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Now published in The Lancet

Multimorbidity, Health Service Use and Catastrophic Health Expenditure by Socio-Economic Groups in China: A Panel Data Analysis

27 Pages Posted: 29 Aug 2019

See all articles by Yang Zhao

Yang Zhao

University of Melbourne - Nossal Institute for Global Health

Rifat Atun

Harvard University - Harvard TH Chan School of Public Health

Brian Oldenburg

University of Melbourne - Melbourne School of Population and Global Health

Barbara McPake

University of Melbourne - Nossal Institute for Global Health

Shenglan Tang

Duke University - Duke Global Health Institute

Stewart Mercer

University of Edinburgh - College of Medicine & Veterinary Medicine

Thomas E. Cowling

London School of Hygiene & Tropical Medicine - Department of Health Services Research and Policy

Grace Sum

National University of Singapore (NUS) - Saw Swee Hock School of Public Health

Vicky Mengqi Qin

National University of Singapore (NUS) - Saw Swee Hock School of Public Health

John Tayu Lee

University of Melbourne - Nossal Institute for Global Health

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Abstract

Background: Multimorbidity, which is the presence of two or more chronic non-communicable diseases (NCDs), is a growing challenge for the health system in China, which faces unprecedented ageing of its population. This study examined: (1) the distribution of multimorbidity in relation to economic status; (2) the relationships between multimorbidity, healthcare service use, and catastrophic health expenditures (CHE); and (3), whether these relationships varied by economic groups and social health insurance schemes in China.

Methods: We used data from the three waves of the nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011-15), including 11 718 participants aged ≥50 years, and applied random-effects logistic regression to examine the socio-demographic correlates of multimorbidity. Random-effects negative binomial models were used to assess the relationship between the number of NCDs and health service use. Random-effects logistic regression models were used to estimate the impact of multimorbidity on CHE.

Findings: Overall, 62% of participants had multimorbidity in China in 2015. The onset of multimorbidity occurred 5 to 10 years earlier in people belonging to the wealthiest socio-economic quartile group compared with the lowest. A higher number of chronic diseases was associated with more frequent health service use for both outpatient visits (Coefficient=0·25, 95% CI=0·24, 0·27) and days of hospitalisation (Coefficient=0·32, 95% CI=0·30, 0·34). There were similar effects from different socioeconomic groups and among those covered by different social health insurance programmes. Overall, multimorbidity was associated with a substantially higher likelihood of experiencing CHE (Adjusted OR=1·29 for the overall population, 95% CI=1·26, 1·32). The effect of multimorbidity on CHE persisted even among the most affluent population and those with the more generous health insurance coverage.

Interpretation: Concerted efforts are needed to reduce health inequalities due to multimorbidity, and its adverse economic impact in population groups in China. Multimorbidity is associated with higher levels of health service use and a greater financial burden in China. Social health insurance reforms must place greater emphasis on reducing out-of-pocket spending for patients with multiple chronic conditions to provide greater financial risk protection to those at risk of high out-of-pocket spending due to multimorbidity.

Funding: None.

Declaration of Interests: We declare no competing interests.

Ethical Approval Statement: The Biomedical Ethics Review Committee of Peking University approved the CHARLS study, and all interviewees were required to provide informed consent. The ethical approval number was IRB00001052–11015.

Keywords: multimorbidity, health service, catastrophic health expenditure, panel analysis, China

Suggested Citation

Zhao, Yang and Atun, Rifat and Oldenburg, Brian and McPake, Barbara and Tang, Shenglan and Mercer, Stewart and Cowling, Thomas E. and Sum, Grace and Qin, Vicky Mengqi and Lee, John Tayu, Multimorbidity, Health Service Use and Catastrophic Health Expenditure by Socio-Economic Groups in China: A Panel Data Analysis (08/19/2019 06:25:50). , Global Health, Volume 8, Issue 6, June 2020, Pages e840-e849, https://doi.org/10.1016/S2214-109X(20)30127-3, Available at SSRN: https://ssrn.com/abstract=3439585 or http://dx.doi.org/10.2139/ssrn.3439585

Yang Zhao (Contact Author)

University of Melbourne - Nossal Institute for Global Health

Level 4, 161 Barry St
Carlton, Victoria 3010
Australia

Rifat Atun

Harvard University - Harvard TH Chan School of Public Health

665 Huntington Avenue
Building 1, Suite 1202
Boston, MA 02115
United States

Brian Oldenburg

University of Melbourne - Melbourne School of Population and Global Health ( email )

4/207 Bouverie Street
Parkville, Victoria
Australia

Barbara McPake

University of Melbourne - Nossal Institute for Global Health ( email )

Level 4, 161 Barry St
Carlton, Victoria 3010
Australia

Shenglan Tang

Duke University - Duke Global Health Institute ( email )

310 Trent Drive
Box 90519
Durham, NC 27710
United States

Stewart Mercer

University of Edinburgh - College of Medicine & Veterinary Medicine

United States

Thomas E. Cowling

London School of Hygiene & Tropical Medicine - Department of Health Services Research and Policy

London
United Kingdom

Grace Sum

National University of Singapore (NUS) - Saw Swee Hock School of Public Health

12 Science Drive 2
#10-01
117549
Singapore

Vicky Mengqi Qin

National University of Singapore (NUS) - Saw Swee Hock School of Public Health

12 Science Drive 2
#10-01
117549
Singapore

John Tayu Lee

University of Melbourne - Nossal Institute for Global Health

Level 4, 161 Barry St
Carlton, Victoria 3010
Australia