University Library
  • Login
A gateway to Melbourne's research publications
Minerva Access is the University's Institutional Repository. It aims to collect, preserve, and showcase the intellectual output of staff and students of the University of Melbourne for a global audience.
View Item 
  • Minerva Access
  • Medicine, Dentistry & Health Sciences
  • Melbourne School of Population and Global Health
  • Melbourne School of Population and Global Health - Research Publications
  • View Item
  • Minerva Access
  • Medicine, Dentistry & Health Sciences
  • Melbourne School of Population and Global Health
  • Melbourne School of Population and Global Health - Research Publications
  • View Item
JavaScript is disabled for your browser. Some features of this site may not work without it.

    Multimorbidity and out-of-pocket expenditure on medicines: a systematic review

    Thumbnail
    Download
    Published version (726.7Kb)

    Citations
    Scopus
    Web of Science
    Altmetric
    20
    16
    Author
    Sum, G; Hone, T; Atun, R; Millett, C; Suhrcke, M; Mahal, A; Koh, GC-H; Lee, JT
    Date
    2018-01-01
    Source Title
    BMJ Global Health
    Publisher
    BMJ PUBLISHING GROUP
    University of Melbourne Author/s
    Lee, Ta-Yu; Mahal, Ajay
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Sum, G., Hone, T., Atun, R., Millett, C., Suhrcke, M., Mahal, A., Koh, G. C. -H. & Lee, J. T. (2018). Multimorbidity and out-of-pocket expenditure on medicines: a systematic review. BMJ GLOBAL HEALTH, 3 (1), https://doi.org/10.1136/bmjgh-2017-000505.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/254889
    DOI
    10.1136/bmjgh-2017-000505
    Abstract
    Background: Multimorbidity, the presence of two or more non-communicable diseases (NCD), is a costly and complex challenge for health systems globally. Patients with NCDs incur high levels of out-of-pocket expenditure (OOPE), often on medicines, but the literature on the association between OOPE on medicines and multimorbidity has not been examined systematically. Methods: A systematic review was conducted via searching medical and economics databases including Ovid Medline, EMBASE, EconLit, Cochrane Library and the WHO Global Health Library from year 2000 to 2016. Study quality was assessed using Newcastle-Ottawa Scale. PROSPERO: CRD42016053538. Findings: 14 articles met inclusion criteria. Findings indicated that multimorbidity was associated with higher OOPE on medicines. When number of NCDs increased from 0 to 1, 2 and ≥3, annual OOPE on medicines increased by an average of 2.7 times, 5.2 times and 10.1 times, respectively. When number of NCDs increased from 0 to 1, 2, ≥2 and ≥3, individuals spent a median of 0.36% (IQR 0.15%-0.51%), 1.15% (IQR 0.62%-1.64%), 1.41% (IQR 0.86%-2.15%), 2.42% (IQR 2.05%-2.64%) and 2.63% (IQR 1.56%-4.13%) of mean annual household net adjusted disposable income per capita, respectively, on annual OOPE on medicines. More multimorbidities were associated with higher OOPE on medicines as a proportion of total healthcare expenditures by patients. Some evidence suggested that the elderly and low-income groups were most vulnerable to higher OOPE on medicines. With the same number of NCDs, certain combinations of NCDs yielded higher medicine OOPE. Non-adherence to medicines was a coping strategy for OOPE on medicines. Conclusion: Multimorbidity of NCDs is increasingly costly to healthcare systems and OOPE on medicines can severely compromise financial protection and universal health coverage. It is crucial to recognise the need for better equity and financial protection, and policymakers should consider health system financial options, cost sharing policies and service patterns for those with NCD multimorbidities.

    Export Reference in RIS Format     

    Endnote

    • Click on "Export Reference in RIS Format" and choose "open with... Endnote".

    Refworks

    • Click on "Export Reference in RIS Format". Login to Refworks, go to References => Import References


    Collections
    • Minerva Elements Records [45689]
    • Melbourne School of Population and Global Health - Research Publications [4369]
    Minerva AccessDepositing Your Work (for University of Melbourne Staff and Students)NewsFAQs

    BrowseCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjects
    My AccountLoginRegister
    StatisticsMost Popular ItemsStatistics by CountryMost Popular Authors