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Multiple Chronic Conditions, Delayed Medical Care and Hospitalization: A Comparison Between the United States and
Chen-Yang Wang1, Ching-Ching Claire Lin1,2,3, Raymond N Kuo1,2
1Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
Background:
Delays in medical care can be especially critical for individuals with multiple chronic conditions (MCCs). The United States and Taiwan, with vastly different healthcare systems, offer contrasting contexts for access to care. This study aims to examine the relationship between MCCs, delayed medical care and hospitalization in the US and Taiwan.
Methods:
This analysis used data from the US National Health Interview Survey (NHIS) 2021 (n=29 482) and the Taiwan Social Change Survey (TSCS) 2021 health module (n=1604). We estimated multivariable logit regression models and calculated differential effects of MCCs status (no chronic conditions, one chronic condition, MCCs) on outcomes. Precision measures were estimated with delta method. All analyses for the US population incorporated applicable complex survey design and weighting, and for the Taiwan population incorporated weighting when appropriate.
Results:
Compared to those with no chronic conditions, individuals in the US with one chronic condition (2.0 percentage-points, P<.001) or MCCs (3.6 percentage-points, P<.001) had a higher likelihood of delayed care due to costs. In Taiwan, delayed care was less likely among individuals with one chronic condition (5.6 percentage-points, P=.08) or MCCs (9.5 percentage-points, P=.02), compared to individuals with no chronic conditions. Furthermore, individuals with MCCs or one chronic condition are associated with higher hospitalization in both the US (6.1 percentage-point, P<.001; 1.6 percentage-point, P=.001, respectively) and Taiwan (15.7 percentage-point, P<.001, 3.8 percentage-point, P=.08, respectively), although the differential effect of one chronic condition in Taiwan did not reach statistical significance.
Conclusion:
Analyzing data from two national health systems, this analysis shows differing relationships between MCC status and delayed care, suggesting a possible bidirectional effect. As both regions undergo reforms-US efforts to improve coordination and Taiwan's rising risk of fragmented care-these findings offer insights relevant to policy-makers and health system leaders beyond each country's context.
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