Original Article

Factors Affecting Healthcare Utilization among Patients with Single and Multiple Chronic Diseases


Background: We aimed to investigate the factors affecting healthcare utilization among patients with single and multiple chronic diseases using the Andersen healthcare utilization model.

Methods: We used a combination of the data from the sixth and seventh Korea National Health and Nutrition Survey (2014–2016). The study population was 3,901 patients with single chronic disease and 1,829 patients with multiple chronic diseases as defined by the WHO. Participants were aged 19 yr or older. Multiple regression analysis was employed using the Andersen model to identify factors affecting healthcare utilization (inpatient and outpatient).

Results: According to the Andersen model (comprising predisposing, enabling, and need factors and health behaviors), the factors that increased outpatients with single chronic disease were female, being aged 65 yr or older, having basic livelihood security benefit, immobility, and poor subjective health status. Factors that increased inpatients with single chronic disease were being aged under 65, having private insurance, immobility, poor subjective health status, and nondrinking. Moreover, factors that increased outpatients and inpatients with multiple chronic diseases were female, being aged under 65, immobility, and poor subjective health status and immobility, poor subjective health status, nondrinking, and not engaging in physical activity, respectively.

Conclusion: We identified factors affecting outpatient and inpatient care utilization among patients with single and multiple chronic diseases, using the Andersen healthcare utilization model. The findings can be used as foundational data to develop preventive and management strategies in healthcare utilization among patients with single and multiple chronic diseases.

1. Centers for Disease Control and Prevention (2019). About chronic diseases. Available from: https://www.cdc.gov/chronicdisease/about/index.htm (accessed 27 October 2019).
2. Raghupathi W, Raghupathi V (2018). An empirical study of chronic diseases in the United States: A visual analytics approach. Int J Environ Res Public Health, 15(3):431.
3. Australian Government Department of Health. Chronic conditions. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/chronic-disease#footnote (accessed 8 Nov 2019).
4. Vainieri M, Quercioli C, Maccari M, Barsanti S, Murante AM (2018). Reported experi-ence of patients with single or multiple chronic diseases: Empirical evidence from Italy. BMC Health Serv Res, 18(1):659.
5. World Health Organization (2019). Chronic diseases and health promotion. Available from: https://www.who.int/chp/chronic_disease_report/part2_ch1/en/index12.html (accessed 8 Nov 2019).
6. Hajat C, Stein E (2018). The global burden of multiple chronic conditions: A narra-tive review. Prev Med Rep, 12:284–293.
7. Atella V, Piano Mortari A, Kopinska J, et al (2019). Trends in age-related disease bur-den and healthcare utilization. Aging Cell, 18(1): e12861.
8. Ko D, Bratzke LC, Roberts T (2018). Self-management assessment in multiple chronic conditions: A narrative review of literature. Int J Nurs Stud, 83:83–90.
9. Wang SY, Chen LK, Hsu SH, Wang SC (2012). Health care utilization and health outcomes: a population study of Taiwan. Health Policy Plan, 27(7):590-599.
10. Jiang M, Yang G, Fang L, et al (2018). Fac-tors associated with healthcare utilization among community-dwelling elderly in shanghai, China. PLoS One, 13(12):e0207646.
11. Hopman P, Heins MJ, Korevaar JC, Rijken M, Schellevis FG (2016). Health care utili-zation of patients with multiple chronic diseases in the Netherlands: Differences and underlying factors. Eur J Intern Med, 35:44–50.
12. Andersen RM (1995). Revisiting the behav-ioral model and access to medical care: Does it matter? J Health Soc Behav, 36(1):1–10.
13. Tesfaye G, Chojenta C, Smith R, Loxton D (2018). Application of the Andersen-Newman model of health care utilization to understand antenatal care use in Kersa District, Eastern Ethiopia. PLoS One, 13:e0208729.
14. Shao S, Wang M, Jin G, Zhao Y, Lu X, Du J (2018). Analysis of health service utiliza-tion of migrants in Beijing using Ander-son health service utilization model. BMC Health Serv Res, 18:462.
15. Korea Centers for Disease Control and Prevention (2016). The Seventh Korea National Health and Nutrition Examina-tion Survey. Seoul: KCDC.
16. Bernell S, Howard SW (2016). Use your words carefully: What is a chronic dis-ease? Front Public Health, 4:159.
17. Graziadei IW (2011). The clinical challenges of acute on chronic liver failure. Liver Int, 3:24–6.
18. Lee s, Huang H, Zelen M (2004). Early de-tection of disease and scheduling of screening examinations. Stat Methods Med Res, 13(6):443-456.
19. Fonseca VR, Nobre MR, Pronk NP, Santos LA (2010). The association between physical activity, productivity, and health care utilization among employees in Bra-zil. J Occup Environ Med, 52(7):706–712.
20. Jacobs JM, Rottenberg Y, Cohen A, Stess-man J (2013). Physical activity and health service utilization among older people. J Am Med Dir Assoc, 14(2):125–129.
21. Kang SW, Xiang X (2017). Physical activity and health services utilization and costs among U.S. adults. Prev Med, 96:101–105.
22. Vozoris NT, O'Donnell DE (2012). Preva-lence, risk factors, activity limitation and health care utilization of an obese, popu-lation-based sample with chronic ob-structive pulmonary disease. Can Respir J, 19(3):e18–e24.
23. Bähler C, Huber CA, Brüngger B, Reich O (2015). Multimorbidity, health care utiliza-tion and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res, 15:23.
24. Decker SL, Doshi JA, Knaup AE, Polsky D (2012). Health service use among the pre-viously uninsured: is subsidized health in-surance enough? Health Econ, 21(10):1155–1168.
25. Zayas CE, He Z, Yuan J, et al (2016). Exam-ining healthcare utilization patterns of el-derly middle-aged adults in the United States. Proc Int Fla AI Res Soc Conf, 361–366.
26. Zarkin GA, Bray JW, Babor TF, Higgins-Biddle JC (2004). Alcohol drinking pat-terns and health care utilization in a man-aged care organization. Health Serv Res, 39(3):553–570.
27. Jeon B, Noguchi H, Kwon S, Ito T, Tamiya N (2017). Disability, poverty, and role of the basic livelihood security system on health services utilization among the el-derly in South Korea. Soc Sci Med, 178:175–183.
28. Kim MJ, Lee H, Kim EH, et al (2017). Dis-parity in health screening and health utili-zation according to economic status. Ko-rean J Fam Med, 38(4): 220–225.
IssueVol 49 No 12 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v49i12.4820
Single chronic disease; Multiple chronic diseases Andersen model Healthcare utilization

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How to Cite
KIM KY, LEE E, CHO J. Factors Affecting Healthcare Utilization among Patients with Single and Multiple Chronic Diseases. Iran J Public Health. 2020;49(12):2367-2375.