Exploring the determinants of endocrinologist visits by patients with diabetes

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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    King, H., et al.: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21, 1414–1431 (1998)

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Nita, M.E., et al.: Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system. Rev. Assoc. Med. Bras. 58, 294–301 (2012)

    PubMed  Google Scholar 

  3. 3.

    Malcolm, J.C., et al.: Transition of patients with type 2 diabetes from specialist to primary care: a survey of primary care physicians on the usefulness of tools for transition. Can. J. Diabetes 32, 37–45 (2008)

    Article  Google Scholar 

  4. 4.

    ADA.: Economic costs of diabetes in the US in 2012. Diabetes Care. 36, 1033–1046 (2013)

  5. 5.

    Iezzi, E., et al.: The role of GP’s compensation schemes in diabetes care: evidence from panel data. J. Health Econ. 34, 104–120 (2014)

    Article  PubMed  Google Scholar 

  6. 6.

    Clarke, P., et al.: Estimating the cost of complications of diabetes in Australia using administrative health-care data. Value Health 11, 199–206 (2008)

    Article  PubMed  Google Scholar 

  7. 7.

    Bhattacharyya, S.K., Else, B.A.: Medical costs of managed care in patients with type 2 diabetes mellitus. Clin. Ther. 21, 2131–2142 (1999)

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Bell, R.A., et al.: Primary and specialty medical care among ethnically diverse, older rural adults with type 2 diabetes: the ELDER diabetes study. J. Rural Health 21, 198–205 (2005)

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Khunti, K., Ganguli, S.: Who looks after people with diabetes: primary or secondary care? J. R. Soc. Med. 93, 183–186 (2000)

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Gnavi, R., et al.: Determinants of quality in diabetes care process: the population-based Torino study. Diabetes Care 32, 1986–1992 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    De Berardis, G., Pellegrini, F., Franciosi, M., Belfiglio, M., Di Nardo, B., Greenfield, S., Kaplan, S.H., Rossi, M.C., Sacco, M., Tognoni, G., Valentini, M., Nicolucci, A.: QuED Study: quality of care and outcomes in type 2 diabetic patients: a comparison between general practice and diabetes clinics. Diabetes Care 27, 398–406 (2004)

    Article  PubMed  Google Scholar 

  12. 12.

    Hung, J.-H., Chang, L.: Has cost containment after the national health insurance system been successful? Determinants of Taiwan hospital costs. Health Policy 85, 321–335 (2008)

    Article  PubMed  Google Scholar 

  13. 13.

    Pane, G.A., Taliaferro, E.H.: Health care cost containment: an overview of policy options. Ann. Emerg. Med. 23, 103–108 (1994)

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Gendreau, J., Gilbert, F., Lapie-Legouis, P., Sevilla-Dedieu, C.: Recours au médecin endocrinologue dans une population diabétique. Rev. Epidemiol. Sante Publique 62, S186 (2014)

    Article  Google Scholar 

  15. 15.

    Hirth, R.A., et al.: Out-of-pocket spending and medication adherence among dialysis patients in twelve countries. Health Aff. (Millwood) 27, 89–102 (2008)

    Article  Google Scholar 

  16. 16.

    Eco-Santé. http://www.ecosante.fr/ (2014). Accessed 7 April 2014

  17. 17.

    Ricci, P., et al.: Diabète traité: quelles évolutions entre 2000 et 2009 en France ? Bull. Epidemiol. Hebd 42–43, 425–440 (2010)

    Google Scholar 

  18. 18.

    Manning, W.G., Morris, C.N., Newhouse, J.P., Orr, L.L., Duan, N., Keeler, E.B., Leibowitz, A., Marquis, K.H., Marquis, M.S., Phelps, C.E.: A two-part model for the demand of medical care: preliminary results from the health insurance study. In: van der Gaag, J., Perlman, M. (eds.) Health, economics, and health economics, pp. 103–123. North-Holland, Amsterdam (1981)

    Google Scholar 

  19. 19.

    Gerdtham, U.G.: Equity in health care utilization: further tests based on hurdle models and Swedish micro data. Health Econ. 6, 303–319 (1997)

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Pohlmeier, W., Ulrich, V.: An econometric model of the two-part decision making process in the demand for health care. J. Human Resour. 30, 339–361 (1995)

    Article  Google Scholar 

  21. 21.

    Madden, D.: Sample selection versus two-part models revisited: the case of female smoking and drinking. J. Health Econ. 27, 300–307 (2008)

    Article  PubMed  Google Scholar 

  22. 22.

    Heckman, J.J.: Sample selection as a specification error. Econometrica 47, 153–161 (1979)

    Article  Google Scholar 

  23. 23.

    Mullahy, J.: Much ado about two: reconsidering retransformation and the two-part model in health econometrics. J Health Econ 17, 247–281 (1998)

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Pregibon, D.: Goodness of link tests for generalized linear models. Appl. Stat. 29, 15–24 (1980)

    Article  Google Scholar 

  25. 25.

    Hosmer, D., Lemeshow, S.: Applied Logistic Regression. Wiley, New York (2000)

    Google Scholar 

  26. 26.

    Copas, J.: Regression, prediction and shrinkage. J. R. Stat. Soc 45, 311–354 (1983)

    Google Scholar 

  27. 27.

    Park, R.: Estimation with heteroscedastic error terms. Econometrica 34, 888 (1966)

    Article  Google Scholar 

  28. 28.

    Delattre, E., Dormont, B.: Induction de la demande de soins par les médecins libéraux français. Étude micro-économétrique sur données de panel. Econ. Previs. 142, 137–161 (2000)

  29. 29.

    Grossman, M.: On the concept of health capital and the demand for health. J. Polit. Econ. 80, 223–255 (1972)

    Article  Google Scholar 

  30. 30.

    Kaestner, R.: The Grossman model after 40 years: a reply to Peter Zweifel. Eur. J. Health Econ. 14, 357–360 (2013)

    Article  PubMed  Google Scholar 

  31. 31.

    Kaestner, R.: The Grossman model after 40 years: a reply to Robert Kaestner. Eur. J. Health Econ. 14, 361–362 (2013)

    Article  Google Scholar 

  32. 32.

    Raynaud, D.: Les déterminants individuels des dépenses de santé: l’influence de la catégorie sociale et de l’assurance maladie complémentaire. Études et résultats no. 378. Paris: Direction de la recherche, des études, de l’évaluation et des statistiques (DREES) (2005)

  33. 33.

    Wedig, G.J.: Health status and the demand for health: results on price elasticities. J. Health Econ. 7, 151–163 (1988)

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Jurges, H.: Health insurance status and physician-induced demand for medical services in Germany: new evidence from combined district and individual level data. Discussion paper #689. German Institute for Economic Research, Berlin (2007)

  35. 35.

    Gachter, M., et al.: Physician density in a two-tiered health care system. Health Policy 106, 257–268 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Jimenez-Martin, S., et al.: An empirical analysis of the demand for physician services across the European Union. Eur. J. Health Econ. 5, 150–165 (2004)

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Christine Sevilla-Dedieu.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Diabetes management
  • Health costs
  • Count data

JEL Classification

  • I1