Abstract
BackgroundChronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors.MethodsThe study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency.ResultsPrevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient.ConclusionsMultimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0698-2) contains supplementary material, which is available to authorized users.
Highlights
Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide
Overall, we found a high prevalence of multimorbidity in this sample of a Swiss community-dwelling elderly population, and considerable variations in health care utilization and health care costs in individuals with and without multiple chronic conditions
We discovered that even though individuals living in communities with a lower purchasing power were more likely to suffer from multiple chronic conditions, lower purchasing power was associated with lower numbers of consultations and lower total costs
Summary
Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. In view of the growing number of elderly individuals and the expected increase of patients with two or more chronic diseases, and due to the increased availability of new therapies and advanced medical technologies, the need of health care especially in the elderly general. Multimorbidity was associated with more than twice as many contacts per year with physicians, whereby the number of contacts as well as the number of different physicians contacted increased steadily with each additional chronic condition [7]. Differences exist depending on the underlying health care system and the function of primary care physicians (e.g. gatekeeper). While a higher use of medications was most strongly predicted by more medical diagnoses, physician contact was only weakly associated with medical diagnosis in a previous German study [13]
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