Quality of diabetes follow-up care and hospital admissions

  • L. F. Andrade
  • T. Rapp
  • C. Sevilla-DedieuEmail author
Research Article


Diabetes may lead to severe complications. For this reason, disease prevention and improvement of medical follow-up represent major public health issues. The aim of this study was to measure the impact of adherence to French follow-up guidelines on hospitalization of people with diabetes. We used insurance claims data from the years 2010 to 2013 collected for 52,027 people aged over 18, affiliated to a French social security provider and treated for diabetes. We estimated panel data models to explore the association between adherence to guidelines and different measures of hospitalization, controlling for socioeconomic characteristics, diabetes treatment and density of medical supply. The results show that adherence to four guidelines was associated with a significant decrease in hospital admissions, up to approximatively 30% for patients monitored for a complete lipid profile or microalbuminuria during the year. In addition, our analyses confirmed the strong protective effect of income and a significant positive correlation with good supply of hospital care. In conclusion, good adherence to French diabetes guidelines seems to be in line with the prevention of health events, notably complications, that could necessitate hospitalization.


Chronic disease follow-up Hospital admissions Panel data 

JEL Classification




This project was financed by the MGEN Foundation for Public Health. We would like to thank Marie-Hélène Jeanneret-Crettez, Pauline Chauvin and Pascale 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. 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. 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 Manchester, and more precisely to our discussant Seamus Kent and the chair of our session Alastair Gray from the University of Oxford. We are also thankful to the participants of the Days of the French Health Economists (JESF) in Dijon, in particular to our discussants Anne-Sophie Aguadé and Grégoire de Lagasnerie from the French National Health Insurance Fund for Employees (CNAMTS), for the insightful comments we received.


