Health care utilization of patients with multiple chronic diseases in the Netherlands: Differences and underlying factors

Published:September 15, 2016DOI:


      • Care use of 60% of multimorbid patients is comparable to single disease patients.
      • 8% of multimorbid patients are excessive health care users.
      • Demographic and disease characteristics are associated with excessive use of care.



      To examine health care utilization of people with multiple chronic diseases in The Netherlands compared to people with a single chronic disease, and to identify subgroups of multimorbid patients according to health care utilization.


      All patients diagnosed with one or more chronic diseases in 2008–2009 (N = 54,051) were selected from the nationwide NIVEL Primary Care Database, and data on their GP contacts and medication in 2010 were retrieved. Data on hospital admissions, household size and income were added. Chi-square-tests and multivariate regression analyses were performed to analyze differences between multimorbid patients and patients with a single chronic disease, and between subgroups of multimorbid patients derived from cluster analysis.


      Multimorbid patients (37% of all patients) had more GP contacts, prescribed medications, and hospital admissions (all p < .0001) than patients with a single chronic disease. The largest cluster of multimorbid patients (57%) had a relatively low level of health care utilization, a smaller cluster (36%) had higher levels of health care utilization, and 7.6% of patients were heavy health care users (p < .0001 for all variables). The latter were older, more often female, had a lower income, lived in a smaller household, had more chronic diseases, and more often had specific chronic diseases such as COPD, diabetes and heart failure.


      The majority of multimorbid patients have only slightly higher health care utilization than patients with a single chronic disease. Extensive health care utilization among multimorbid patients seems to be related to patient characteristics as well as chronic disease numbers and patterns.


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