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Int J Equity Health. 2013 Aug 20;12:69. doi: 10.1186/1475-9276-12-69.

The influence of socio-economic status and multimorbidity patterns on healthcare costs: a six-year follow-up under a universal healthcare system.

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Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan.



Multimorbidity has been linked to elevated healthcare utilization and previous studies have found that socioeconomic status is an important factor associated with multimorbidity. Nonetheless, little is known regarding the impact of multimorbidity and socioeconomic status on healthcare costs and whether inequities in healthcare exist between socioeconomic classes within a universal healthcare system.


This longitudinal study employed the claims database of the National Health Insurance of Taiwan (959 990 enrolees), adopting medication-based Rx-defined morbidity groups (Rx-MG) as a measurement of multimorbidity. Mixed linear models were used to estimate the effects of multimorbidity and socioeconomic characteristics on annual healthcare costs between 2005 and 2010.


The distribution of Rx-MGs and total costs presented statistically significant differences among gender, age groups, occupation, and income class (pā€‰<ā€‰.001). Nearly 80% of the enrolees were classified as multimorbid and low income earners presented the highest prevalence of multimorbidity. After controlling for age and gender, increases in the number of Rx-MG assignments were associated with higher total healthcare costs. After controlling for the effects of Rx-MG assignment and demographic characteristics, physicians, paramedical personnel, and public servant were found to generate higher total costs than typical employees/self-employed enrolees, while low-income earners generated lower costs. High income levels were also found to be associated with lower total costs. It was also revealed that occupation and multimorbidity have a moderating effect on healthcare cost.


Increases in the prevalence of multimorbidity are associated with higher health care costs. This study determined that instances of multimorbidity varied according to socioeconomic class; likewise there were inequities in healthcare utilization among individuals of various occupations and income levels, even when demographic characteristics and multimorbidity were controlled for. This highlights the importance of socioeconomic status with regard to healthcare utilization. These results indicate that socioeconomic factors should not be discounted when discussing the utilization of healthcare by patients with multimorbidity.

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