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The effects of non-adherence on health care utilisation: panel data evidence on uncontrolled diabetes

Author

Listed:
  • Gil, J.
  • Sicras-Mainar, A.
  • Zucchelli, E.

Abstract

Despite size and relevance of non-adherence to health treatments, robust evidence on its effects on health care utilisation is very limited. We focus on non-adherence to diabetes treatments, a widespread problem, andemploy longitudinal administrative data from Spain (2004-2010) to identify and quantify the effects of uncontrolled type 2 diabetes on health care utilisation. We use a biomarker (glycated haemoglobin, HbA1c) to detect the presence of uncontrolled diabetes and explore its effects on both primary and secondary health care. We estimate a range of panel count data models, including negative binomials with random effects, dynamic and hurdle specifications to account for unobserved heterogeneity, previous utilisation and selection. We find uncontrolled diabetes in around 30% of patients of both genders. Although women appear to systematically consume more health care compared to men, their consumption levels do not appear to be influenced by uncontrolled diabetes. Conversely, among men uncontrolled diabetes increases the average number of GP visits per year by around 4%, specialist visits by 4.4% and greatly extends hospital length of stay.

Suggested Citation

  • Gil, J. & Sicras-Mainar, A. & Zucchelli, E., 2016. "The effects of non-adherence on health care utilisation: panel data evidence on uncontrolled diabetes," Health, Econometrics and Data Group (HEDG) Working Papers 16/07, HEDG, c/o Department of Economics, University of York.
  • Handle: RePEc:yor:hectdg:16/07
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    References listed on IDEAS

    as
    1. 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.
    2. Elena Bastida & José A. Pagán, 2002. "The impact of diabetes on adult employment and earnings of Mexican Americans: Findings from a community based study," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 403-413.
    3. Zhang, Xiaohui & Zhao, Xueyan & Harris, Anthony, 2009. "Chronic diseases and labour force participation in Australia," Journal of Health Economics, Elsevier, vol. 28(1), pages 91-108, January.
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    9. Maria Alva & Alastair Gray & Borislava Mihaylova & Philip Clarke, 2014. "The Effect Of Diabetes Complications On Health‐Related Quality Of Life: The Importance Of Longitudinal Data To Address Patient Heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 23(4), pages 487-500, April.
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    More about this item

    Keywords

    non-adherence; diabetes; biomarkers; health care utilisation; panel count data;

    JEL classification:

    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • I1 - Health, Education, and Welfare - - Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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