The Lancet Global Health: Health-care system reforms need to focus on multimorbidity, in the COVID-19 era

A new research published in The Lancet Global Health found multimorbidity increased health service use levels and financial burden. 

It was the first study from China that uses panel survey data to examine socioeconomic group differences in the prevalence of physical multimorbidity in China, and its effect on healthcare use and catastrophic health expenditures.

The study used three waves of the nationally representative data from China Health and Retirement Longitudinal Study for 2011, 2013, and 2015. Researchers analysed data from 11,817 respondents.

The government, via its Healthy China 2030 Plan and through a series of far-reaching health reforms, has set a bold vision for achieving universal health coverage and important advances have been made. Since 2011, more than 92% of the total population of 1.4 billion China citizens has been covered by one of three social health insurance programmes.

“Among middle aged and older Chinese population, patients with multimorbidity experienced higher incidence of catastrophic health expenditures than those individuals with a single disease,” first author Dr Yang Zhao, research fellow at The George Institute China, and research scholar at University of Melbourne said.“The effects of multimorbidity persisted even among the higher socioeconomic groups and across all health insurance programmes.”

University of Melbourne Nossal Institute for Global Health senior lecturer and senior author, Dr John Tayu Lee, said, “As disease-specific guidelines are inadequate for the effective management of individuals with multimorbidity, new clinical guidelines for multimorbidity are clearly needed in China.”

Co-author and Harvard University Professor of Global Health Systems, Professor Rifat Atun, said,“Multimorbidity in the context of population aging poses major challenges to China’s health system as multimorbidity leads to higher use of health services, longer hospital stays and greater likelihood of catastrophic health expenditures which can push citizens into impoverishment.”

Researchers say the co-morbid COVID-19 had placed increased pressure on public health emergency management systems in China.

“There is increasing evidence to indicate that people with multimorbidity are more susceptible to COVID-19 and are more likely to have a more severe illness and poorer outcomes compared to others. However, that situation is temporary,” Dr. Zhao said. “The Chinese government has made unprecedented efforts and invested enormous resources to stem the spread of the disease.” 

For the future social health insurance reform, Dr. Zhao said  that there still needs to be an emphasis on reducing out-of-pocket spending for patients with multimorbidity to provide greater financial risk protection. 

“tackling multimorbidity will be essential to reach the Sustainable Development Goals, and to progress ‘integrated people-centred’ health services.”

“Further studies examining the effect of multimorbidity from physical, mental and social conditions, and the burden of comorbidity of non-communicable diseases and infectious diseases (eg, tuberculosis, AIDS, COVID-19) are warranted. ”

Professor Craig Anderson, Executive Director of The George Institute for Global Health, China said, “as health services are conventionally organized around single disease areas, people with multiple illnesses have to see lots of doctors for different reasons which adds complexity, costs and problems over communications. Innovative integrated solutions, such as increasing the skills of doctors in primary health care, and use of digital health and electronic communications systems, are required.” 

Associate Professor Puhong Zhang, Associate Director of The George Institute China said, “The longitudinal analysis clearly illustrates the high prevalence of multimorbidity and its impact on health service use and catastrophic health expenditure in China. Considering the relatively low capacity and limited resources of primary healthcare in China, innovative solutions such as digital Health technology and multi-driven strategies should be introduced to facilitate, motivate and regulate the patient-centred prevention and management of multimorbidity.”

A specific comment from The Lancet Global Health described, “Dr Zhao and colleagues have contributed new knowledge that will assist with improving health system reform to promote healthy ageing and reduce inequities.” “Several innovative findings from this study suggest options for better health policies for China and low-income and middle income countries.”