Gender and Age Differences in Health Care Utilization and Spending Among the Older Adult Outpatient with Multimorbidity

Main Article Content

Ming-Jye Wang
Li-Chen Hung
Yi-Ting Lo


multimorbidity, health care utilization, health care spending.


Background and objective
An aging population and multimorbidity are our inevitable future. Multimorbidity is associated with increased healthcare utilization and costs. Little is known about sex- and age-specific healthcare uti-lization and spending change. A prospective cohort study and a better understanding of sex- and age-related issues and trends are needed so that necessary programs, resources allocation, and cost containment can be executed.
Material and methods
This study used data drawn from the National Health Insurance database of Taiwan and a person-based longitudinal analysis to investigate outpatients aged 55 years and older over a 10-year period.

Among those with multimorbidity, the proportion of multimorbidity was higher for women than for men, especially in the 55–69 age group. There were sex and age differences in healthcare utilization/ spending: overall, women had more ambulatory visits than men, but men had a higher total claims amount than women. With regard to age-specific ambulatory visits, more women were in the 55–64 age group, and their total claims amount was not higher than that of men. Men had more ambulatory visits in the 65–79 age group, and their total claims amount was higher than that of women.

Healthcare utilization was greater among women than men, but men had higher healthcare spending than women. There were evidently differences among age groups. Strategies regarding public health policies and appropriate interventions are urgently needed, particularly for men. It is necessary to increase men’s health awareness and encourage health promotion incentives to reduce the consump-tion of medical resources.


