Patients with multiple chronic diseases left out of pocket

A new study has highlighted the high number of people in middle-income countries who suffer from more than one chronic disease.

Researchers at Imperial College London looked at data from WHO surveys in China, India, Mexico, Russia, Ghana and South Africa to assess the impact of “multimorbidity” – having two or more chronic conditions.

The surveys asked respondents if they had ever been diagnosed with angina, arthritis, asthma, cataracts, diabetes, stroke, chronic lung disease, high blood pressure or depression.

The study, published in PLOS ONE, found the highest prevalence of multimorbidity in Russia, where 33.6 per cent of the adult population has more than one chronic disease. The highest rates of multimorbidity were in older people, with 40 per cent of people aged 70 or over having more than one disease across the countries studied.

As expected, the study found that people with multiple chronic diseases spent more days in hospital and made more hospital visits as outpatients.

They also spent more on healthcare. Although the countries in the study have taken steps toward universal health coverage, many patients are not covered by health insurance and some who are still have to pay a proportion of the costs of their treatment. In India and China, less than five per cent of respondents reported that their last healthcare visit was free. In Russia and South Africa, more than half of outpatient visits were free.

Rates of multimorbidity were higher among city-dwellers and more affluent groups, possibly resulting from wealthier people being more likely to have their chronic diseases diagnosed.

Study lead author Dr John Tayu Lee, from the School of Public Health at Imperial College London, said: “These findings show that multimorbidity places an enormous burden on health systems and on individuals who have to pay for their treatment. They emphasise the importance of pushing for universal health insurance in low and middle-income countries.

“To reduce the burden of multimorbidity, strong primary care systems are crucial to coordinate the diagnosis and management of chronic conditions. Countries also need to invest in public health programmes that help prevent chronic diseases and reduce risk factors in the population.”

Dr Christopher Millett,  the senior author, also from the School of Public Health at Imperial, said: “Despite the growing prevalence of multimorbidity, current clinical practice frequently focuses on single diseases in isolation. Our findings suggest we need to think more carefully about how to treat patients who have multiple chronic conditions.” 

Reference: J.T. Lee et al. ‘Impact of noncommunicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: cross sectional analysis.’ PLOS ONE, 8 July 2015 DOI: 10.1371/journal.pone.0127199