Abstract
BackgroundMultimorbidity is a significant contributor to inequalities in healthcare and has become a major unaddressed challenge for the health system in China. The aim of this study is to assess the socio-demographic distribution of multimorbidity and the relationships between multimorbidity, primary healthcare, hospitalization and healthcare spending.MethodsWe conducted this nationwide population-based panel data study in China. Study participants included 12,306 residents aged ≥45 years from the China Health and Retirement Longitudinal Study in 2011, 2013 and 2015. Random-effects logistic regression models were applied to estimate the association between multimorbidity and primary healthcare as well as admission to the hospital. We used log-linear regression models to investigate the association between multimorbidity and health spending.ResultsOverall, 46.2% of total interviewees reported multimorbidity. Random-effects logistic regression analyses showed that multimorbidity was associated with a higher likelihood of medication use (Adjusted odds ratio (AOR) =19.19, 95% CI = 17.60, 20.93), health check (AOR = 1.51, 95% CI = 1.43, 1.59), outpatient care (AOR = 2.39, 95% CI = 2.23, 2.56) and admission to hospital (AOR = 2.94, 95% CI = 2.68, 3.21). Log-linear regression models showed that multimorbidity was also positively associated with spending for outpatient care (coefficient = 0.64, 95% CI = 0.59, 0.68) and hospitalization (coefficient = 0.65, 95% CI = 0.60, 0.71).ConclusionsMultimorbidity is associated with higher levels of primary care, hospitalization and greater financial burden to individuals in China. Health systems need to shift from single-disease models to new financing and service delivery models to more effectively manage multimorbidity.
Highlights
Chronic conditions are both a major contributor to inequalities in healthcare and the leading cause of premature mortality in China [1, 2]
Despite the growing prevalence of multimorbidity in China, there is little evidence regarding the impact of multimorbidity on access to and inequalities in primary care and health service use compared to the impact of a single chronic condition
To improve access to primary care and equity in financial protection, the China New Health System Reform resulted in a significant increase in health insurance coverage, with 95.7% of the Chinese population being covered by one of the three main health insurance schemes in 2011 (that is, the Urban Employee Basic Medical Insurance (UEBMI) scheme, the Urban Resident Basic Medical Insurance (URBMI) scheme, and the New Rural Cooperative Medical Scheme (NCMS)) [5, 6]
Summary
Chronic conditions are both a major contributor to inequalities in healthcare and the leading cause of premature mortality in China [1, 2]. Despite the growing prevalence of multimorbidity in China, there is little evidence regarding the impact of multimorbidity on access to and inequalities in primary care and health service use compared to the impact of a single chronic condition. To improve access to primary care and equity in financial protection, the China New Health System Reform resulted in a significant increase in health insurance coverage, with 95.7% of the Chinese population being covered by one of the three main health insurance schemes in 2011 (that is, the Urban Employee Basic Medical Insurance (UEBMI) scheme, the Urban Resident Basic Medical Insurance (URBMI) scheme, and the New Rural Cooperative Medical Scheme (NCMS)) [5, 6]. The aim of this study is to assess the socio-demographic distribution of multimorbidity and the relationships between multimorbidity, primary healthcare, hospitalization and healthcare spending
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