Exploring the determinants of endocrinologist visits by patients with diabetes



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.


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.


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.


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.

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This project was financed by the MGEN Foundation for Public Health. We would like to thank Marie-Hélène Jeanneret-Crettez, Pauline Chauvin and Pascal Lapie-Legouis for their contributions to the inception of this project. We wish to thank particularly Fabien Gilbert for giving so much help in building the dataset. This paper also benefited from the data expertise of Nathalie Billaudeau and Mylène Limbé. We also express gratitude to Magali Coldefy from IRDES who allowed us access to the data on the distance to endocrinologists. The authors are also grateful to all who contributed richly to the interpretation of these data and to the improvement of the manuscript, notably the participants of the winter Health Economists’ Study Group (HESG) meeting in Leeds, and more precisely to our discussant Julian Forder from the University of Manchester and to the chair of our session Lise Rochaix from the Paris School of Economics. We are also thankful to Thomas Barnay from the University of Rouen and Nicolas Sirven from the University of Paris Descartes for their helpful comments and discussions regarding the econometric modelling implemented in this project.

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Correspondence to Christine Sevilla-Dedieu.

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Andrade, L.F., Rapp, T. & Sevilla-Dedieu, C. Exploring the determinants of endocrinologist visits by patients with diabetes. Eur J Health Econ 17, 1173–1184 (2016). https://doi.org/10.1007/s10198-016-0794-1

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  • Diabetes management
  • Health costs
  • Count data

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