Study On Direct Economic Burden And Its Influencing Factors Of Elderly Patients With Chronic Disease Based On Disability Classification

[Purpose] Compare the distribution of health service utilization(HSU)and direct economic burden(DEB)of chronically ill elderly in China under different classifications of disability and conditions about multimorbidity,analyze the impact of the classification of disability and condition about multimorbidity on HSU and DEB,discuss other influencing factors of DEB and HSU,and provide targeted strategies related to the reduction of economic burden of disease and the improvement of health status of the elderly.[Methods] Based on the literature analysis of the disability assessment and classification methods,the relationship between multimorbidity and disability and HSU and health expenditure,the influencing factors of disease economic burden,the strategies about multimorbidity management and disability prevention,the 2015 data from the China Health and Retirement Longitudinal Study was used for empirical analysis.7155 elderly people aged 60 and above with at least one chronic disease were selected as the research sample.Based on the descriptive statistical analysis of HSU and DEB for the samples of different classifications of disability,latent category analysis and association rule analysis were used to determine the latent categories of multimorbidity and the common multimorbidity patterns of people in different latent categories respectively.And negative binomial regression model,binary logit regression model and multiple linear regression model were adopted to study the impact of classification of disability,condition about multimorbidity(including whether having multimorbidity,the number of multimorbidity and the latent category of multimorbidity),population socioeconomic and health related factors on DEB and HSU.[Results]1.In the overall sample,the prevalence of multimorbidity was 61.4%,and the impairment rates of cognitive function,IADL and ADL were 57.3%,41.4% and 32.4%respectively.In terms of the classification of disability,the proportion of the non-disabled elderly was relatively small(24.6%),and the moderately,the moderately to severely,the severely and the mildly disabled elderly accounted for 34.2%,17.0%,14.8% and 9.4% ofthe total respectively.The differences of ADL,IADL and cognitive impairment,and the classification of disability between multimorbidity and non-multimorbidity all passed the significant test.With the deterioration of ADL and IADL,the prevalence of multimorbidity also increased,while the prevalence of multimorbidity among the elderly without impaired cognitive function was higher than that of the elderly with impaired cognitive function.2.With the descriptive statistical analysis,we found that there were significant difference of the distribution of visit rate,hospitalization rate,self-treatment rate,number of visits and hospitalizations,DEB,direct medical burden(DMB)and direct non-medical burden(DNB)in terms of the classifications of disability.The visit rate,hospitalization rate,number of hospitalizations,DEB and DMB showed an upward trend with the degree of disability.3.Latent category analysis revealed five latent categories of multimorbidity,namely the high circulatory system disease prevalence group(n=634,8.9%),the high respiratory system disease prevalence group(n=1056,14.8%),the high musculoskeletal system disease prevalence group(n=1407,19.7%),the high digestive system disease prevalence group(n=1421,19.9%)and the lower prevalence group(n=2637,36.9%).The results of association rule analysis showed the common multimorbidity patterns of people in different latent categories.With the descriptive statistical analysis,we found that there were significant difference of the distribution of visit rate,hospitalization rate,self-treatment rate,number of visits and hospitalizations,DEB,DMB and DNB in terms of the conditions about multimorbidity.Multimorbid patients had higher visit rate,hospitalization rate,self-treatment rate,number of visits and hospitalizations,DEB,DMB and DNB than non-multimorbid patients.The visit rate,hospitalization rate,self-treatment rate,number of visits and hospitalizations,DEB,DMB and DNB were the highest in the high circulatory system disease prevalence group.As the number of multimorbidity increased,the DEB,DMB and DNB also increased,and the visit rate,hospitalization rate,self-treatment rate,number of visits and hospitalizations showed an upward trend.4.The results of multivariate analysis showed that,the classification of disability,thenumber of multimorbidity and the latent category of multimorbidity were the influencing factors for HSU and DEB.Compared with the non-disabled elderly,the moderately to severely and the severely disabled elderly had a lower probability of self-treatment,but had higher number of visits,number of hospitalizations and DEB.Multimorbid patients had more HSU and DEB than non-multimorbid patients,and the number of multimorbidity had a positive effect.Compared with other groups,the high circulatory system disease prevalence group had higher levels of HSU and DEB.Males had a lower probability of self-treatment,but had higher number of hospitalizations and DEB.Compared with the self-financed elderly,the elderly who participate in Urban Employee Basic Medical Insurance and other types of medical insurance(mostly for free medical care)had higher levels of HSU and DMB.The rural elderly had higher levels of DNB than the urban elderly.[Conclusions]1.The classification of disability was closely related to the hospitalization of elderly patients with chronic diseases,and the multimorbid elderly with severe disability faced heavier DEB.Therefore,it is suggested that in order to alleviate the pressure on the supply of medical resources and reduce the cost burden of disabled people,on the one hand,we should base on preventing the occurrence and aggravation of disability,and formulate and implement comprehensive and effective intervention strategies and measures.On the other hand,it is necessary to accelerate the establishment of a formal long-term care system to reasonably protect the medical expenses of disabled people.In addition,it also shows that the prevention and control of chronic diseases and multimorbidity is particularly important for the disabled elderly.2.The multimorbid elderly who suffered from more co-existing chronic diseases or cardiovascular diseases made more use of health services and faced considerably heavy DEB.It is recommended to continue to promote early prevention screening and disease control management of chronic diseases and multimorbidity,strengthen primary prevention and health management of cardiovascular diseases,actively prevent cardiovascular disease patients from developing other chronic diseases,especially diabetes.Besides,we suggestaccelerating the establishment of standardized clinical practice guidelines for multimorbidity in China,and promoting clinicians to comprehensively consider coexisting conditions of each individual with multimorbidity for clinical decision-making by developing general medicine and improving general practitioner system.3.The elderly with chronic diseases in rural areas faced higher DNB than those with chronic diseases in urban areas.Further improving the allocation of medical resources in remote areas,and enhancing the accessibility of residents’ medical resources is recommended.And for rural areas,the construction of health care services system needs continuous efforts in capacity building,and the improvement of residents’ access to medical care needs to emphasize the accessibility of high-quality medical resources.4.The elderly who participate in UEBMI or free medical care(these two types of medical insurance have a relatively higher level of security)had more out-of-pocket expenses than the uninsured elderly.This requires strengthening the control of medical expenses from both the medical service demand side and the supply side to further alleviate the burden of patients’ out-of-pocket expenditures and the payment pressure of medical insurance fund.