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Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study.
Marthias, Tiara; Anindya, Kanya; Ng, Nawi; McPake, Barbara; Atun, Rifat; Arfyanto, Hafiz; Hulse, Emily Sg; Zhao, Yang; Jusril, Hafizah; Pan, Tianxin; Ishida, Marie; Lee, John Tayu.
  • Marthias T; Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
  • Anindya K; Department of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
  • Ng N; Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia kanindya@student.unimelb.edu.au.
  • McPake B; School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Atun R; Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
  • Arfyanto H; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
  • Hulse ES; SMERU Research Institute, Jakarta, Indonesia.
  • Zhao Y; Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
  • Jusril H; The George Institute for Global Health, Peking University Health Science Center, Beijing, China.
  • Pan T; WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia.
  • Ishida M; Center for Health Research, Universitas Indonesia, Depok, Indonesia.
  • Lee JT; Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open ; 11(2): e041870, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088252
ABSTRACT

OBJECTIVES:

To examine non-communicable diseases (NCDs) multimorbidity level and its relation to households' socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.

DESIGN:

This study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).

SETTING:

The original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.

PARTICIPANTS:

We included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents. PRIMARY OUTCOME

MEASURES:

We examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,

RESULTS:

Women were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.

CONCLUSIONS:

NCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Expenditures / Noncommunicable Diseases Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-041870

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Expenditures / Noncommunicable Diseases Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-041870