Multimorbidity and its associated factors in Indonesia through universal health coverage scheme: A cross-sectional study based on national claims data

Multimorbidity has been increasing globally and is usually associated with higher health care utilization and costs. Indonesia has been implementing Universal Health Coverage (UHC) program since 2014. However, there is a limited study of the prevalence of multimorbidity and its impact on health care utilization and costs through the UHC scheme in Indonesia. This study aimed to determine the prevalence of multimorbidity and its associated factors, particularly the health care utilization and costs of patients with multimorbidity compared to patients with one chronic condition in the hospitals in Indonesia based on the UHC scheme. The study was a comparative cross-sectional design. The data was collected from the Social Security Agency for Health/Badan Penyelanggara Jaminan Sosial Kesehatan (BPJS Health) National Sample Data 2015-2016. All patients [&ge;]60 years of age and have at least one chronic condition in the hospital were included. Descriptive statistics, bivariate analysis, and multivariable regression analysis were conducted to analyze the data. In a sample of 23,460 patients, the prevalence of multimorbidity was 44.4% among patients with chronic conditions in the hospital. We observed significant difference in gender, marital status, and membership segmentations between patients with multimorbidity and one chronic condition (p<0.05). Health care utilization and costs were significantly higher in multimorbid patients (p<0.001). This positive association between multimorbidity and health care utilization (OR: 1.70, 95% CI: 1.61-1.79) and health care costs (unstandardized coefficient 0.483, 95% CI: 0.443-0.524, p<0.001) remains significant after adjusting for age and gender. The analysis found that the prevalence of multimorbidity was high and positively associated with higher health care utilization and costs through the UHC scheme in Indonesia. Therefore, health policymakers and healthcare professionals need to consider the burden of multimorbidity more when structuring health care.