Impact of multimorbidity on health service use and catastrophic health expenditure in China: an analysis of data from a nationwide longitudinal survey

Abstract

BackgroundMultimorbidity (the presence of two or more chronic conditions) is a significant contributor to inequalities in health care and has become the major unaddressed challenge for the health system in China. We assessed the distribution of multimorbidity in relation to economic status and the relationships between multimorbidity, health-care use, and catastrophic health expenditure in China. MethodsWe conducted a longitudinal study using three waves of data (2011, 2013, and 2015) from the China Health and Retirement Longitudinal Study (CHARLS), including 12 096 participants aged 45 years and older. Random effects logistic regression models were used to determine the sociodemographic correlates of multimorbidity, including age, sex, marital status, education, residence location, socioeconomic status quartiles (yearly per-capita household consumption expenditure), health insurance, and geographical region. Negative binomial regression models were used to assess the relationship between multimorbidity and outpatient visits, as well as days of hospitalisation. Multivariate logistic regression models were used to estimate the effect of multimorbidity on catastrophic health expenditure, defined as the point at which annual household health payments exceeded 40% of non-food household expenditure. The Biomedical Ethics Review Committee of Peking University approved the CHARLS study (approval number IRB00001052–11015), and all interviewees were required to provide informed consent. FindingsOf 12 096 participants, 5566 (46·0%) in 2011, 6069 (50·2%) in 2013, and 7399 (61·2%) in 2015 had two or more chronic diseases. The onset of multimorbidity occurred 5–10 years earlier in people in the highest economic quartile group than in the lowest group. Multimorbidity was positively associated with health service use, including outpatient visits (coefficient 0·25, 95% CI 0·24–0·27) and days of hospitalisation (0·31, 0·31–0·35). Multimorbidity was associated with an increased likelihood of experiencing catastrophic health expenditure (odds ratio 1·30, 95% CI 1·27–1·33). These associations appeared to be similar among people covered by health insurance across economic groups. By contrast, income-related disparities in the association between multimorbidity and health service use were more pronounced in the population without health insurance. InterpretationMultimorbidity is associated with higher levels of health service use and a greater financial burden to individuals in China. Acceleration of progress to achieve universal health insurance coverage could improve disparities in access to health care among economic groups. Health-care reforms in China should place greater emphasis on reducing out-of-pocket spending for patients with multimorbidity. FundingNone.