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What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study

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posted on 15.09.2022, 08:31 authored by James LarkinJames Larkin, Brendan Walsh, Frank MoriartyFrank Moriarty, Barbara ClyneBarbara Clyne, Patricia Harrington, Susan SmithSusan Smith

Objectives: Individuals with multimorbidity use more health services and take more medicines. This can lead to high out-of-pocket (OOP) healthcare expenditure. This study, therefore, aimed to assess the association between multimorbidity (two or more chronic conditions) and OOP healthcare expenditure in a nationally representative sample of adults aged 50 years or over.

Design: Cross-sectional analysis of data collected in 2016 from wave 4 of The Irish Longitudinal Study on Ageing.

Setting: Ireland.

Participants: Community-dwelling adults aged 50 years and over.

Method: A generalised linear model with log-link and gamma distributed errors was fitted to assess the association between multimorbidity and OOP healthcare expenditure (including general practitioner, emergency department, outpatients, specialist consultations, hospital admissions, home care and prescription drugs).

Results: Overall, 3453 (58.5%) participants had multimorbidity. Among those with any OOP healthcare expenditure, individuals with multimorbidity spent more on average per annum (€806.8 for two conditions, €885.8 for three or more conditions), than individuals with no conditions (€580.3). Pharmacy-dispensed medicine expenditure was the largest component of expenditure. People with multimorbidity on average spent more of their equivalised household income on healthcare (7.1% for two conditions, 9.7% for three or more conditions), than people with no conditions (5.0%). A strong positive association was found between number of conditions and OOP healthcare expenditure (p<0.001) and between having private health insurance and OOP healthcare expenditure (p<0.001). A strong negative association was found between eligibility for free primary/hospital care and heavily subsidised medicines and OOP healthcare expenditure (p<0.001).

Conclusions: This study suggests that having multimorbidity in Ireland increases OOP healthcare expenditure, which is problematic for those with more conditions who have lower incomes. This highlights the need for this financial burden to be considered when designing healthcare/funding systems to address multimorbidity, so that access to essential healthcare can be maximised for those with greatest need.

Funding

The Health Research Board (CDA-2018-003)

History

Comments

The original article is available at https://bmjopen.bmj.com/

Published Citation

Larkin J, Walsh B, Moriarty F, Clyne B, Harrington P, Smith SM. What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study. BMJ Open, 2022;12:e060502.

Publication Date

1 September 2022

Department/Unit

  • General Practice
  • School of Pharmacy and Biomolecular Sciences

Research Area

  • Population Health and Health Services

Publisher

BMJ

Version

  • Published Version (Version of Record)