Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis.
Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis.
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DOI：
10.1371/journal.pone.0127199
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Millett C
中科院分区：
文献类型：
--
作者：
Lee JT;Hamid F;Pati S;Atun R;Millett C
在人口老龄化的低收入和中等收入国家，非传染性疾病的负担迅速增加，多发病(两种以上并存的慢性病)的患病率不断上升，这将大大增加本已捉襟见肘的卫生系统的压力。我们评估了非传染性疾病多发病对中国、加纳、印度、墨西哥、俄罗斯和南非这六个中等收入国家的医疗保健利用率和自付支出的影响。对世卫组织2007-2010年全球老龄化与成人健康研究(SAGE)中成年参与者(18岁)的横断面数据进行二次分析。我们使用多元Logistic回归来确定多发病的社会人口学相关因素。使用Logistic模型、负二项模型和对数线性模型评估非传染性疾病的数量与医疗保健利用率以及自付支出之间的关系。成人人群的多发病患病率从加纳的3∙9%到俄罗斯的33∙6%不等。对于患有越来越多的非传染性疾病的人来说，初级和二级保健中的医生就诊次数大幅增加。多病与中国的门诊次数相关(非传染性疾病次数系数=0∙56，95%CI=0∙46，0∙66)，在印度住院的可能性较高(∙=1∙59，95%CI=1∙45，1∙75)，在印度和中国的门诊自付费用较高，在俄罗斯的住院费用较高。在大多数国家，药品是多发病患者自付费用的最大比例(中国门诊88∙3%，住院55∙9%)。在中等收入国家，多发病与更高水平的医疗保健利用率和更大的个人经济负担有关。我们的研究支持世卫组织呼吁在低收入国家建立全民医疗保险和医疗服务覆盖范围，特别是为患有多发病的老年人等弱势群体提供医疗保险。
The burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Secondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007–2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models. The prevalence of multimorbidity in the adult population varied from 3∙9% in Ghana to 33∙6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0∙56, 95% CI = 0∙46, 0∙66), a higher likelihood of being hospitalised in India (AOR = 1∙59, 95% CI = 1∙45, 1∙75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88∙3% for outpatient, 55∙9% for inpatient visit in China) in most countries. Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.
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影响因子：
168.9
作者：
Atun, Rifat;Marie Knaul, Felicia;Frenk, Julio
通讯作者：
Frenk, Julio
影响因子：
8
作者：
FARRAR, DE;GLAUBER, RR
通讯作者：
GLAUBER, RR
影响因子：
4.4
作者：
Fortin, M;Bravo, G;Lapointe, L
通讯作者：
Lapointe, L
DOI：
10.1136/bmj.d4044
发表时间：
2011-07-28
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Barton P;Andronis L;Briggs A;McPherson K;Capewell S
通讯作者：
Capewell S
影响因子：
4.5
作者：
Hosseinpoor AR;Bergen N;Mendis S;Harper S;Verdes E;Kunst A;Chatterji S
通讯作者：
Chatterji S