The impact of mental and physical multimorbidity on healthcare utilization and health spending in China: A nationwide longitudinal population‐based study

Abstract

Background In China, little evidence exists on the effect of mental and physical multimorbidity on individuals and the health system. This study aims to examine the prevalence of mental–physical multimorbidity and its impact on health service utilization and health expenditures. Methods We conducted a panel study using two waves of data (in 2011 and 2015) from the China Health and Retirement Longitudinal Study, including 10,181 participants aged 45 years and older. Generalized linear regression models were used to assess the association of multimorbidity with total health expenditure and out‐of‐pocket expenditure (OOPE) on outpatient and inpatient care. Random‐effects logistic regression models were used to examine the impact of multimorbidity on outpatient visits, admission to hospital and incidence of catastrophic health expenditure (CHE). Results Overall, 3210 participants (31.53% of 10,181) had mental–physical multimorbidity in 2015 in China. Compared to patients with a single physical disease, individuals with physical‐mental multimorbidity had over 150% of the increase in the number of outpatient visits and days of hospitalization. The percentage change of OOPE for outpatient and inpatient care was 156.8% and 163.6%, respectively. Mental–physical multimorbidity was associated with an increased likelihood of experiencing CHE (OR = 2.205, 95% CI = 2.048, 2.051). Conclusion Multimorbidity, particularly mental–physical multimorbidity, is associated with higher levels of health service use and a greater financial burden to individuals in China. Healthcare system needs to shift from single‐disease models to new financing and service delivery models to more effectively manage mental–physical multimorbidity.

Medical costs and out-of-pocket expenditures associated with multimorbidity in China: quantile regression analysis

“…The higher treatment cost and financial burden for individuals with multimorbidity are in line with earlier published studies. 6 13 37 Chen et al 13 found that the expenditure on patients with multiple chronic diseases was over three times higher than those with a single disease. This positive relationship between the number of NCDs and OOPE was also consistent with earlier studies.…”

“…As multimorbidity is costly to individuals and the health systems, there is a need for concerted efforts and other LMICs with ageing populations to reduce the treatment burden among patients with multimorbidity and its impact on financial risk protection. 6 Prevention strategies for NCDs should adopt approaches that take into account multimorbidity in healthcare management, rather than single-disease approaches, particularly in funds allocation and in designing policies on financial protection. 7 Furthermore, preventing multimorbidity and developing more sustainable models of care is a key priority.…”

“…5 Similarly, a recent study in China, based on 11 physical NCDs, found that the prevalence of multimorbidity increased from 51% for those aged 50-54 years to 71% for those aged 75 years and above. 6 Patients with multimorbidity are costly to healthcare systems due…”

“… 5 Similarly, a recent study in China, based on 11 physical NCDs, found that the prevalence of multimorbidity increased from 51% for those aged 50–54 years to 71% for those aged 75 years and above. 6 Patients with multimorbidity are costly to healthcare systems due to the complex needs and greater health service utilisation. 7 8 Evidence from high-income countries (HICs) suggest that the economic consequences of a health condition may differ significantly among the highest users of health services, compared with those at the bottom or middle of treatment cost distributions.…”

Do Drug Accessibility and OOP Burden Affect Health-Related Quality of Life of Patients With Chronic Diseases? — EQ-5D-5L Evaluation Evidence From Five Districts in China

“…In China, people suffering from multimorbidity are inseparable from the level of health service use and the patient's own financial affordability (36). People with multiple chronic diseases must have richer information and flexibility in order to better manage personal health, otherwise they may be faced with more complicated situation (37).…”