Skip to main content

Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten

Effects of multimorbidity on health care utilization and costs

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz volume 55, pages 685–692 (2012)Cite this article

Zusammenfassung

Multimorbidität ist eine bestimmende Realität in der Versorgung älterer Patienten. Über die spezifischen Effekte von Mehrfacherkrankungen auf die Inanspruchnahme von Versorgungsleistungen und Versorgungskosten ist jedoch nur wenig bekannt. Der vorliegende Beitrag fasst empirische Studien aus der internationalen Literatur zusammen, die den Zusammenhang zwischen Mehrfacherkrankungen und Leistungsinanspruchnahme (ambulante Versorgung, stationäre Versorgung, Pharmakotherapie) und/oder medizinischen Versorgungskosten in der älteren Allgemeinbevölkerung untersucht haben. Obwohl methodische Unterschiede zwischen den Studien ihre Vergleichbarkeit erschwerten – insbesondere aufgrund unterschiedlicher Definitionen und Konzepte von Multimorbidität –, zeigen fast alle einen signifikanten Zusammenhang zwischen der Zahl an vorliegenden chronischen Erkrankungen und der Inanspruchnahme von Versorgungskosten beziehungsweise den Versorgungskosten. In vielen Studien nahmen Inanspruchnahme und/oder Kosten mit jeder zusätzlichen Erkrankung signifikant zu. Im Lichte dieser Ergebnisse werden wichtige Implikationen für die Forschung und Versorgung von Menschen mit Mehrfacherkrankungen vorgestellt und diskutiert.

Abstract

Multiple chronic conditions (multimorbidity) are common among elderly patients; however, little is known about the specific effects of multimorbidity on health care utilization and health care costs. This article reviews empirical studies from the international literature that investigated the relationship between multiple chronic conditions and health care utilization (e.g. ambulatory care, stationary care, pharmacotherapy) and/or health care costs in elderly general populations. Although synthesis of studies was complicated, especially because of ambiguous definitions and measurements of multimorbidity, almost all studies observed a positive association of multimorbidity and utilization and costs. Many studies found that utilization and costs significantly increased with each additional chronic condition. In light of these findings coupled with the fear that current care arrangements may be inappropriate for many multimorbid patients, important implications for research and policy are presented and discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2

Literatur

  1. Marengoni A, Angleman S, Melis R et al (2011) Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 10:430–439

    PubMed  Article  Google Scholar 

  2. Bussche H van den, Hansen H, Koller D et al (2011) Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health 11:101

    PubMed  Article  Google Scholar 

  3. Fortin M, Bravo G, Hudon C et al(2005) Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 3:223–228

    PubMed  Article  Google Scholar 

  4. Schnoor J, Daumann F, Kaisers UX (o J) Demografie und (Multi-)Morbiditätsentwicklung im Krankenhaus. Gesundh Ökon Qual Manag 16:310–315

  5. Fortin M, Lapointe L, Hudon C, Vanasse A. (2005) Multimorbidity is common to family practice: is it commonly researched? Can Fam Physician 51:244–245

    PubMed  Google Scholar 

  6. Anderson G (2010) Chronic care: Making the case for ongoing care. http://www.rwjf.org/files/research/50968chronic.care.chartbook.pdf

  7. Lehnert T, Heider D, Leicht H et al (2011) Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev 68:387–420

    PubMed  Article  Google Scholar 

  8. Scheidt-Nave C, Richter S, Fuchs J, Kuhlmey A (2010) Herausforderungen an die Gesundheitsforschung für eine alternde Gesellschaft am Beispiel „Multimorbidität“. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 53:441–450

    Article  CAS  Google Scholar 

  9. Fortin M, Soubhi H, Hudon C et al (2007) Multimorbidity’s many challenges. BMJ 334:1016–1017

    PubMed  Article  Google Scholar 

  10. U.S. Department of Health and Human Services. (2010) Multiple chronic conditions – a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions. http://www.hhs.gov/ash/initiatives/mcc/index.html

  11. Boyd CM, Fortin M (2010) Future of multimorbidity research: How should understanding of multimorbidity inform health system design? Public Health Rev 32:451–474

    Google Scholar 

  12. Iezzoni LI (2010) Multiple chronic conditions and disabilities: implications for health services research and data demands. Health Serv Res 45(5):1523–1539

