IDEAS home Printed from https://ideas.repec.org/p/hhs/sduhec/2020_001.html

Cost and quality impacts of treatment loci for type 2 diabetes patients with moderate disease severity: Hospital- vs. GP-basedmonitoring

Author

Listed:
  • Wyeth Pullyblank, Ryan

    (University of Southern Denmark, DaCHE - Danish Centre for Health Economics)

  • Laudicella, Mauro

    (University of Southern Denmark, DaCHE - Danish Centre for Health Economics)

  • Rose Olsen, Kim

    (University of Southern Denmark, DaCHE - Danish Centre for Health Economics)

Abstract

Objectives: This study investigates cost and quality implications of pushing regular monitoring of moderateseverity type 2 diabetes (T2D) patients away from specialized hospital clinics into general practice(GP). Methods: 152,630 hospital- and 21,361 GP-monitored T2D patients with moderate disease severity werealgorithmically identified in Danish administrative databases in 2016. Total annual healthcare costis decomposed into GP, medication, nonhospital-specialist, hospital outpatient and inpatient costs.Emergency hospitalizations are used to proxy for quality of care. Cost and quality impacts oftreatment loci are assessed using an instrumental variable (IV) analysis. A wide range of patientconfounders are used to reduce selection bias, with distance to nearest hospital diabetes clinic usedas an instrument to control for remaining endogeneity of treatment locus. Two-part models areused for zero-inflated outcomes. Results: Hospital monitoring is associated with higher total annual healthcare costs (64.0%, p Conclusion: For type 2 diabetes patients with moderate disease severity, IV analysis controlling for treatmentlocus endogeneity bias identifies an expected efficiency improvement (average cost reductionwithout reduction of quality) of moving regular disease management from hospital-based settingto primary care.

Suggested Citation

  • Wyeth Pullyblank, Ryan & Laudicella, Mauro & Rose Olsen, Kim, 2020. "Cost and quality impacts of treatment loci for type 2 diabetes patients with moderate disease severity: Hospital- vs. GP-basedmonitoring," DaCHE discussion papers 2020:1, University of Southern Denmark, Dache - Danish Centre for Health Economics.
    • Handle: RePEc:hhs:sduhec:2020_001
    DOI: 10.21996/f3x3-xz83
    as

    Download full text from publisher

    File URL: https://findresearcher.sdu.dk:8443/ws/portalfiles/portal/170700180/DaCHE_Discussion_Paper_2020_1.pdf
    File Function: Full text
    Download Restriction: no
    File URL: https://libkey.io/10.21996/f3x3-xz83?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Lippi Bruni, Matteo & Nobilio, Lucia & Ugolini, Cristina, 2009. "Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care," Health Policy, Elsevier, vol. 90(2-3), pages 140-148, May.
    2. N. Meltem Daysal & Mircea Trandafir & Reyn van Ewijk, 2015. "Saving Lives at Birth: The Impact of Home Births on Infant Outcomes," American Economic Journal: Applied Economics, American Economic Association, vol. 7(3), pages 28-50, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pulleyblank, Ryan & Laudicella, Mauro & Olsen, Kim Rose, 2021. "Cost and quality impacts of treatment setting for type 2 diabetes patients with moderate disease severity: Hospital- vs. GP-based monitoring," Health Policy, Elsevier, vol. 125(6), pages 760-767.
    2. Hope Corman & Dhaval Dave & Nancy E. Reichman, 2018. "Evolution of the Infant Health Production Function," Southern Economic Journal, John Wiley & Sons, vol. 85(1), pages 6-47, July.
    3. Anaka Aiyar & Naveen Sunder, 2024. "Health insurance and child mortality: Evidence from India," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 870-893, May.
    4. N. Meltem Daysal & Jonas Cuzulan Hirani, 2021. "Early-life medical care and human capital accumulation," World of Labour, LISER, pages 217-217, September.
    5. Abhishek Dureja & Digvijay S. Negi, 2024. "Birth Order Effects in Maternal Health-Seeking Behavior: Evidence from India," Working Papers 118, Ashoka University, Department of Economics.
    6. Maria Koch Gregersen, 2024. "Earlier routine induction of labor—Consequences on mother and child morbidity," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2399-2418, October.
    7. Maibom, Jonas & Sievertsen, Hans H. & Simonsen, Marianne & Wüst, Miriam, 2021. "Maternity ward crowding, procedure use, and child health," Journal of Health Economics, Elsevier, vol. 75(C).
    8. Patricia I. Ritter & Ricardo A. Sanchez, 2023. "The effects of an epidemic on prenatal investments, childhood mortality and health of surviving children," Journal of Population Economics, Springer;European Society for Population Economics, vol. 36(1), pages 505-544, January.
    9. Friedman, Willa & Keats, Anthony & Mutua, Martin Kavao, 2022. "Disruptions to healthcare quality and early child health outcomes: Evidence from health-worker strikes in Kenya," Journal of Health Economics, Elsevier, vol. 86(C).
    10. Daysal, N. Meltem & Trandafir, Mircea & van Ewijk, Reyn, 2013. "Returns to Childbirth Technologies: Evidence from Preterm Births," IZA Discussion Papers 7834, IZA Network @ LISER.
    11. Kumar, Rahul & Maity, Bipasha, 2022. "Cultural norms and women’s health: Implications of the practice of menstrual restrictions in Nepal," World Development Perspectives, Elsevier, vol. 27(C).
    12. Donghoon Lee & Anirban Basu, 2025. "Deploying Differential Distance as an Instrumental Variable: Alternative Forms, Estimators, and Specifications," Health Economics, John Wiley & Sons, Ltd., vol. 34(10), pages 1832-1852, October.
    13. Daysal, N. Meltem & Trandafir, Mircea & van Ewijk, Reyn, 2016. "Heterogeneous Effects of Medical Interventions on the Health of Low-Risk Newborns," IZA Discussion Papers 9810, IZA Network @ LISER.
    14. Freedman, Seth & Hoehn-Velasco, Lauren & Jolles, Diana R., 2025. "Intensive care supply and admission decisions," Journal of Health Economics, Elsevier, vol. 100(C).
    15. Paola Bertoli & Veronica Grembi, 2017. "The life‐saving effect of hospital proximity," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 78-91, September.
    16. David Mmopelwa, 2019. "Prenatal care utilization and infant health in Botswana," Discussion Papers 2019-09, University of Nottingham, CREDIT.
    17. Thaksha Thavam & Rose Anne Devlin & Amardeep Thind & Gregory S. Zaric & Sisira Sarma, 2020. "The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1279-1293, December.
    18. Grépin, Karen A. & Habyarimana, James & Jack, William, 2019. "Cash on delivery: Results of a randomized experiment to promote maternal health care in Kenya," Journal of Health Economics, Elsevier, vol. 65(C), pages 15-30.
    19. Okeke, Edward N. & Chari, A.V., 2018. "Health care at birth and infant mortality: Evidence from nighttime deliveries in Nigeria," Social Science & Medicine, Elsevier, vol. 196(C), pages 86-95.
    20. David B. Audretsch, 2015. "Knowledge spillovers and future jobs," World of Labour, LISER, pages 218-218, December.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hhs:sduhec:2020_001. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Christian Volmar Skovsgaard (email available below). General contact details of provider: https://edirc.repec.org/data/hesdudk.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.