ArticleBMC health services research2021
Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Equitable utilization of non-communicable disease services in low- and middle-income countries; associated factors and intervention effects: a systematic review and meta-analysis.BMC health services research · 2026Pooled it
- The association between educational level and multimorbidity among adults in Southeast Asia: A systematic review.PloS one · 2021Pooled it
- Article
- Financial burden of noncommunicable diseases on households in Bangladesh: a quasi-experimental analysis using national survey data.Health economics review · 2026Article
- Financial burden of older inpatients with multimorbidity in China: a cross-sectional study.Frontiers in public health · 2026Article
- How do people with multimorbidity prioritise healthcare when faced with tighter financial constraints? A national survey with a choice experiment component.BMC primary care · 2025Article
- Effectiveness of Community Nurse-Led Intervention in Managing Older Adults with Multimorbidity: A Systematic Review of Randomized Controlled Trials.Journal of multidisciplinary healthcare · 2025Review
- Impact of age and gender differences in the prevalence and patterns of multimorbidity in the Thai Cohort Study.International health · 2024Article
- Treatment Nonadherence among Multimorbid Chronic Disease Patients: Evidence from 3515 Subjects in Indonesia.Medicina (Kaunas, Lithuania) · 2024Article
- The impact of multimorbidity among adults with cardiovascular diseases on healthcare costs in Indonesia: a multilevel analysis.BMC public health · 2024Article
- Out-of-pocket expenditures associated with double disease burden in Pakistan: a quantile regression analysis.BMC public health · 2024Article
- Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis.BMC public health · 2024Article
- Findings from the Indonesian family life survey on patterns and factors associated with multimorbidity.Scientific reports · 2023Article
- Functional limitation as a mediator of the relationship between multimorbidity on health-related quality of life in Australia: evidence from a national panel mediation analysis.Frontiers in medicine · 2023Article
- The impact of depression and physical multimorbidity on health-related quality of life in China: a national longitudinal quantile regression study.Scientific reports · 2022Article
- Article
- Role of publicly funded health insurance in financial protection of the elderly from hospitalisation expenditure in India-findings from the longitudinal aging study.BMC geriatrics · 2022Article
- How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state.Health economics review · 2022Article
- Catastrophic health expenditure due to hospitalisation for COVID-19 treatment in India: findings from a primary survey.BMC research notes · 2022Article
- Multimorbidity and out-of-pocket expenditure on medicine in Europe: Longitudinal analysis of 13 European countries between 2013 and 2015.Frontiers in public health · 2022Article
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Authors and funding
9 authors.
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Abstract
backgroundMultimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE).
methodsWe conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE.
resultsOverall, 20.8% of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95% CI 0.07-0.14 for outpatient care and coefficient 0.09 (95% CI 0.02-0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95% CI 11.4-42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95% CI 0.5-1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95% CI 15.9-46.2).
conclusionMultimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher level of health care utilisation.
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