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https://doi.org/10.1371/journal.pone.0127199
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dc.title | Impact of noncommunicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: Cross sectional analysis | |
dc.contributor.author | Lee J.T. | |
dc.contributor.author | Hamid F. | |
dc.contributor.author | Pati S. | |
dc.contributor.author | Atun R. | |
dc.contributor.author | Millett C. | |
dc.date.accessioned | 2019-11-06T01:28:58Z | |
dc.date.available | 2019-11-06T01:28:58Z | |
dc.date.issued | 2015 | |
dc.identifier.citation | Lee J.T., Hamid F., Pati S., Atun R., Millett C. (2015). Impact of noncommunicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: Cross sectional analysis. PLoS ONE 10 (7) : e0127199. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0127199 | |
dc.identifier.issn | 19326203 | |
dc.identifier.uri | https://scholarbank.nus.edu.sg/handle/10635/161500 | |
dc.description.abstract | Background: The burden of non-communicable disease (NCDs) has grown rapidly in low- and middleincome 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. Methods: 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. Results: 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. Conclusion: 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. Copyright: © 2015 Lee et al. | |
dc.rights | Attribution 4.0 International | |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.source | Unpaywall 20191101 | |
dc.subject | adult | |
dc.subject | age | |
dc.subject | aged | |
dc.subject | Article | |
dc.subject | China | |
dc.subject | cost benefit analysis | |
dc.subject | cost of illness | |
dc.subject | cross-sectional study | |
dc.subject | developing country | |
dc.subject | female | |
dc.subject | Ghana | |
dc.subject | health care cost | |
dc.subject | health care utilization | |
dc.subject | health insurance | |
dc.subject | hospital admission | |
dc.subject | human | |
dc.subject | India | |
dc.subject | major clinical study | |
dc.subject | male | |
dc.subject | Mexico | |
dc.subject | middle aged | |
dc.subject | morbidity | |
dc.subject | multimorbidity | |
dc.subject | non communicable disease | |
dc.subject | outpatient care | |
dc.subject | prevalence | |
dc.subject | Russian Federation | |
dc.subject | South Africa | |
dc.subject | urban rural difference | |
dc.subject | very elderly | |
dc.subject | young adult | |
dc.subject | comorbidity | |
dc.subject | demography | |
dc.subject | developing country | |
dc.subject | diseases | |
dc.subject | economics | |
dc.subject | income | |
dc.subject | outpatient | |
dc.subject | patient attitude | |
dc.subject | Adult | |
dc.subject | Comorbidity | |
dc.subject | Cross-Sectional Studies | |
dc.subject | Demography | |
dc.subject | Developing Countries | |
dc.subject | Disease | |
dc.subject | Female | |
dc.subject | Health Expenditures | |
dc.subject | Humans | |
dc.subject | Income | |
dc.subject | Male | |
dc.subject | Outpatients | |
dc.subject | Patient Acceptance of Health Care | |
dc.type | Article | |
dc.contributor.department | SAW SWEE HOCK SCHOOL OF PUBLIC HEALTH | |
dc.description.doi | 10.1371/journal.pone.0127199 | |
dc.description.sourcetitle | PLoS ONE | |
dc.description.volume | 10 | |
dc.description.issue | 7 | |
dc.description.page | e0127199 | |
dc.published.state | Published | |
Appears in Collections: | Staff Publications Elements |
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