Abstract
BackgroundMultimorbidity is a major challenge for healthcare systems. However, currently, its magnitude and impact in healthcare expenditures is still mostly unknown.ObjectiveTo present an overview of the prevalence and costs of multimorbidity by socioeconomic levels in the whole Basque population.MethodsWe develop a cross-sectional analysis that includes all the inhabitants of the Basque Country (N = 2,262,698). We utilize data from primary health care electronic medical records, hospital admissions, and outpatient care databases, corresponding to a 4 year period. Multimorbidity was defined as the presence of two or more chronic diseases out of a list of 52 of the most important and common chronic conditions given in the literature. We also use socioeconomic and demographic variables such as age, sex, individual healthcare cost, and deprivation level. Predicted adjusted costs were obtained by log-gamma regression models.ResultsMultimorbidity of chronic diseases was found among 23.61% of the total Basque population and among 66.13% of those older than 65 years. Multimorbid patients account for 63.55% of total healthcare expenditures. Prevalence of multimorbidity is higher in the most deprived areas for all age and sex groups. The annual cost of healthcare per patient generated for any chronic disease depends on the number of coexisting comorbidities, and varies from 637 € for the first pathology in average to 1,657 € for the ninth one.ConclusionMultimorbidity is very common for the Basque population and its prevalence rises in age, and unfavourable socioeconomic environment. The costs of care for chronic patients with several conditions cannot be described as the sum of their individual pathologies in average. They usually increase dramatically according to the number of comorbidities. Given the ageing population, multimorbidity and its consequences should be taken into account in healthcare policy, the organization of care and medical research.
Highlights
Most OECD countries face major challenges inorganising the funding and provision of care to respond to the increasing demands of patients with chronic diseases
Individuals manifesting multimorbidities typically have a lower quality of life, and higher degree of disability, psychological distress, risk of mortality, and utilisation of health services than if we considered their chronic conditions in isolation or individuals with a single chronic condition [4]
Chronic conditions are more common in females than in males, and their prevalence rises with age up to 85 years old, when there is a slight decrease
Summary
Most OECD countries face major challenges in (re-)organising the funding and provision of care to respond to the increasing demands of patients with chronic diseases. Most studies on this topic refer to the re-organisation of provision [5], [6], the economic impact is a major concern given the concentration of health expenditures on these patients [7] This health policy challenge is important in countries where there is a significant proportion of public funding, and even more so in regions affected by the current poor economic situation and outlook, including Spain. In these countries, public policy makers find themselves involved in an urgent search for efficiency in provision while still guaranteeing quality with equity in access, in many systems in the context of universal coverage. Its magnitude and impact in healthcare expenditures is still mostly unknown
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