Compounding the complexity: Designing a health system for comorbidity AUTHORS Emma Finestone Jodi Wishnia Shivani Ranchod
PEER REVIEWER: Shan Naidoo
Abstract BACKGROUND: As the leading cause of death worldwide, non-communicable diseases (NCDs) have been recognised as a major public health concern. The prevalence of NCDs, and so too comorbidity and multimorbidity, is high and increasing in South Africa. As the country moves towards implementation of National Health Insurance (NHI), integrated approaches to tackling chronic disease should be prioritised so as to manage the burden of comorbidity most effectively. The aim of this paper is to illustrate the burden and challenge of comorbidity and multimorbidity in health systems. METHODS: Two quantitative data sets were analysed for this research: household survey data (2016 South African Demographic and Health Survey) and medical scheme data (2020). Four chronic illnesses are included in the analysis: diabetes, hypertension, HIV and cancer. We also use qualitative data in this article, based on primary data collected in one pocket of South Africa, to marry the quantitative findings to the reality on the ground. RESULTS: Costs of comorbidity and multimorbidity are super-additive. Targeting prevention efforts on disease combinations can be substantially more effective than looking through a single-disease prevention lens. Forty-four percent of medical scheme members registered for a chronic condition were registered for two or more such conditions. Eighty-five percent with diabetes also had one or more other chronic conditions. Given the relationship between socioeconomic status and health, the prevalence of chronic disease and multimorbidity is likely to be higher in the uninsured population. CONCLUSION: This paper highlights both the interconnectedness of different chronic conditions and the care that these complex clients require. To provide quality care, the South African health system needs to adapt, allowing for better record-keeping, easier sharing of data and comprehensive clinical care.
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2 0 2 1 SOU T H ERN AFRICAN H E A LT H JO UR N A L P U B L I S H E D B Y T H E B O A R D O F H E A LT H C A R E F U N D E R S
