The moderating effect of mental health and health insurance ownership on the relationships between physical multimorbidity and healthcare utilisation and catastrophic health expenditure in India

Abstract

Background The current demographic transition has resulted in the growth of the older population in India, a population group which has a higher chance of being affected by multimorbidity and its subsequent healthcare and economic consequences. However, little attention has been paid to the dual effect of mental health conditions and physical multimorbidity in India. The present study, therefore, aimed to analyse the moderating effects of mental health and health insurance ownership in the association between physical multimorbidity and healthcare utilisation and catastrophic health expenditure (CHE). Methods We analysed the Longitudinal Aging Study in India, wave 1 (2017–2018). We determined physical multimorbidity by assessing the number of physical conditions. We built multivariable logistic regression models to determine the moderating effect of mental health and health insurance ownership in the association between the number of physical conditions and healthcare utilisation and CHE. Wald tests were used to evaluate if the estimated effects differ across groups defined by the moderating variables. Results Overall, around one-quarter of adults aged 45 and above had physical multimorbidity, one-third had a mental health condition and 20.5% owned health insurance. Irrespective of having a mental condition and health insurance, physical multimorbidity was associated with increased utilisation of healthcare and CHE. Having an additional mental condition strengthened the adverse effect of physical multimorbidity on increased inpatient service use and experience of CHE. Having health insurance, on the other hand, attenuated the effect of experiencing CHE, indicating a protective effect. Conclusions The coexistence of mental health conditions in people with physical multimorbidity increases the demands of healthcare service utilisation and can lead to CHE. The findings point to the need for multidisciplinary interventions for individuals with physical multimorbidity, ensuring their mental health needs are also addressed. Our results urge enhancing health insurance schemes for individuals with mental and physical multimorbidity.

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

“…These findings show the magnitude of the mental condition in the issue of multimorbidity and its outcomes. Mental conditions appear to carry more weight and increase the burden of morbidity when present in these patients [ 14 , 40 ]. It appears as if the presence of a mental condition in a patient with MM had a greater impact on negative outcomes than the two physical medical illnesses.…”

“…Higher rates of utilisation of healthcare services are generally associated with increased health costs and lower patient satisfaction. These high rates also have the potential to contribute to adverse health outcomes, including poor quality of life, negative effects on work productivity, reduced employability, and increased mortality [ 12 , 14 ]. In this challenging context, a regular source of care, especially in primary health settings (Regular Source of Primary Care – RSPC) has been shown as a promising component in the provision of health services [ 15 ].…”