Presentation (CTI)

OBJECTIVES: Multimorbidity is associated with substantial health, and financial burden. Despite relatively universal healthcare coverage in European Union (EU) countries, many individuals continue to face out-of-pocket (OOP) expenditures. This study examined the association between multimorbidity and OOP healthcare expenditure among adults aged 50 years and older across 29 EU countries (Austria, Germany, Sweden, Netherlands, Spain, Italy, France, Denmark, Greece, Switzerland, Belgium, Israel, Czech Republic, Poland, Ireland, Luxembourg, Hungary, Portugal, Slovenia, Estonia, Croatia, Lithuania, Bulgaria, Cyprus, Finland, Latvia, Malta, Romania, Slovakia).
METHODS: A cross-sectional analysis using data from the SHARE Wave 7 was implemented. OOP expenditure represents spending on inpatient care, outpatient care, medications, nursing/home care, and medical aids or appliances. Analyses were restricted to countries with available OOP data. Multimorbidity was measured as the number of chronic diseases (i.e., diabetes, heart conditions, cancer) and categorized as 0, 1, 2, or ≥3 conditions. The mean OOP expenditure was calculated , and a fixed-effect regression model controlling for age, sex, and country were used to assess the association between multimorbidity and OOP expenditure. Due to the skewed distribution of expenditure data, log-transformed annual OOP expenditure was used as the primary outcome. Model diagnostics indicated adequate fit.
RESULTS: Data was analysed for 12,161 responders. Mean annual OOP costs increased with multimorbidity (€489, €565, €631, and €820 for 0, 1, 2, and ≥3 chronic conditions, respectively). Mean OOP expenditure ranged from €1421 in Switzerland to €215 in Czech Republic. In the multivariable model, annual OOP expenditure was 37%, 63%, and 130% higher among individuals with 1, 2, and ≥3 chronic conditions, respectively, compared with those without chronic conditions (all p<0.001).
CONCLUSIONS: Multimorbidity increased the mean OOP payments for healthcare. Policies should focus on reducing these expenditures by improving coverage of essential health services and increasing support of vulnerable households.