Catastrophic health expenditure and multimorbidity among older adults in Brazil
DOI:
https://doi.org/10.11606/s1518-8787.2020054002285Keywords:
Aged, Multimorbidity, Socioeconomic Factors, Cost of Illness, Catastrophic ExpenditureAbstract
OBJECTIVE: To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older. METHODS: This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI – Brazilian Longitudinal Study of Aging) conducted in 2015–2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression. RESULTS: Th e p revalence o f C HE w as 17.9% a nd 7.5%, f or e xpenditures c orresponding t o 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67–2.28, and OR = 1.40, 95%CI 1.11–1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores. CONCLUSIONS: Th e r esults d raw a ttention t o t he n eed f or a n i ntegrated a pproach o f multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions.
References
World Health Organization. Global report: Public Spending on Health: a closer look at global trends. Geneva: WHO; 2018.
Hsiao WC. Why is a systemic view of health financing necessary?health affairs. Health Aff (Millwood). 2007;26(4):950-61.
https://doi.org/10.1377/hlthaff.26.4.950
World Health Organization. Tracking universal health coverage: 2017Global Monitoring Report. Geneva: WHO; 2017. Co-published by the The World Bank.
Wagstaff A, Flores G, Hsu J, Smitz MF, Chepynoga K, Buisman LR, et al. Progress on catastrophic health spending in 133 countries: a retrospective observational study. Lancet Glob Health. 2018;6(2):e169-79.
https://doi.org/10.1016/S2214-109X(17)30429-1
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362(9378):111-7. https://doi.org/10.1016/S0140-6736(03)13861-5
World Health Organization. World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva: WHO; 2018.
Barros AJ, Bastos JL, Dâmaso AH. Catastrophic spending on health care in Brazil: private health insurance does not seem to be the solution. Cad Saude Publica. 2011;27 Suppl 2: s254-62. https://doi.org/10.1590/S0102-311X2011001400012
Boing AC, Bertoldi AD, Barros AJD, Posenato LG, Peres KG. Socioeconomic inequality in catastrophic health expenditure in Brazil. Rev Saude Publica. 2014;48(4):632-41. https://doi.org/10.1590/S0034-8910.2014048005111
McRae I, Yen L, Jeon YH, Herath PM, Essue B. Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions. Aust J Prim Health. 2013;19(2):144-9. https://doi.org/10.1071/PY12035
Sum G, Hone T, Atun R, Millett C, Suhrcke M, Mahal A, et al. Multimorbidity and out-of-pocket expenditure on medicines: a systematic review. BMJ Glob Health. 2018;3(1): e000505. https://doi.org/10.1136/bmjgh-2017-000505
GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-1210.
https://doi.org/10.1016/S0140-6736(17)32152-9
Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an older adult community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15:23. https://doi.org/10.1186/s12913-015-0698-2
World Health Organization. The World Health Report 2008 - primary health care (now more than ever). Geneva: WHO; 2008.
Kingston A, Robinson L, Booth H, Knapp M, Jagger C; MODEM project. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018;47(3):374-80. https://doi.org/10.1093/ageing/afx201
Picco L, Achilla E, Abdin E, Chong SA, Vaingankar JA, McCrone P, et al. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016; 16:173. https://doi.org/10.1186/s12913-016-1421-7
Lima-Costa MF, Facchini LA, Matos DL, Macinko J. Mudanças em dez anos das desigualdades sociais em saúde dos idosos brasileiros (1998-2008). Rev Saude Publica. 2012;46 Supl 1:100-7. https://doi.org/10.1590/S0034-89102012005000059
Lima-Costa MF, Andrade FB, Souza Jr PRB, Neri AL, Duarte YAO, Castro-Costa E, et al. The Brazilian Longitudinal Study of Aging (ELSI-Brazil): objectives and design. Am J Epidemiol. 2018;187(7):1345-53. https://doi.org/10.1093/aje/kwx387
Fry K, Firestone R, Chakraborty NM. Measuring equity with nationally representative wealth quintiles. Washington, DC: Population Services International; 2014.
Azzani M, Roslani AC, Su TT. Determinants of household catastrophic health expenditure: a systematic review. Malays J Med Sci. 2019;26(1):15-43. https://doi.org/10.21315/mjms2019.26.1.3
Arenliu Qosaj F, Froeschl G, Berisha M, Bellaqa B, Holle R. Catastrophic expenditures and impoverishment due to out-of-pocket health payments in Kosovo. Cost Eff Resour Alloc. 2018; 16:26. https://doi.org/10.1186/s12962-018-0111-1
Cavalcanti G, Doring M, Portella MR, Bortoluzzi EC, Mascarelo A, Dellani MP. Multimorbidity associated with polypharmacy and negative self-perception of health. Rev Bras Geriatr Gerontol. 2017;20(5):634-42.
https://doi.org/10.1590/1981-22562017020.170059
Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A. Measuring catastrophic health expenditures and its inequality: evidence from Iran’s Health Transformation Program. Health Policy Plan. 2019;34(4):316-25. https://doi.org/10.1093/heapol/czz031
Castro MC, Massuda A, Almeida G, Menezes-Filho NA, Andrade MV, Noronha KVMS, et al. Brazil’s unified health system: the first 30 years and prospects for the future. Lancet. 2019;394(10195):345-56.
https://doi.org/10.1016/S0140-6736(19)31243-7
Macinko J, Andrade FB, Souza Junior PRB, Lima-Costa MF. Primary care and healthcare utilization among older Brazilians (ELSI-Brazil). Rev Saude Publica. 2018;52 Suppl 2:6s. https://doi.org/10.11606/S1518-8787.2018052000595
Oliveira MA, Luiza VL, Tavares NUL, Mengue SS, Arrais PSD, Farias MR et al. Acesso a medicamentos para doenças crônicas no Brasil: uma abordagem multidimensional. Rev Saude Publica. 2016;50 Supl 2:6s. https://doi.org/10.1590/s1518-8787.2016050006161
Boing AC, Bertoldi AD, Boing AF, Bastos JL, Peres KG. Acesso a medicamentos no setor público: análise de usuários do Sistema Único de Saúde no Brasil. Cad Saude Publica. 2013;29(4):691-701. https://doi.org/10.1590/S0102-311X2013000400007
Matta SR, Bertoldi AD, Emmerick ICM, Fontanella AT, Costa KS, Luiza VL; Grupo PNAUM. Fontes de obtenção de medicamentos por pacientes diagnosticados com doenças crônicas, usuários do Sistema Único de Saúde. Cad Saude Publica. 2018;34(3): e00073817. https://doi.org/10.1590/0102-311x00073817
Knaul FM, Arreola-Ornelas H, Wong R, Lugo-Palacios DG, Méndez-Carniado O. Efecto del Seguro Popular de Salud sobre los gastos catastróficos y empobrecedores en México, 2004-2012. Salud Publica Mex. 2018;60(2):130-40. https://doi.org/10.21149/9064
Zhao SW, Zhang XY, Dai W, Ding YX, Chen JY, Fang PQ. Effect of the catastrophic medical insurance on household catastrophic health expenditure: evidence from China. Gac Sanit. 2020;34(4):370-6. https://doi.org/10.1016/j.gaceta.2018.10.005
Macintyre S, Der G, Norrie J. Are there socioeconomic differences in responses to a commonly used self report measure of chronic illness? Int J Epidemiol. 2005;34(6):1284-90. https://doi.org/10.1093/ije/dyi200
Downloads
Published
Issue
Section
License
Copyright (c) 2020 Revista de Saúde Pública
This work is licensed under a Creative Commons Attribution 4.0 International License.