  1. Anderson, M., Dobkin, C., & Gross, T. (2012). The effect of health insurance coverage on the use of medical services. American Economic Journal: Economic Policy, 4, 1–27.Google Scholar
  2. Assogba, F. A. G., Penfornis, F., Detournay, B., Lecomte, P., Bourdel-Marchasson, I., Druet, C., et al. (2013). Facteurs associés à l’hospitalisation des personnes diabétiques adultes en France. Entred 2007. Bulletin Épidémiologique Hebdomadaire, 37–38, 454–63.Google Scholar
  3. Bhattacharyya, S. K., & Else, B. A. (1999). Medical costs of managed care in patients with type 2 diabetes mellitus. Clinical Therapy, 21, 2131–42.CrossRefGoogle Scholar
  4. Bottle, A., Millett, C., Xie, Y., Saxena, S., Wachter, R., & Majeed, A. (2008). Quality of primary care and hospital admissions for diabetes mellitus in England. Journal of Ambulatory Care Management, 31, 226–38.CrossRefPubMedGoogle Scholar
  5. Chen, J. Y., Tian, H., Taira, J. D., Hodges, K. A., Brand, J. C., Chung, R. S., et al. (2010). The effect of a PPO pay-for-performance program on patients with diabetes. The American Journal of Managed Care, 16, e11–e19.PubMedGoogle Scholar
  6. Chevreul, K., Brigham, K. B., & Bouché, C. (2014). The burden and treatment of diabetes in France. Globalization and Health, 10, 6.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Chevreul, K., Durand-Zaleski, I., Bahrami, S., Hernández-Quevedo, C., & Mladovsky, P. (2010). France: Health system review. Health Systems in Transition, 12(6), 1–291.PubMedGoogle Scholar
  8. Clarke, P., Leal, J., Kelman, C., Smith, M., & Colagiuri, S. (2008). Estimating the cost of complications of diabetes in Australia using administrative health-care data. Value Health, 11, 199–206.CrossRefPubMedGoogle Scholar
  9. Clemens, J., & Gottlieb, J. D. (2014). Do physicians’ financial incentives affect medical treatment and patient health? American Economic Review, 104, 1320–1349.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Downing, A., Rudge, G., Cheng, Y., Tu, Y. K., Keen, J., & Gilthorpe, M. S. (2007). Do the UK government’s new quality and outcomes framework (QOF) scores adequately measure primary care performance? A cross-sectional survey of routine healthcare data. BMC Health Services Research, 7, 166.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Dusheiko, M., Doran, T., Gravelle, H., Fullwood, C., & Roland, M. (2011). Does higher quality of diabetes management in family practice reduce unplanned hospital admissions? Health Services Research, 46, 27–46.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Eco-Santé. (2015). Accessed May 18, 2015, from
  13. Epstein, A. M., Stern, R. S., & Weissman, J. S. (1990). Do the poor cost more? A multihospital study of patients’ socioeconomic status and use of hospital resources. New England Journal of Medicine, 322, 1122–8.CrossRefPubMedGoogle Scholar
  14. Fiorentini, G., Iezzi, E., Lippi Bruni, M., & Ugolini, C. (2011). Incentives in primary care and their impact on potentially avoidable hospital admissions. European Journal of Health Economics, 12, 297–309.CrossRefPubMedGoogle Scholar
  15. Harrison, M. J., Dusheiko, M., Sutton, M., Gravelle, H., Doran, T., & Roland, M. (2014). Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: Controlled longitudinal study. BMJ, 346, g6423.CrossRefGoogle Scholar
  16. Heaton, P. C., Tundia, N. L., & Luder, H. R. (2013). U.S. emergency department visits resulting from poor medication adherence: 2005–07. Journal of the American Pharmacists Association, 53, 513–9.CrossRefPubMedGoogle Scholar
  17. Iezzi, E., Lippi Bruni, M., & Ugolini, C. (2014). The role of GP’s compensation schemes in diabetes care: Evidence from panel data. Journal of Health Economics, 34, 104–120.CrossRefPubMedGoogle Scholar
  18. INSEE. (2013). Accessed December 17, 2013, from
  19. Jones, A. M. (2000). Health econometrics. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of health economics. Amsterdam: Elsevier.Google Scholar
  20. Kaestner, R., & Lo Sasso, A. (2014). Does seeing the doctor more often keep you out of the hospital? Journal of Health Economics, 39, 259–72.CrossRefPubMedGoogle Scholar
  21. Kantarevic, J., & Kralj, B. (2013). Link between pay for performance incentives and physician payment mechanisms: Evidence from the diabetes management incentive in Ontario. Health Economics, 22, 1417–39.CrossRefPubMedGoogle Scholar
  22. Khalid, J. M., Raluy-Callado, M., Curtis, B. H., Boye, K. S., Maguire, A., & Reaney, M. (2013). Rates and risk of hospitalisation among patients with type 2 diabetes: Retrospective cohort study using the UK General Practice Research Database linked to English Hospital Episode Statistics. The International Journal of Clinical Practice, 68, 40–8.CrossRefPubMedGoogle Scholar
  23. Kusnik-Joinville, O., Weill, A., Ricci, P., Ricordeau, P., & Allemand, H. (2009). Motifs et caractéristiques des hospitalisations en 2007 des personnes traitées pour diabète en France. Diabetes & Metabolism, 35(S1), A18.CrossRefGoogle Scholar
  24. Lee, T., Cheng, S., Chen, C., & Lai, M. (2010). A pay-for-performance program for diabetes care in Taiwan: A preliminary assessment. American Journal of Managed Care, 16, 65–69.PubMedGoogle Scholar
  25. Lippi Bruni, M., Nobilio, L., & Ugolini, C. (2009). Economic incentives in general practice: The impact of pay for participation and pay for compliance programs on diabetes care. Health Policy, 90, 140–8.CrossRefPubMedGoogle Scholar
  26. Malcolm, J. C., Liddy, C., Rowan, M., Maranger, J., Keely, E., Harrison, C., et al. (2008). 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. Canadian Journal of Diabetes, 32, 37–45.CrossRefGoogle Scholar
  27. McCall, D. T., Sauaia, A., Hamman, R. F., Reusch, J. E., & Barton, P. (2004). Are low-income elderly patients at risk for poor diabetes care? Diabetes Care, 27, 1060–5.CrossRefPubMedGoogle Scholar
  28. Nay, O., Béjean, S., Benamouzig, D., Bergeron, H., Castel, P., & Ventelou, B. (2016). Achieving universal health coverage in France: Policy reforms and the challenge of inequalities. The Lancet, 387, 2236–49.CrossRefGoogle Scholar
  29. Newhouse, J. (1993). Free for all? Lessons from the RAND Health Insurance Experiment. Cambridge, MA: Harvard University Press.Google Scholar
  30. Ricci, P., Chantry, M., Detournay, B., Poutignat, N., Kusnik-Joinville, O., Raimond, V., et al. (2009). Coûts des soins remboursés par l’Assurance maladie aux personnes traitées pour diabète: Études Entred 2001 et 2007. Bulletin Épidémiologique Hebdomadaire, 42–43, 464–9.Google Scholar
  31. Rodwin, V. G. (2003). The health care system under French national health insurance: Lessons for health reform in the United States. American Journal of Public Health., 93, 31–7.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Saxena, S., George, J., Barber, J., Fitzpatrick, J., & Majeed, A. (2006). Association of population and practice factors with potentially avoidable admission rates for chronic diseases in London: Cross sectional analysis. Journal of the Royal Society of Medicine, 99, 81–9.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Scott, A., Schurer, S., Jensen, P. H., & Sivey, P. (2009). The effects of an incentive program on quality of care in diabetes management. Health Economics, 18, 1091–1108.CrossRefPubMedGoogle Scholar
  34. Sundmacher, L., & Kopetsch, T. (2015). The impact of office-based care on hospitalizations for ambulatory care sensitive conditions. European Journal of Health Economics, 16, 365–375.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.MGEN Foundation for Public HealthParis Cedex 15France
  2. 2.LIRAES (EA 4470)University of Paris DescartesParis Cedex 06France
  3. 3.Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonUSA

Personalised recommendations