The influence of socio-economic status and multimorbidity patterns on healthcare costs: a six-year follow-up under a universal healthcare system

Abstract

IntroductionMultimorbidity has been linked to elevated healthcare utilization and previous studies have found that socioeconomic status is an important factor associated with multimorbidity. Nonetheless, little is known regarding the impact of multimorbidity and socioeconomic status on healthcare costs and whether inequities in healthcare exist between socioeconomic classes within a universal healthcare system.MethodsThis longitudinal study employed the claims database of the National Health Insurance of Taiwan (959 990 enrolees), adopting medication-based Rx-defined morbidity groups (Rx-MG) as a measurement of multimorbidity. Mixed linear models were used to estimate the effects of multimorbidity and socioeconomic characteristics on annual healthcare costs between 2005 and 2010.ResultsThe distribution of Rx-MGs and total costs presented statistically significant differences among gender, age groups, occupation, and income class (p < .001). Nearly 80% of the enrolees were classified as multimorbid and low income earners presented the highest prevalence of multimorbidity. After controlling for age and gender, increases in the number of Rx-MG assignments were associated with higher total healthcare costs. After controlling for the effects of Rx-MG assignment and demographic characteristics, physicians, paramedical personnel, and public servant were found to generate higher total costs than typical employees/self-employed enrolees, while low-income earners generated lower costs. High income levels were also found to be associated with lower total costs. It was also revealed that occupation and multimorbidity have a moderating effect on healthcare cost.ConclusionsIncreases in the prevalence of multimorbidity are associated with higher health care costs. This study determined that instances of multimorbidity varied according to socioeconomic class; likewise there were inequities in healthcare utilization among individuals of various occupations and income levels, even when demographic characteristics and multimorbidity were controlled for. This highlights the importance of socioeconomic status with regard to healthcare utilization. These results indicate that socioeconomic factors should not be discounted when discussing the utilization of healthcare by patients with multimorbidity.

A Systematic Review of Cost-of-Illness Studies of Multimorbidity

“…States [23,24,3,[25][26][27][28][29][30][31][32][33][34], seven in Europe [13,[35][36][37][38][39][40], t wo in Australia [41], one each fro m Canada [42], Singapore 3 [43] and Taiwan [44], and two in middle -or low-inco me regions [40,45]. Overall, twenty studies used a prevalence 4 approach [23, 24, 3, 25-28, 13, 35, 30, 31, 41, 37, 38, 45, 39, 46, 40, 32, 43], seven used an incidence approach [36, 5 29, 44, 42, 33, 34, 27], and only one used an economic model to estimate the lifet ime costs of mult imorb idity [36].…”

Managing the Needs of Older Patients with Multimorbidity—A Systematic Review of the Challenges Faced by the Healthcare Services

“…Other studies that are not included in the present review have also demonstrated that socio-economic status has an impact on both prevalence rates and healthcare utilization rates [10] [43] [44]. Kuo and Lai [44] found that cases of patients with multimorbidity varied according to socio-economic status and demographic characteristics.…”

Sociodemographic Factors and Expenditure Issues in Vietnamese Consideration of Periodic General Health Examination

“…But from a broader point of view, there are various other factors affecting both said readiness and the healthcare fees they might be willing pay, such as: health insurance, family/personal income, job status, gender, health status, education, personal medical knowledge, etc [26][27][28]. Those who work in the medical/healthcare sector, who have ©2016 Vuong QH, Vu QH 4 above-average income, or who are civil servants, are more likely to participate in periodic health examinations; and, being ready for higher payments, their health status are generally better [27][28][29][30]. On the contrary, below-average-income citizens have restricted access to healthcare services and are less likely to take particular medical checks such as periodic GHE [27][28][29]31].…”

“…Those who work in the medical/healthcare sector, who have ©2016 Vuong QH, Vu QH 4 above-average income, or who are civil servants, are more likely to participate in periodic health examinations; and, being ready for higher payments, their health status are generally better [27][28][29][30]. On the contrary, below-average-income citizens have restricted access to healthcare services and are less likely to take particular medical checks such as periodic GHE [27][28][29]31]. Also, females tend to take regular physical examinations more than males due to their general self-care tendencies and their specific physiological attributes [12,32].…”

“…These costs, in turn, are even more severe when the patient is uninsured, or when they are only hospitalized in critical conditions [44][45][46]. Therefore, for policy making concerning health care in general and medical service pricing in particular, it is necessary to thoroughly consider all demographic and socioeconomic-related factors [27].…”