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Universal Health Coverage for Multimorbidity

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 15787

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Special Issue Editor

Dr. John Tayu Lee

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Guest Editor

School of Public Health, University of Melbourne, Melbourne, Australia
Interests: disease modeling; health economics; disease burden

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on universal health coverage for multimorbidity in low-and middle-income countries in the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed, scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information about the journal, we refer you to https://0-www-mdpi-com.brum.beds.ac.uk/journal/ijerph.

Non-communicable diseases (NCDs) are the leading cause of global disease burden, with 80% of NCD mortality occurring in low- and middle-income countries (LMICs). As the populations in these countries age, the prevalence of multimorbidity, defined as persons with two or more co-existing chronic conditions, will likely increase. A recent nationally representative Chinese study, based on 11 physical chronic conditions, found that the prevalence of multimorbidity increased from 51% in those aged between 50 and 54 years to 71% for those aged 75 years and above. Despite the growing prevalence of NCD multimorbidity in LMICs, there is little attention given to the impacts of multimorbidity on individuals and health systems as opposed to a single chronic disease.
The United Nations High-Level Meeting on NCDs in 2018 stressed the enormous challenge posed by the growing burden of NCDs for health systems in LMICs.
This Special Issue seeks contributions involving health system and health economics research in multimorbidity in topics such as

The economic causes and consequences of multimorbidity in high- income countries (HICs), and LMICs;
Health seeking behaviour for patients with multimorbidity in high-income countries (HICs) LMICs;
Patterns of multimorbidity, including the relationships between physical and mental NCDs;
Health policies and interventions to tackle risk factors for multimorbidity;

5. Health system reform to improve access and financial protection for patients with NCDs.

Dr. John Tayu Lee
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

chronic condition
non-communicable disease
multimorbidity
LMICs
mental health condition
primary care
universal health coverage

Published Papers (5 papers)

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Research

13 pages, 706 KiB

Open AccessArticle

Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens

by Sanghamitra Pati, Abhinav Sinha, Shishirendu Ghosal, Sushmita Kerketta, John Tayu Lee and Srikanta Kanungo

Int. J. Environ. Res. Public Health 2022, 19(16), 9850; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19169850 - 10 Aug 2022

Cited by 5 | Viewed by 1370

Abstract

Most evidence on multimorbidity is drawn from an individual level assessment despite the fact that multimorbidity is modulated by shared risk factors prevailing within the household environment. Our study reports the magnitude of family-level multimorbidity, its correlates, and healthcare expenditure among older adults using data from the Longitudinal Ageing Study in India (LASI), wave-1. LASI is a nationwide survey amongst older adults aged ≥45 years conducted in 2017–2018. We included (n = 22,526) families defined as two or more members coresiding in the same household. We propose a new term, “family-level multimorbidity”, defined as two or more members of a family having multimorbidity. Multivariable logistic regression was used to assess correlates, expressed as adjusted odds ratios with a 95% confidence interval. Family-level multimorbidity was prevalent among 44.46% families, whereas 41.8% had conjugal multimorbidity. Amongst siblings, 42.86% reported multimorbidity and intergenerational (three generations) was 46.07%. Family-level multimorbidity was predominantly associated with the urban and affluent class. Healthcare expenditure increased with more multimorbid individuals in a family. Our findings depict family-centred interventions that may be considered to mitigate multimorbidity. Future studies should explore family-level multimorbidity to help inform programs and policies in strategising preventive as well as curative services with the family as a unit. Full article

(This article belongs to the Special Issue Universal Health Coverage for Multimorbidity)

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13 pages, 996 KiB

Open AccessArticle

Multimorbidity and Complex Multimorbidity in India: Findings from the 2017–2018 Longitudinal Ageing Study in India (LASI)

by Abhinav Sinha, Sushmita Kerketta, Shishirendu Ghosal, Srikanta Kanungo, John Tayu Lee and Sanghamitra Pati

Int. J. Environ. Res. Public Health 2022, 19(15), 9091; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159091 - 26 Jul 2022

Cited by 10 | Viewed by 1893

Abstract

Complex multimorbidity refers to the co-occurrence of three or more chronic illnesses across >2 body systems, which may identify persons in need of additional medical support and treatment. There is a scarcity of evidence on the differences in patient outcomes between non-complex (≥2 conditions) and complex multimorbidity groups. We evaluated the prevalence and patient outcomes of complex multimorbidity and compared them to non-complex multimorbidity. We included 30,489 multimorbid individuals aged ≥45 years from the Longitudinal Ageing Study in India (LASI) from wave-1 conducted in 2017–2018. We employed a log link in generalised linear models (GLM) to identify possible risk factors presenting the adjusted prevalence–risk ratio (APRR) and adjusted prevalence–risk difference (APRD) with 95% confidence interval. The prevalence of complex multimorbidity was 34.5% among multimorbid individuals. Participants residing in urban areas [APRR: 1.10 (1.02, 1.20)], [APRD: 0.04 (0.006, 0.07)] were more likely to report complex multimorbidity. Participants with complex multimorbidity availed significantly higher inpatient department services and had higher expenditure as compared to the non-complex multimorbidity group. Our findings have major implications for healthcare systems in terms of meeting the requirements of people with complicated multimorbidity, as they have significantly higher inpatient health service utilisation, higher medical costs, and poorer self-rated health. Full article

