| Title | Medical costs and out-of-pocket expenditures associated with multimorbidity in China: quantile regression analysis |
| Authors | Zhao, Yang Atun, Rifat Anindya, Kanya McPake, Barbara Marthias, Tiara Pan, Tianxin Heusden, Alexander van Zhang, Puhong Duolikun, Nadila Lee, John Tayu |
| Affiliation | Peking Univ, Hlth Sci Ctr, George Inst Global Hlth, Beijing, Peoples R China WHO, Collaborating Ctr Implementat Res Prevent & Contr, Melbourne, Vic, Australia Harvard Univ, Harvard TH Chan Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA 02115 USA Harvard Univ, Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA 02115 USA Univ Melbourne, Nossal Inst Global Hlth, Melbourne, Vic, Australia Univ Gadjah Mada, Dept Publ Hlth, Fac Med Publ Hlth & Nursing, Yogyakarta, Indonesia Univ Melbourne, Melbourne Sch Populat & Global Hlth, Melbourne, Vic, Australia Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia Imperial Coll London, Sch Publ Hlth, Dept Primary Care & Publ Hlth, Publ Hlth Policy Evaluat Unit, London, England |
| Issue Date | 2021 |
| Publisher | BMJ GLOBAL HEALTH |
| Abstract | Objective Multimorbidity is a growing challenge in low-income and middle-income countries. This study investigates the effects of multimorbidity on annual medical costs and the out-of-pocket expenditures (OOPEs) along the cost distribution. Methods Data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS 2015), including 10 592 participants aged >= 45 years and 15 physical and mental chronic diseases, were used for this nationally representative cross-sectional study. Quantile multivariable regressions were employed to understand variations in the association of chronic disease multimorbidity with medical cost and OOPE. Results Overall, 69.5% of middle-aged and elderly Chinese had multimorbidity in 2015. Increased number of chronic diseases was significantly associated with greater health expenditures across every cost quantile groups. The effect of chronic diseases on total medical cost was found to be larger among the upper tail than those in the lower tail of the cost distributions (coefficients 12, 95% CI 6 to 17 for 10th percentile; coefficients 296, 95% CI 71 to 522 for 90th percentile). Annual OOPE also increased with chronic diseases from the 10th percentile to the 90th percentile. Multimorbidity had larger effects on OOPE and was more pronounced at the upper tail of the health expenditure distribution (regression coefficients of 8 and 84 at the 10th percentile and 75th percentile, respectively). Conclusion Multimorbidity is associated with escalating healthcare costs in China. Further research is required to understand the impact of multimorbidity across different population groups. |
| URI | http://hdl.handle.net/20.500.11897/608963 |
| ISSN | 2059-7908 |
| DOI | 10.1136/bmjgh-2020-004042 |
| Indexed | SCI(E) SSCI |
| Appears in Collections: | 医学部待认领 |
