Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study

Abstract

Objective: The objective was to analyze possible inequalities by gender in the utilization of health services (general practitioner [GP] and hospital), among people with non-communicable diseases (NCDs) in the Republic of Serbia, with special reference to multimorbidity. In addition, we examined the prevalence patterns of NCDs by sociodemographic characteristics of the population.

Study design: This study is a population-based, cross-sectional survey.

Methods: A secondary analysis from the 2013 Serbian National Health Survey included 13,765 adults aged ≥20 years. Multivariable logistic and linear regression analyses were performed to assess the association between NCDs and health care utilization.

Results: Multimorbidity was present in 30.2% of the total sample. An increased number of NCDs was associated with a higher utilization of both primary (odds ratio [OR] for having any GP visit is 3.17 in males and 3.14 in females; unstandardized coefficient [B] for number of GP visits is 0.33 for both gender) and secondary health care services (OR for having any hospitalization is 2.45 in males and 1.97 in females; B for number of overnight stays in hospital is 1.62 in males and 0.97 in females) in Serbia.

Conclusions: Our study provided strong evidence that an increased number of NCDs was significantly associated with a higher utilization of health care services in Serbia. There is a need for wise, decisive, and integrated care interventions for effective management of NCDs and their risk factors. Further research is necessary with special emphasis on the role of the health system in satisfying needs of such patients.

Keywords: Cross-sectional study; Health care utilization; Multimorbidity; Non-communicable diseases; Serbia.