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Exploring the determinants of endocrinologist visits by patients with diabetes

Author

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  • Luiz Flavio Andrade

    (MGEN Foundation for Public Health
    University of Paris Descartes)

  • Thomas Rapp

    (University of Paris Descartes)

  • Christine Sevilla-Dedieu

    (MGEN Foundation for Public Health)

Abstract

Background Diabetes is today a major public health concern in terms of its financial and social burden. Previous studies have revealed that specialist care for patients with diabetes leads to more positive outcomes than care by general practitioners (GPs) alone. The aim of this study was to estimate the determinants of endocrinologist consultation by patients with diabetes. Methods We used a two-part model to explore both the decision to consult and the frequency of consultations. We used claim data collected for 65,633 affiliates of a French social security provider. Patients were aged over 18 and treated for diabetes (types I and II). We controlled for patients’ socioeconomic characteristics, type of diabetes treatment, medical care, and health status. We also controlled for variables, such as the cost of a visit, the distance to the nearest endocrinologist’s office, the density of medical practitioners and the prevalence of diabetes in the area. Results The results show that the parameters associated with the decision to consult an endocrinologist were considerably different from factors associated with the frequency of consultations. A marked positive effect of income on the decision to consult was found, whereas travel time to the office had a negative impact on both the decision to consult and the frequency of consultations. Increasing treatment complexity is associated with a higher probability of consulting an endocrinologist. We found evidence of a significant substitution effect between GPs and endocrinologists. Finally, consultation price is a barrier to seeing an endocrinologist. Conclusion Given that financial barriers were identified in the relatively wealthy population analysed here, it is likely that this may be even more of an obstacle in the general population.

Suggested Citation

  • Luiz Flavio Andrade & Thomas Rapp & Christine Sevilla-Dedieu, 2016. "Exploring the determinants of endocrinologist visits by patients with diabetes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(9), pages 1173-1184, December.
    • Handle: RePEc:spr:eujhec:v:17:y:2016:i:9:d:10.1007_s10198-016-0794-1
    DOI: 10.1007/s10198-016-0794-1
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    as
    1. John Mullahy, 1998. "Much Ado About Two: Reconsidering Retransformation and the Two-Part Model in Health Economics," NBER Technical Working Papers 0228, National Bureau of Economic Research, Inc.
    2. Gächter, Martin & Schwazer, Peter & Theurl, Engelbert & Winner, Hannes, 2012. "Physician density in a two-tiered health care system," Health Policy, Elsevier, vol. 106(3), pages 257-268.
    3. Sergi Jiménez-Martín & José Labeaga & Maite Martínez-Granado, 2004. "An empirical analysis of the demand for physician services across the European Union," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 150-165, May.
    4. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    5. Madden, David, 2008. "Sample selection versus two-part models revisited: The case of female smoking and drinking," Journal of Health Economics, Elsevier, vol. 27(2), pages 300-307, March.
    6. Éric Delattre & Brigitte Dormont, 2000. "Induction de la demande de soins par les médecins libéraux français. Étude micro-économétrique sur données de panel," Économie et Prévision, Programme National Persée, vol. 142(1), pages 137-161.
    7. Daryl Pregibon, 1980. "Goodness of Link Tests for Generalized Linear Models," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 29(1), pages 15-24, March.
    8. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
    9. Mullahy, John, 1998. "Much ado about two: reconsidering retransformation and the two-part model in health econometrics," Journal of Health Economics, Elsevier, vol. 17(3), pages 247-281, June.
    10. Ulf‐ G. Gerdtham, 1997. "Equity in Health Care Utilization: Further Tests Based on Hurdle Models and Swedish Micro Data," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 303-319, May.
    11. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    12. Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
    13. Wedig, Gerard J., 1988. "Health status and the demand for health : Results on price elasticities," Journal of Health Economics, Elsevier, vol. 7(2), pages 151-163, June.
    14. Hung, Jung-Hua & Chang, Li, 2008. "Has cost containment after the National Health Insurance system been successful: Determinants of Taiwan hospital costs," Health Policy, Elsevier, vol. 85(3), pages 321-335, March.
    15. Robert Kaestner, 2013. "The Grossman model after 40 years: a reply to Peter Zweifel," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 357-360, April.
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    1. Clémence Bussière & Nicolas Sirven & Thomas Rapp & Christine Sevilla‐Dedieu, 2020. "Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 508-522, April.

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    More about this item

    Keywords

    Diabetes management; Health costs; Count data;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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