The impact of multimorbidity on healthcare utilisation, healthcare expenditure, and health insurance participation in Odisha, India

Studies on multimorbidity have been conducted in different regions and countries, and some work has been done in India, which have examined the association of multimorbidity with healthcare utilisation, healthcare expenditure, or health insurance enrolment; relatively few have examined these dimensions together in a rural setting using primary household data. Therefore, this study examined the multimorbidity prevalence, made a comparison between multimorbidity and non-multimorbidity, in terms of healthcare utilisation, healthcare expenditure, and health insurance enrolment, and analysed the effect of multimorbidity on healthcare utilisation, and healthcare expenditure by using the primary data from a rural village in Odisha. This study was based on primary data, collected from all 162 households with 669 individuals of Haladigundi village of Tarava Gram Panchayat of Dhenkanal district, Odisha, India, through a well-structured schedule. Descriptive statistics were used to examine the multimorbidity prevalence and to make a comparison between multimorbidity and non-multimorbidity. To examine the effect of multimorbidity on healthcare utilisation and healthcare expenditure, negative binomial regression and a two-part model were used, respectively. The study found that 19.28% of individuals were suffering from chronic diseases, of which 8.22% of individuals were suffering from multimorbidity. Multimorbidity was higher in the case of females, the highest age group, lower education, retired individuals, individuals working in primary occupation, Other Backwards Classes /Socially and Economically Backwards Classes, caste, Separated/ Divorced/ widow(er) individuals, individuals not consuming alcohol, and smokers. Healthcare utilisation, healthcare expenditure, and health insurance enrolment were higher in the case of multimorbidity in comparison to non-multimorbidity. There was a significant effect of multimorbidity on healthcare utilisation and healthcare expenditure. Similarly, there was a significant effect of the number of chronic conditions on healthcare utilisation and healthcare expenditure. Chronic diseases were more common in the study village, which causes an increase in multimorbidity and creates a burden in all aspects for the people in the study region. More attention should be paid to multimorbidity management and to increasing awareness of health insurance among individuals.