Tablets in a pill box

Patients with multiple chronic diseases face higher out-of-pocket expenses

Tackling each disease in isolation may lead to the prescription of unnecessary medicines, resulting in expenses that are disproportionate to the number of conditions a patient has.

These out-of-pocket expenditures (OOPE), which are costs not covered by insurance, increase dramatically with the number of non-communicable diseases (NCDs) a patient has, according to a study led by SSHSPH and the University of Melbourne that was recently published in BMJ Global Health.

The team systematically reviewed 14 studies across Australia, Canada, India, South Korea and USA, and found that when compared to patients with no chronic diseases, annual OOPE on medicines increased by 2.7 times for patients with one NCD, 5.2 times for patients with two NCDs and 10.1 times for those with three or more NCDs. To add on, the elderly and low-income groups are more vulnerable to higher OOPE on medicines.

For these patients with high spending on medicines, a common coping mechanism is non-adherence, where they stop taking their medication by failing to refill their prescriptions.

The study was led by SSHSPH PhD student Dr Grace Sum Chi-En and senior author Dr John Tayu Lee from the University of Melbourne. Associate Professor Gerald Koh, Domain Leader (Health Systems & Behavioural Sciences), is also a co-author in this study.

This paper was also presented by Dr Sum at the 10th European Public Health Conference, held on 1–4 November 2017 in Stockholm, Sweden.

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