Care-Seeking Pattern and Costs of Health Services in Individuals with Multiple Chronic Conditions

OBJECTIVES: Individuals with multiple chronic conditions require not only intensive but also comprehensive care, which is more complicated than those with only one or no chronic condition. The extent to which the medical care they receive is coordinated can have an impact on their health status, health-related quality of life, and, medical expenditures. Therefore, this study aimed to examine care-seeking pattern and medical costs of individuals with multiple chronic conditions, and identify factors associated with the pattern and medical costs.

METHODS: Adults with multiple chronic conditions were identified from the National Health Insurance (NHI) claims data, and subjects were randomly selected from those with 2-3, 4-5, and >5 chronic conditions, respectively. Logistic regression model was adopted to identify factors associated with better continuity of care index (COCI). Generalized linear models were used to examine factors associated with outpatient, inpatient, and total medical costs.

RESULTS: The majority of the sample were more than 65 years old and female. Subjects with more chronic conditions tended to be female, older, having lower income, having lower COCI, seeking medical care primarily from hospitals of higher accreditation levels, and incurring higher medical costs. Older age, more chronic conditions, seeking medical care primarily from hospitals of lower accreditation levels were associated with poorer continuity of care. Higher number of chronic conditions, poorer continuity of care, and seeking medical care primarily from hospitals of higher accreditation levels were associated with higher outpatient, inpatient, and total medical costs.

CONCLUSIONS: The findings of this study demonstrated that individuals with more chronic conditions were more likely to have poorer continuity of care, both were factors associated with higher medical costs. Therefore, it is of importance to provide coordinated care to individuals with multiple chronic conditions, particularly those suffering from more chronic conditions.