    PubMed  Article  Google Scholar 

  13. OECD (2011) OECD health data: economic references. http://stats.oecd.org/BrandedView.aspx?oecd_bv_id ( health-data-en&doi ( data-00548-en

  14. Bussche H van den, Schon G, Kolonko T et al (2011) Patterns of ambulatory medical care utilization in elderly patients with special reference to chronic diseases and multimorbidity – results from a claims data based observational study in Germany. BMC Geriatr 11:54

    PubMed  Article  Google Scholar 

  15. Hessel A, Gunzelmann T, Geyer M, Brähler E (2000) Inanspruchnahme medizinischer Leistungen und Medikamenteneinnahme bei über 60jährigen in Deutschland. Z Gerontol Geriatr 33:289–299

    PubMed  Article  CAS  Google Scholar 

  16. Linden M, Horgas AL, Gilberg R Steinhagen-Thiessen E (1997) Predicting health care utilization in the very old – the role of physical health, mental health, attitudinal and social factors. J Aging Health 9:3–27

    PubMed  Article  CAS  Google Scholar 

  17. Schneider KM, O’Donnell BE, Dean D (2009) Prevalence of multiple chronic conditions in the United States‘ Medicare population. Health Qual Life Outcomes 7:82

    PubMed  Article  Google Scholar 

  18. Starfield B, Lemke KW, Herbert R et al (2005) Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med 3:215–222

    PubMed  Article  Google Scholar 

  19. Xakellis GC (2005) Are patients who use a generalist physician healthier than those who seek specialty care directly? Fam Med 37:719–726

    PubMed  Google Scholar 

  20. Martin MY, Powell MP, Peel C et al (2006) Leisure-time physical activity and health-care utilization in older adults. J Aging Phys Act 14:392–410

    PubMed  Google Scholar 

  21. Rapoport J, Jacobs P, Bell NR, Klarenbach S (2004) Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can 25:13–21

    PubMed  Google Scholar 

  22. Glynn LG, Valderas JM, Healy P et al (2011) The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract 0:1–8

    Google Scholar 

  23. Condelius A, Edberg AK, Jakobsson U, Hallberg IR (2008) Hospital admissions among people 65 + related to multimorbidity, municipal and outpatient care. Arch Gerontol Geriatr 46:41–55

    PubMed  Article  Google Scholar 

  24. Landi F, Onder G, Cesari M et al (2004) Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol 57:832–836

    PubMed  Article  Google Scholar 

  25. Shelton P, Sager M, Schraeder C (2000) The community assessment risk screen (CARS): identifying elderly persons at risk of a hospitalization or emergency room visit. J Am Geriatr Soc 48:S96–S96

    Google Scholar 

  26. Chan DK, Chong R, Basilikas J et al (2002) Survey of major chronic iIlnesses and hospital admissions via the emergency department in a randomized older population in Randwick, Australia. Emerg Med (Fremantle) 14:387–392

    Article  Google Scholar 

  27. Ionescu-Ittu R, McCusker J, Ciampi A et al (2007) Continuity of primary care and emergency department utilization among elderly people. CMAJ 177:1362–1368

    PubMed  Article  Google Scholar 

  28. Shah MN, Rathouz PJ, Chin MH (2001) Emergency department utilization by noninstitutionalized elders. Acad Emerg Med 8:267–273

    PubMed  Article  CAS  Google Scholar 

  29. Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 162:2269–2276

    PubMed  Article  Google Scholar 

  30. Chu LW, Pei CK (1999) Risk factors for early emergency hospital readmission in elderly medical patients. Gerontology 45:220–226

    PubMed  Article  CAS  Google Scholar 

  31. Marcantonio ER, McKean S, Goldfinger M et al (1999) Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med 107:13–17

    PubMed  Article  CAS  Google Scholar 

  32. Librero J, Peiro S, Ordinana R (1999) Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. J Clin Epidemiol 52:171–179

    PubMed  Article  CAS  Google Scholar 

  33. Qato DM, Alexander GC, Conti RM et al (2008) Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 300:2867–2878

    PubMed  Article  CAS  Google Scholar 

  34. Ramage-Morin PL (2009) Medication use among senior Canadians. Health Rep 20:37–44

    PubMed  Google Scholar 

  35. Rogowski J, Lillard LA, Kington R (1997) The financial burden of prescription drug use among elderly persons. Gerontologist 37:475–482

