[go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/p/yor/hectdg/18-28.html
   My bibliography  Save this paper

Uncontrolled diabetes and health care utilisation: a bivariate Latent Markov model approach

Author

Listed:
  • Gill, J.;
  • Li Donni, P.;
  • Zucchelli, E.;
Abstract
While uncontrolled diabetes (UD) or poor glycaemic control is a widespread condition with potentially life-threatening consequences, there is sparse evidence of its effects on health care utilisation. We model the propensities to consume health care and UD by employing an innovative bivariate Latent Markov model which allows for dynamic unobserved heterogeneity, movements between latent states and the endogeneity of UD. We estimate the effects of UD on primary and secondary health care consumption using a panel dataset of rich administrative records from Spain and measure UD using a biomarker. We find that UD does not have a statistically significant effect on health care use. Furthermore, individuals appear to move across latent classes and increase their propensities to poor glycaemic control and health care use over time. Our results suggest that by ignoring time-varying unobserved heterogeneity and the endogeneity of UD, the effects of UD on health care utilisation might be overestimated and this could lead to biased findings. Our approach reveals heterogeneity in behaviour beyond standard groupings of frequent versus infrequent users of health care services. We argue that this dynamic latent Markov approach could be used more widely to model the determinants of health care use.

Suggested Citation

  • Gill, J.; & Li Donni, P.; & Zucchelli, E.;, 2018. "Uncontrolled diabetes and health care utilisation: a bivariate Latent Markov model approach," Health, Econometrics and Data Group (HEDG) Working Papers 18/28, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:18/28
    as

    Download full text from publisher

    File URL: https://www.york.ac.uk/media/economics/documents/hedg/workingpapers/1828.pdf
    File Function: Main text
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Giorgio E. Montanari & Silvia Pandolfi, 2018. "Evaluation of long-term health care services through a latent Markov model with covariates," Statistical Methods & Applications, Springer;Società Italiana di Statistica, vol. 27(1), pages 151-173, March.
    2. 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.
    3. Deb, Partha & Trivedi, Pravin K., 2002. "The structure of demand for health care: latent class versus two-part models," Journal of Health Economics, Elsevier, vol. 21(4), pages 601-625, July.
    4. Francesco Bartolucci & Silvia Bacci & Fulvia Pennoni, 2014. "Longitudinal analysis of self-reported health status by mixture latent auto-regressive models," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 63(2), pages 267-288, February.
    5. Francesco Bartolucci & Alessio Farcomeni, 2015. "A discrete time event-history approach to informative drop-out in mixed latent Markov models with covariates," Biometrics, The International Biometric Society, vol. 71(1), pages 80-89, March.
    6. Francesco Bartolucci, 2006. "Likelihood inference for a class of latent Markov models under linear hypotheses on the transition probabilities," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 68(2), pages 155-178, April.
    7. Judex Hyppolite & Pravin Trivedi, 2012. "Alternative Approaches For Econometric Analysis Of Panel Count Data Using Dynamic Latent Class Models (With Application To Doctor Visits Data)," Health Economics, John Wiley & Sons, Ltd., vol. 21(S1), pages 101-128, June.
    8. Vincenzo Atella & Francesco Brindisi & Partha Deb & Furio C. Rosati, 2004. "Determinants of access to physician services in Italy: a latent class seemingly unrelated probit approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 657-668, July.
    9. Deb, Partha & Trivedi, Pravin K, 1997. "Demand for Medical Care by the Elderly: A Finite Mixture Approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 313-336, May-June.
    10. Bartolucci, Francesco & Farcomeni, Alessio, 2009. "A Multivariate Extension of the Dynamic Logit Model for Longitudinal Data Based on a Latent Markov Heterogeneity Structure," Journal of the American Statistical Association, American Statistical Association, vol. 104(486), pages 816-831.
    11. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    12. John A. Rizzo & Thomas A. Abbott & Steven Pashko, 1996. "Labour productivity effects of prescribed medicines for chronically ill workers," Health Economics, John Wiley & Sons, Ltd., vol. 5(3), pages 249-265, May.
    13. World Health Organisation (WHO), 2016. "Global Report on Diabetes," Working Papers id:10553, eSocialSciences.
    14. Partha Deb & Ann M. Holmes, 2000. "Estimates of use and costs of behavioural health care: a comparison of standard and finite mixture models," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 475-489, September.
    15. Li Donni, Paolo, 2019. "The unobserved pattern of material hardship and health among older Americans," Journal of Health Economics, Elsevier, vol. 65(C), pages 31-42.
    16. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    17. Martin Schellhorn & Andreas E. Stuck & Christoph E. Minder & John C. Beck, 2000. "Health services utilization of elderly Swiss: evidence from panel data," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 533-545, September.
    18. Manel Mata-Cases & Marc Casajuana & Josep Franch-Nadal & Aina Casellas & Conxa Castell & Irene Vinagre & Dídac Mauricio & Bonaventura Bolíbar, 2016. "Direct medical costs attributable to type 2 diabetes mellitus: a population-based study in Catalonia, Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(8), pages 1001-1010, November.
    19. Judex Hyppolite & Pravin Trivedi, 2012. "Alternative Approaches For Econometric Analysis Of Panel Count Data Using Dynamic Latent Class Models (With Application To Doctor Visits Data)," Health Economics, John Wiley & Sons, Ltd., vol. 21(S1), pages 101-128, June.
    20. Sergi Jiménez‐Martín & José M. Labeaga & Maite Martínez‐Granado, 2002. "Latent class versus two‐part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321, June.
    21. Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
    22. Joan Gil & Antoni Sicras-Mainar & Eugenio Zucchelli, 2018. "Uncontrolled diabetes and health care utilisation: panel data evidence from Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 785-795, July.
    23. Kahn, Matthew E, 1998. "Health and Labor Market Performance: The Case of Diabetes," Journal of Labor Economics, University of Chicago Press, vol. 16(4), pages 878-899, October.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Ugolini, Cristina & Lippi Bruni, Matteo & Leucci, Anna Caterina & Fiorentini, Gianluca & Berti, Elena & Nobilio, Lucia & Moro, Maria Luisa, 2019. "Disease management in diabetes care: When involving GPs improves patient compliance and health outcomes," Health Policy, Elsevier, vol. 123(10), pages 955-962.
    2. Simon Spika & Friedrich Breyer, 2020. "Domain-specific effects of physical activity on the demand for physician visits," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 65(5), pages 583-591, June.