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1. Ageing and health. World Health Organization; 2015 [cited 2017 Sep 7]. Available from: http://
2. Population Projections for Taiwan: 2016–2060. National Development Council; 2016 [cited 2017 Sep 7]. Available from: cp.aspx?n=2E5DCB04C64512CC
3. Monthly Bulletin of Interior Statistics. Ministry of the Interior. [cited 2017 Sep 7] Available from:
4. World Population Ageing: 1950–2050. United Nations, Department of Economic and Social Affairs. [cited 2017 Sep 7]. Available from: http:// worldageing19502050/
5. Salisbury CJ, Mercer SW, Fortin M. The ABC of multimorbidity. Oxford: Wiley-Blackwell; 2014.
6. Van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA. Multimorbidity in gen-eral practice: Prevalence, incidence, and determi-nants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 1998;51:367–75. https://
7. Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005;3:223–8. afm.272
8. Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA. Epidemiology and impact of multimorbidity in primary care: A retrospective cohort study. Br J Gen Pract 2011;61:e12–21.
9. Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: A systematic review of the literature. Age Res Rev 2011;10:430–9. https://
10. Schellevis FG. Epidemiology of multiple chronic conditions: An international perspective. J Comorb 2013;3:36–40. joc.2013.3.25
11 . Lehnert T, Heider D, Leicht H, et al. Review: Health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev 2011;68(4):387–420. 10.1177/1077558711399580
12. Yoon J, Zulman D, Scott JY, Maciejewski ML. Costs associated with multimorbidity among VA patients. Med Care 2014;52 Suppl 3:S31–6. https://
13. Ose D, Miksch A, Urban E, et al. Health related quality of life and comorbidity. A descriptive anal-ysis comparing EQ-5D dimensions of patients in the German Disease Management Program for type 2 diabetes and patients in routine care. BMC Health Serv Res 2011;11:179. 10.1186/1472-6963-11-179
14. Lee TA, Shields AE, Vogeli C, et al. Mortality rate in veterans with multiple chronic conditions. J Gen Intern Med 2007;22 Suppl 3:403–7. https://
15. Dy SM, Pfoh ER, Salive ME, Boyd CM. Health-related quality of life and functional status quality indicators for older persons with multiple chronic conditions. J Am Geriatr Soc 2013;61:2120–7.
16. Marengoni A, von Strauss E, Rizzuto D, Winblad B, Fratiglioni L. The impact of chronic multimor-bidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med 2009;265:288–95.
17. Alimohammadian M., Majidi A, Yaseri M, et al. Multimorbidity as an important issue among women: Results of a gender difference investiga-tion in a large population-based cross-sectional study in West Asia. BMJ Open 2017;7(5):e013548.
18. Sambamoorthi U, Tan X, Deb A. Multiple chronic conditions and healthcare costs among adults. Expert Rev Pharmacoecon Outcomes Res. 2015;15(5):823–32. 167.2015.1091730
19. Blumenthal D, Chernof B, Fulmer T, Lumpkin J, Selberg J. Caring for high-need, high-cost patients-an urgent priority. N Engl J Med 2016;375:909–11.
20. Fortin M, Dionne J, Pinho G, Gignac J, Almirall J, Lapointe L. Randomized controlled trials: Do they have external validity for patients with multi-ple comorbidities? Ann Fam Med 2006;4:104–8.
21. Ageing and life-course-Specifically the Strategy focuses on five strategic objectives. World Health Organization. [cited 2017 Nov 3]. Available from:
22. National Health Insurance Research Database. National Health Research Institutes. [cited 2014 Mar 12]. Available from: en/index.html
23. Fu S, Huang N, Chou Y. Trends in the prevalence of multiple chronic conditions in Taiwan from 2000 to 2010. Prev Chronic Dis 2014;11:E187.
24. Van Oostrom SH, Gijsen R, Stirbu I, et al. Time trends in prevalence of chronic diseases and mul-timorbidity not only due to aging: Data from General practices and health surveys. PLoS One 2016;11(8):e0160264. pone.0160264
25. Fortin M, Hudon C, Haggerty J, Akker M, Almirall J. Prevalence estimates of multimorbid-ity: A comparative study of two sources. BMC Health Serv Res 2010;10:111. https://doi. org/10.1186/1472-6963-10-111
26. Agur K, McLean G, Hunt K, Guthrie B, Mercer SW. How does sex influence multimorbidity? Secondary analysis of a large nationally repre-sentative dataset. Int J Environ Res Public Health 2016;13(4):391. ijerph13040391
27. Murtagh KN, Hubert HB. Gender differences in physical disability among an elderly cohort. Am J Public Health 2004;94:1406–11. https://doi. org/10.2105/AJPH.94.8.1406
28. Autenrieth CS, Kirchberger I, Heier M, et al. Physical activity is inversely associated with multi-morbidity in elderly men: Results from the KORA-Age Augsburg study. Prev Med 2013;57:17–19.
29. Khanam MA, Streatfield PK, Kabir ZN, Qiu C, Cornelius C, Wahlin A. Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: A cross-sectional study. J Health Popul Nutr 2011;29(4):406–14 10.3329/jhpn.v29i4.8458
30. Harvard Medical School. Mars vs. Venus: The Gender Gap in Health. Harv Mens Health Watch 2010;14(6):1–5.
31. Calasanti T. Gender relations and applied research on aging. Gerontologist 2010;50(6):720–34. https://
32. O’Brien R, Hunt K, Hart G. It’s caveman stuff, but that is to a certain extent how guys still oper-ate: Men’s accounts of masculinity and help seeking. Soc Sci Med 2005;61:503–16. https://
33. Is it basic biology? [cited 2017 Oct 13]. Available from:
34. Vaidya V, Partha G, Karmakar M. Gender differ-ences in utilization of preventive care services in the United States. J Womens Health (Larchmt), 2012;21(2):140–5. 2011.2876
35. Galdas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: Literature review. J Adv Nurs 2005;49:616–23. j.1365-2648.2004.03331.x
36. Juel K, Christensen K. Are men seeking medical advice too late? Contacts to general practitioners and hospital admissions in Denmark 2005.
J Public Health 2008;30(1):111–3. 10.1093/pubmed/fdm072
37. Schoenborn CA, Heyman KM. Health character-istics of adults aged 55 years and over: United States, 2004–2007. Natl Health Stat Report 2009;8(16):1–31. 009-001
38. Stenholm S, Westerlund H, Salo P, et al. Age-related trajectories of physical functioning in work and retirement: The role of sociodemo-graphic factors, lifestyle and disease. J Epidemiol Community Health 2014;68(6):503–9. https://doi. org/10.1136/jech-2013-203555
39. Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H. A systematic review of preva-lence studies on multimorbidity: Toward a more  uniform methodology. Ann Fam Med 2012;10(2):142–51. 1337
40. Vegda K, Nie JX, Wang L, Tracy CS, Moineddin R, Upshur RE. Trends in health services utiliza-tion, medication use, and health conditions among older adults: A 2-year retrospective chart review in a primary care practice. BMC Health Serv Res 2009;9:217. 1472-6963-9-217
41. Ek S. Gender differences in health information behaviour: A Finnish population-based survey. Health Promot Int 2015;30:736–45. https://doi. org/10.1093/heapro/dat063