    PubMed  Article  CAS  Google Scholar 

  36. Sambamoorthi U, Shea D, Crystal S (2003) Total and out-of-pocket expenditures for prescription drugs among older persons. Gerontologist 43:345–359

    PubMed  Article  Google Scholar 

  37. Fahlman C, Lynn J, Doberman D et al (2006) Prescription drug spending for beneficiaries in the last Medicare plus choice year of life. J Palliat Med 9:884–893

    PubMed  Article  Google Scholar 

  38. Moxey ED, O’Connor JP, Novielli KD et al (2003) Prescription drug use in the elderly: a descriptive analysis. Health Care Financ Rev 24:127–141

    PubMed  Google Scholar 

  39. Mueller C, Schur C, O’Connell J 1997) Prescription drug spending: the impact of age and chronic disease status. Am J Public Health 87:1626–1629

    Google Scholar 

  40. Liu-Ambrose TY, Ashe MC, Marra C (2010) Independent and inverse association of healthcare utilisation with physical activity in older adults with multiple chronic conditions. Br J Sports Med 44(14):1024–1028

    PubMed  Article  CAS  Google Scholar 

  41. Crystal S, Johnson RW, Harman J et al (2000) Out-of-pocket health care costs among older Americans. J Gerontol B Psychol Sci Soc Sci 55:S51–S62

    PubMed  Article  CAS  Google Scholar 

  42. Fishman P, Korff M von, Lozano P, Hecht J (1997) Chronic care costs in managed care. Health Aff 16:239–247

    Article  CAS  Google Scholar 

  43. Hoffman C, Rice D, Sung HY (1996) Persons with chronic conditions – their prevalence and costs. JAMA 276:1473–1479

    PubMed  Article  CAS  Google Scholar 

  44. Rice DP, LaPlante MP (1992) Medical expenditures for disability and disabling comorbidity. Am J Public Health 82:739–741

    PubMed  Article  CAS  Google Scholar 

  45. Tinetti ME, Bogardus ST Jr, Agostini JV (2004) Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med 351:2870–2874

    PubMed  Article  CAS  Google Scholar 

  46. Busse R, Drösler S, Glaeske G et al (2007) Wissenschaftliches Gutachten für die Auswahl von 50 bis 80 Krankheiten zur Berücksichtigung im morbiditätsorientierten Risikostrukturausgleich. http://www.der-gesundheitfonds.de/fileadmin/redaktion/Dokumente/Gutachten_Beirat_Krankheitsauswahl_gesamt.pdf

  47. Norris SL, High K, Gill TM et al (2008) Health care for older Americans with multiple chronic conditions: a research agenda. J Am Geriatr Soc 56:149–159

    PubMed  Article  Google Scholar 

  48. Coleman EA, Parry C, Chalmers S, Min SJ (2006) The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 166:1822–1828

    PubMed  Article  Google Scholar 

  49. Coleman K, Austin BT, Brach C, Wagner EH (2009) Evidence on the chronic care model in the new millennium. Health Aff 28:75–85

    Article  Google Scholar 

  50. Boyd CM, Shadmi E, Conwell LJ et al (2008) A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med 23:536–542

    PubMed  Article  Google Scholar 

Download references

Danksagung

Diese Arbeit wurde durch das Bundesministerium für Bildung und Forschung gefördert (Förderkennzeichen 01ET1006A und 01ET1004C).

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

  1. Institut für Medizinische Soziologie, Sozialmedizin und Gesundheitsökonomie (IMSG), Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    T. Lehnert & H.-H. König

Authors
  1. T. Lehnert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.-H. König
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Lehnert.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lehnert, T., König, HH. Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten. Bundesgesundheitsbl. 55, 685–692 (2012). https://doi.org/10.1007/s00103-012-1475-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00103-012-1475-6

Schlüsselwörter

  • Multimorbidität
  • Mehrfacherkrankungen
  • Leistungsinanspruchnahme
  • Versorgungskosten
  • Literaturübersicht

Keywords

  • Multimorbidity
  • Multiple chronic conditions
  • Health care utilization
  • Health care costs
  • Literature review