Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis

Anindya, Kanya and Ng, Nawi and Atun, Rifat and Marthias, Tiara and Zhao, Yang and McPake, Barbara and van Heusden, Alexander and Pan, Tianxin and Lee, John Tayu (2021) Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis. BMC Health Services Research, 21 (1). ISSN 14726963

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Abstract

Background: Multimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE). Methods: We conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE. Results: Overall, 20.8 of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95 CI 0.07–0.14 for outpatient care and coefficient 0.09 (95 CI 0.02–0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95 CI 11.4–42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95 CI 0.5–1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95 CI 15.9–46.2). Conclusion: Multimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher level of health care utilisation. © 2021, The Author(s).

Item Type: Article
Additional Information: Cited by: 21; All Open Access, Gold Open Access
Uncontrolled Keywords: Aged; Cross-Sectional Studies; Health Expenditures; Humans; Indonesia; Multimorbidity; Noncommunicable Diseases; Regression Analysis; aged; cross-sectional study; epidemiology; health care cost; human; Indonesia; multiple chronic conditions; non communicable disease; regression analysis
Subjects: R Medicine > RB Biomedical Sciences
Divisions: Faculty of Medicine, Public Health and Nursing > Public Health and Nutrition
Depositing User: Sri JUNANDI
Date Deposited: 28 Sep 2024 01:41
Last Modified: 28 Sep 2024 01:41
URI: https://ir.lib.ugm.ac.id/id/eprint/4515

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