title: Multiple chronic disorders - health care system's modern challenge in the Maccabi Health Care System.
abstract: BACKGROUND
  One of the major challenges health care systems face in modern time is treating chronic disorders. In recent years, the increasing occurrence of multiple chronic disorders (MCC) in single individuals has compounded the complexity of health care. In 2008, it was estimated that worldwide as many as one quarter of the population between the ages of sixty five to sixty nine suffered from two or more chronic conditions and this prevalence rose with age. Clinical guidelines provide guidance for management of single disorders, but not for MCC. The aim of the present study was the study of the prevalence, distribution and impact of MCC in a large Israeli health system.
  
  
  METHODS
  We performed a cross-sectional study of MCC in the Maccabi Healthcare System (MHS), Israel's second largest healthcare service, providing care for approximately two million people. Data regarding chronic conditions was collected through electronic medical records and organizational records, as was demographic and socioeconomic data. Age and sex specific data were compared with previously published data from Scotland.
  
  
  RESULTS
  Two thirds of the population had two or more chronic disorders. This is significantly higher than previously published rates. A correlation between patient age and number of chronic disorders was found, as was a correlation between number of chronic disorders and low socioeconomic status, with the exception of children due to a high prevalence of learning disabilities, asthma, and visual disturbances.
  
  
  CONCLUSIONS
  MCC is very prevalent in the MHS population, increases with age, and except for children is more prevalent in lower socioeconomic classes, possibly due to the a combination of the structure of the Israeli universal insurance and requirements of the ministry of education for exemptions and benefits. A higher than previously reported prevalence of MCC may be due to the longtime use of use of integrated electronic medical records.
  
  
  CONCLUSIONS
  To effectively deal with MCC health care systems must devise strategies, including but not limited to, information technologies that enable shared teamwork based on clinical guidelines which address the problem of multiple, as opposed to single chronic disorders in patients.
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel ; Faculty of Medicine, Ben-Gurion University, Beer Sheva, Israel.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Arbelle
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel ; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Goldstein
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel ; Faculty of Medicine, Ben-Gurion University, Beer Sheva, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Porath