Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study

Abstract

BackgroundNon communicable disease (NCD) multimorbidity is increasingly becoming common in high income settings but little is known about its epidemiology and associated impacts on citizens and health systems in low and middle-income countries (LMICs). We aim to examine the socio-demographic distribution of NCD multimorbidity (≥2 diseases) and its implications for health care utilization and out-of-pocket expenditure (OOPE) in India.MethodsWe analyzed cross-sectional nationally representative data from the World Health Organisaion Study on Global Ageing and Adult Health (WHO-SAGE), conducted in India during 2007. Multiple logistic regression was used to determine socio-demographic predictors of self-reported multimorbidity. A two part model was used to assess the relationship between number of NCDs and health care utilization including OOPE.Results28.5% of the sample population had at least one NCD and 8.9% had NCD multimorbidity. The prevalence of multimorbidity increased from 1.3% in 18–29 year olds to 30.6% in those aged 70 years and above. Mean outpatient visits in the preceding 12 months increased from 2.2 to 6.2 and the percentage reporting an overnight hospital stay in the past 3 years increased from 9% to 29% in those with no NCD and ≥2 NCDs respectively (p <0.001).OOPE incurred during the last outpatient visit increased from INR 272.1 (95% CI = 249.0-295.2) in respondents with no NCDs to INR 454.1 (95% CI = 407.8-500.4) in respondents with ≥2 NCDs. However, we did not find an increase in OOPE during the last inpatient visit with number of NCDs (7865.9 INR for those with zero NCDs compared with 7301.3 for those with ≥2 NCDs). For both outpatient and inpatient OOPE, medicine constitutes the largest proportion of spending (70.7% for outpatient, 53.6% for inpatient visit), followed by spending for health care provider (14.0% for outpatient, 12.2% for inpatient visit).ConclusionNCD multimorbidity is common in the Indian adult population and is associated with substantially higher healthcare utilization and OOPE. Strategies to address the growing burden of NCDs in LMICs should include efforts to improve the management of patients with multimorbidity and reduce associated financial burden to individuals and households.

Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana

“…This is in line with previous studies, which reported that having multiple chronic conditions was a strong predictor of healthcare utilization [6,11–13]. Results from a study in India indicated that the prevalence of chronic multimorbidity was high among older adults and utilization of outpatient care increased with an increasing number of chronic diseases [33]. …”

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries

“…An estimated 50 million more suffer from catastrophic health expenditures, commonly defined as expenditures of 10% or more of income (31). Moreover, poorer persons spend a higher proportion of income on health care which might induce (financial) perceived stress (32), in particular following catastrophic expenditure (33) or high out-of-pocket expenditure in areas with no health insurance (33), although this is not universal in all LMICs (34). Furthermore, treatments costs may increase the likelihood that patients in LMICs forgo needed treatment, in particular when there is a need for multiple medications, which are often prescribed to treat chronic diseases and multimorbidity (35).…”

A study on effective utilization of health care services provided by primary health centre and sub-centres in rural Tamilnadu, India

“…It was decided to integrate and strengthen the rural health care institutions through suitable organization and functional linkages between the different tiers of the primary health care system. 1 In most developing countries such as India, utilization of basic health services has remained poor even though there has been increasing public and private expenditure on the provision of advanced health care. 2 Various studies have been done to evaluate the rates of utilization of the public and private sector health services.…”