The Association between Multimorbidity and Out-Of-Pocket Healthcare Expenditure among Community-Dwelling Adults: findings from The Irish Longitudinal Study on Ageing (TILDA)

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2D.1

Presenter:

James Larkin

Twitter:

@LarkinJames

Co-authors:

Brendan Walsh PhD(2,3), Frank Moriarty PhD(1), Barbara Clyne PhD(1,5), Patricia Harrington PhD(5), Susan M. Smith MD(1,3)

Author institutions:

(1) RCSI University of Medicine and Health Sciences, Dublin, (2)Economic and Social Research Institute, Dublin 2, (3) Trinity College Dublin, Dublin 2, (4) The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, (5) Health Information and Quality Authority, Dublin,

Problem

Individuals with multimorbidity utilise more health services and take more medicines. This can lead to high out-of-pocket (OOP) healthcare expenditure. There are many potential consequences of high OOP healthcare expenditure, including reduced quality of life as well as non-adherence to medication and healthcare non-attendance, which in turn can have negative health consequences. 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.

Approach

We conducted a cross-sectional analysis of data collected in 2016 from Wave 4 of The Irish Longitudinal Study on Ageing. Participants were community-dwelling adults aged 50 years and over. A generalised linear model with log-link, and gamma distributed errors was fitted to assess the association between multimorbidity and self-reported OOP healthcare expenditure (including GP, emergency department, outpatients, specialist medical consultations, hospital admissions, home care and prescription drugs). The regression controlled for demographic and entitlement variables. A descriptive analysis of the relationship between multimorbidity and financial burden of healthcare was also conducted. Financial burden was defined as proportion of equivalised household income (household income divided by number of people in the household, with a weight of one for the first adult, 0.5 for each additional adult and 0.3 for each child) spent on healthcare. The research question and the conclusions were developed in consultation with a panel of people living with multimorbidity.

Findings

Overall, 3,453 (58.5%) participants had multimorbidity. Individuals with multimorbidity spent more on average per annum (€777.1 for two conditions, €853.9 for three or more conditions), than individuals with one condition (€651.9) or no conditions (€451.8). Prescription medicine expenditure was the largest component of expenditure. People with multimorbidity on average spent more of their equivalised household income on healthcare (6.8% for two conditions, 9.4% for three or more conditions), than people with one condition (5.9%) or no conditions (3.9%). A strong positive association was found between number of conditions and OOP healthcare expenditure (p<.001). A strong negative association was found between eligibility for free primary/hospital care and heavily subsidised medicines and OOP healthcare expenditure (p<.001).

Consequences

This study shows that having multimorbidity in Ireland increases OOP healthcare expenditure, even when controlling for several sociodemographic factors. This places a large financial burden on those with multimorbidity, which can lead to reduced quality of life as well as non-adherence to medication and healthcare non-attendance which in turn can have negative health consequences. 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 the greatest need.

Submitted by:

James Larkin

Funding acknowledgement:

This study is part of JL’s PhD, which is funded by the Health Research Board [CDA-2018-003]. TILDA, the original study on which this is based, is funded by the Irish Department of Health, Irish Life and Atlantic Philanthropies. BC is funded by Health Research Board (HRB) Emerging Investigator Award (EIA-2019-09).