorbidity in the Middle East: A Systematic Review of Observational Studies," IJERPH, MDPI, vol. 19(24), pages 1-10, December.
    12. Ahmed Abdelmajed Alkhodary & Syed Mohamed Aljunid & Aniza Ismail & Amrizal Muhammad Nur & Suzana Shahar, 2022. "Health Care Utilization and Out-of-Pocket Payments among Elderly with Cognitive Frailty in Malaysia," IJERPH, MDPI, vol. 19(6), pages 1-18, March.
    13. Charlotte Arena & Christine Holmberg & Volker Winkler & Philipp Jaehn, 2021. "The Health Status and Healthcare Utilization of Ethnic Germans in Russia," IJERPH, MDPI, vol. 19(1), pages 1-13, December.
    14. Pushpendra Singh & Virendra Kumar, 2017. "The Rising Burden of Healthcare Expenditure in India: A Poverty Nexus," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(2), pages 741-762, September.
    15. Qinfeng Zhao & Jian Wang & Stephen Nicholas & Elizabeth Maitland & Jingjie Sun & Chen Jiao & Lizheng Xu & Anli Leng, 2020. "Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province," IJERPH, MDPI, vol. 17(24), pages 1-13, December.

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