Healthcare Utilization Fragmentation and Total Costs Among Adults with Multiple Chronic Conditions Evidence from the Medical Expenditure Panel Survey
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Background
Healthcare fragmentation among adults with multiple chronic conditions (MCC) may drive inefficient care and increased costs, yet little is known about this relationship at the national level.
Objective
To examine the association between healthcare utilization fragmentation and total healthcare costs among US adults with multiple chronic conditions, and assess how this relationship varies by insurance type.
Methods
Cross-sectional analysis of 21,876 adults from the 2020 Medical Expenditure Panel Survey (MEPS). I measured healthcare fragmentation using a composite score based on utilization across multiple provider types and settings. Multiple chronic conditions were defined as ≥3 diagnosed conditions. I used surveyweighted regression models to examine associations between fragmentation, MCC status, and total healthcare expenditures, controlling for demographics, socioeconomic status, and insurance type.
Results
The sample represented 256 million US adults, with 44.7% (SE: 0.6%) having multiple chronic conditions. Adults with MCC had significantly higher healthcare costs than those without MCC (mean: $13,847 vs. $2,145, respectively). Healthcare fragmentation was associated with dramatic cost increases: expenditures ranged from $909 for no fragmentation to $34,956 for high fragmentation. In adjusted models, MCC was associated with a 167% increase in healthcare costs, while each unit increase in fragmentation score was associated with a 784% cost increase. High fragmentation affected 57.9% of the adult population.
Conclusions
Healthcare fragmentation is strongly associated with substantially higher costs, particularly among adults with multiple chronic conditions. These findings suggest that care coordination interventions could yield significant cost savings while potentially improving quality of care.
