The impact of multimorbidity among adults with cardiovascular diseases on healthcare costs in Indonesia: a multilevel...

Area of Science:

• Health Economics
• Public Health
• Epidemiology

Background:

• Cardiovascular diseases (CVDs) are the leading cause of death in Indonesia, contributing to 38% of total mortality in 2019.
• Healthcare expenditure for CVDs is substantial under Indonesia's National Health Insurance (NHI).
• This study investigates CVDs, comorbidities, and their association with healthcare costs, differentiating between subsidized and non-subsidized NHI households.

Purpose of the Study:

• To analyze the association between cardiovascular diseases (CVDs) with or without comorbidities and healthcare costs in Indonesian adults.
• To determine if this association differs between subsidized (poorer) and non-subsidized (better-off) NHI households.
• To inform targeted healthcare strategies for managing CVDs and multimorbidity.

Main Methods:

• A retrospective cohort study using the NHI database (2016-2018) of 271,065 individuals with chronic diseases.
• Three-level multilevel linear regression analysis (individuals, households, districts) to assess healthcare costs (transformed using inverse hyperbolic sine).
• Cross-level interaction analysis to examine the influence of NHI household subsidy status on the diagnosis-cost relationship.

Main Results:

• Patients with CVDs and multimorbidity incurred higher outpatient and inpatient costs than other diagnosis groups.
• Predicted mean outpatient costs for CVDs with multimorbidity were over double those with CVDs alone, particularly in non-subsidized households.
• NHI household subsidy status modified the diagnosis-cost association, showing a weaker effect in subsidized households, indicating socioeconomic disparities in healthcare cost burden.

Conclusions:

• CVDs and multimorbidity are linked to elevated healthcare costs, with a more pronounced effect in non-subsidized NHI households.
• Household subsidy status reflects socioeconomic inequalities impacting healthcare access.
• Interventions for CVDs and multimorbidity must consider differential impacts on subsidized households, necessitating targeted NCD management programs.