MOH Office for Healthcare Transformation, Harbourfront Centre, Maritime Square, Singapore, 099253, Singapore.
Policy, Research and Evaluation Division, Ministry of Health, Singapore, Singapore.
BMC Psychiatry. 2022 Mar 19;22(1):203. doi: 10.1186/s12888-022-03827-0.
It is pertinent to focus on chronic medical condition (CMC) comorbidity with mental health conditions (MHC) as their co-occurrence has significant cost and health implications. However, current evidence on co-occurrence of MHC with CMC is mixed and mostly from Western settings. Therefore, our study aimed to (i) describe the association between MHC and total healthcare expenditure, (ii) examine the association between CMC and total healthcare expenditure and (iii) examine determinants of total and different types of healthcare expenditure in respondents with and without MHC in an Asian setting.
The data from Singapore Mental Health Study (SMHS) 2016, a nationwide epidemiological survey, were linked with the National claims record (from 2017 to 2019). Multivariable Generalized Linear Models (GLM) were used to examine the association between MHC and total and different types of healthcare expenditure.
A total of 3077 survey respondents were included in current analysis. Respondents with MHC had a lower mean age of 38.6 years as compared to those without MHC (47.1 years). MHC was associated with increased total healthcare expenditure after adjusting for covariates (b = 0.508, p < 0.05). In respondents with MHC, presence of CMC increased the total healthcare expenditure by 35% as compared to 40% increase in those without MHC. Interestingly, 35-49 years age group with MHC had almost 3 times higher total healthcare expenditure and 7.5 times higher inpatient expenditure as compared to the 18-34 years age group.
Our study highlights variations in association of CMC and age with total healthcare expenditure in those with versus without MHC in an Asian setting. Practical recommendations include appropriate planning and resource allocation for early diagnosis and management of MHC, proactive screening for CMC in those with MHC and addressing the dual issues of treatment gap and stigma to facilitate early help seeking and prevent episodic, costly healthcare utilization.
关注慢性疾病（CMC）与心理健康状况（MHC）共病具有重要意义，因为它们的共病会带来重大的成本和健康影响。然而，目前关于 MHC 与 CMC 共病的证据存在差异，且主要来自西方背景。因此，我们的研究旨在：（i）描述 MHC 与总医疗支出之间的关联，（ii）检验 CMC 与总医疗支出之间的关联，以及（iii）在亚洲背景下，检验 MHC 患者和非 MHC 患者的总医疗支出和不同类型医疗支出的决定因素。
我们使用了来自 2016 年新加坡心理健康研究（SMHS）的全国性流行病学调查数据，并将其与国家索赔记录（2017 年至 2019 年）进行了关联。我们使用多变量广义线性模型（GLM）来检验 MHC 与总医疗支出和不同类型医疗支出之间的关联。
共有 3077 名调查对象纳入当前分析。与无 MHC 的调查对象（47.1 岁）相比，有 MHC 的调查对象平均年龄较小，为 38.6 岁。调整了协变量后，MHC 与总医疗支出增加有关（b=0.508，p<0.05）。在有 MHC 的调查对象中，与无 MHC 的调查对象相比，存在 CMC 使总医疗支出增加了 35%。有趣的是，与 18-34 岁年龄组相比，35-49 岁年龄组的总医疗支出增加了近 3 倍，住院支出增加了 7.5 倍。
我们的研究强调了在亚洲背景下，MHC 患者和非 MHC 患者的 CMC 和年龄与总医疗支出之间关联的差异。实践建议包括为 MHC 的早期诊断和管理进行适当的规划和资源分配，对 MHC 患者进行 CMC 的主动筛查，以及解决治疗差距和污名化的双重问题，以促进早期寻求帮助，防止 episodic，昂贵的医疗利用。