(This article belongs to the Special Issue Universal Health Coverage for Multimorbidity)

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15 pages, 4999 KiB

Open AccessFeature PaperArticle

Socioeconomic Determinants of Universal Health Coverage in the Asian Region

by Tomoyuki Takura and Hiroko Miura

Int. J. Environ. Res. Public Health 2022, 19(4), 2376; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042376 - 18 Feb 2022

Cited by 9 | Viewed by 3371

Abstract

The World Health Organization (WHO) states that examining medical financial systems is the most important process in evaluating universal health coverage (UHC). This study used the service coverage index (SCI) as a proxy of the progress toward UHC in eleven Asian countries. We employed a fixed-effects regression model to analyze panel data from 2015 to 2017, to explain the interrelationship between the SCI and major socioeconomic indicators. We also conducted a performance analysis (ratio of achieved SCI level to gross domestic product (GDP) or health expenditure displacement) to examine the balance between the degree of achievements related to UHC and a country’s economic level. The results showed that GDP and health expenditure were significantly positively correlated with the SCI (p < 0.01). The panel data analysis results showed that GDP per capita was a factor that greatly influenced the SCI as well as poverty (partial regression coefficient: 0.0017, 95% CI: 0.0013–0.0021). The results of the performance analysis showed that the Philippines had the highest scores (GDP: 1.84 SCI score/USD per capita, health expenditure: 1.04 SCI score/USD per capita) and South Korea the lowest. We conclude that socioeconomic factors, such as GDP, health expenditure, unemployment, poverty, and population influence the progress of UHC, regardless of system maturity or geographic characteristics. Full article

(This article belongs to the Special Issue Universal Health Coverage for Multimorbidity)

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13 pages, 763 KiB

Open AccessArticle

Association of Oral Health with Multimorbidity among Older Adults: Findings from the Longitudinal Ageing Study in India, Wave-1, 2017–2019

by Srikanta Kanungo, Shishirendu Ghosal, Sushmita Kerketta, Abhinav Sinha, Stewart W Mercer, John Tayu Lee and Sanghamitra Pati

Int. J. Environ. Res. Public Health 2021, 18(23), 12853; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312853 - 06 Dec 2021

Cited by 13 | Viewed by 2510

Abstract

India is witnessing an increase in the prevalence of multimorbidity. Oral health is related to overall health but is seldom included in the assessment of multimorbidity. Hence, this study aimed to estimate the prevalence of oral morbidity and explore its association with physical multimorbidity using data from Longitudinal Ageing Study in India (LASI). LASI is a nationwide survey amongst adults aged ≥ 45 years conducted in 2018. Descriptive analysis was performed on included participants (n = 59,764) to determine the prevalence of oral morbidity. Multivariable logistic regression assessed the association between oral morbidity and physical multimorbidity. Self-rated health was compared between multimorbid participants with and without oral morbidity. Oral morbidity was prevalent in 48.56% of participants and physical multimorbidity in 50.36%. Those with multimorbidity were at a higher risk of having any oral morbidity (AOR: 1.60 (1.48–1.73)) than those without multimorbidity. Participants who had only oral morbidity rated their health to be good more often than those who had physical multimorbidity and oral morbidity (40.84% vs. 32.98%). Oral morbidity is significantly associated with physical multimorbidity. Multimorbid participants perceived their health to be inferior to those with only oral morbidity. The findings suggest multidisciplinary health teams in primary care should include the management of oral morbidity and physical multimorbidity. Full article

(This article belongs to the Special Issue Universal Health Coverage for Multimorbidity)

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22 pages, 2849 KiB

Open AccessArticle

Reorienting Primary Health Care Services for Non-Communicable Diseases: A Comparative Preparedness Assessment of Two Healthcare Networks in Malawi and Zambia

by Veronica Shiroya, Naonga Shawa, Beatrice Matanje, John Haloka, Elvis Safary, Chikondi Nkhweliwa, Olaf Mueller, Sam Phiri, Florian Neuhann and Andreas Deckert

Int. J. Environ. Res. Public Health 2021, 18(9), 5044; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18095044 - 10 May 2021

Cited by 4 | Viewed by 5607

Abstract

Despite positive NCD policies in recent years, majority of Sub-Saharan African (SSA) health systems are inadequately prepared to deliver comprehensive first-line care for NCDs. Primary health care (PHC) settings in countries like Malawi and Zambia could be a doorway to effectively manage NCDs by moving away from delivering only episodic care to providing an integrated approach over time. As part of a collaborative health system strengthening project, we assessed and compared the preparedness and operational capacity of two target networks of public PHC settings in Lilongwe (Malawi) and Lusaka (Zambia) to integrate NCD services within routine service delivery. Data was collected and analyzed using validated health facility survey tools. These baseline assessments conducted between August 2018 and March 2019, also included interviews with 20 on-site health personnel and focal persons, who described existing barriers in delivering NCD services. In both countries, policy directives to decentralize disease-specific NCD services to the primary care level were initiated to meet increased demand but lacked operational guidance. In general, the assessed PHC sites were inadequately prepared to integrate NCDs into various service delivery domains, thus requiring further support. In spite of existing multi-faceted limitations, there was motivation among healthcare staff to provide NCD services. Full article

(This article belongs to the Special Issue Universal Health Coverage for Multimorbidity)

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