    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. Teresa Bago d'Uva, 2006. "Latent class models for utilisation of health care," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 329-343, April.
    2. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    3. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    4. Hendrik Schmitz, 2012. "More health care utilization with more insurance coverage? Evidence from a latent class model with German data," Applied Economics, Taylor & Francis Journals, vol. 44(34), pages 4455-4468, December.
    5. Erik Schokkaert & Tom Van Ourti & Diana De Graeve & Ann Lecluyse & Carine Van de Voorde, 2010. "Supplemental health insurance and equality of access in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 377-395, April.
    6. Joan Gil & Antoni Sicras-Mainar & Eugenio Zucchelli, 2018. "Uncontrolled diabetes and health care utilisation: panel data evidence from Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 785-795, July.
    7. Teresa Bago d'Uva, 2005. "Latent class models for use of primary care: evidence from a British panel," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 873-892, September.
    8. Majo, M.C., 2010. "A microeconometric analysis of health care utilization in Europe," Other publications TiSEM 1cf5fd2f-8146-4ef8-8eb5-e, Tilburg University, School of Economics and Management.
    9. Joan Gil & Antonio Sicras-Mainar & Eugenio Zucchelli, 2016. "The effects of non-adherence on health care utilisation: panel data evidence on uncontrolled diabetes," Working Papers 2016-06, FEDEA.
    10. Mauro Laudicella & Paolo Li Donni, 2022. "The dynamic interdependence in the demand of primary and emergency secondary care: A hidden Markov approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 37(3), pages 521-536, April.
    11. Majo, M.C. & van Soest, A.H.O., 2011. "The Fixed-Effects Zero-Inflated Poisson Model with an Application to Health Care Utilization," Other publications TiSEM 68cf0f9b-fc68-4017-97a9-a, Tilburg University, School of Economics and Management.
    12. McLeod, Logan, 2011. "A nonparametric vs. latent class model of general practitioner utilization: Evidence from Canada," Journal of Health Economics, Elsevier, vol. 30(6), pages 1261-1279.
    13. Monika Sander, 2008. "Is There Migration-Related Inequity in Access to or in the Utilisation of Health Care in Germany?," SOEPpapers on Multidisciplinary Panel Data Research 147, DIW Berlin, The German Socio-Economic Panel (SOEP).
    14. Sergi Jiménez-Martín & José Labeaga & Maite Martínez-Granado, 2004. "An empirical analysis of the demand for physician services across the European Union," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 150-165, May.
    15. Jones, A.M, 2010. "Models For Health Care," Health, Econometrics and Data Group (HEDG) Working Papers 10/01, HEDG, c/o Department of Economics, University of York.
    16. Galina Besstremyannaya, 2014. "Heterogeneous effect of coinsurance rate on healthcare costs: generalized finite mixtures and matching estimators," Discussion Papers 14-014, Stanford Institute for Economic Policy Research.
    17. Jeffrey E. Harris & Sandra G. Sosa-Rubi, 2009. "Impact of "Seguro Popular" on Prenatal Visits in Mexico, 2002-2005: Latent Class Model of Count Data with a Discrete Endogenous Variable," NBER Working Papers 14995, National Bureau of Economic Research, Inc.
    18. Alegre, Joaquín & Mateo, Sara & Pou, Llorenç, 2011. "A latent class approach to tourists’ length of stay," Tourism Management, Elsevier, vol. 32(3), pages 555-563.
    19. Richard Layte & Anne Nolan, 2015. "Eligibility for free GP care and the utilisation of GP services by children in Ireland," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 3-27, March.
    20. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.

    More about this item

    Keywords

    diabetes; health care utilisation; unobserved heterogeneity; Latent Markov model;
    All these keywords.

    JEL classification:

    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

    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:yor:hectdg:18/28. 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: Jane Rawlings (email available below). General contact details of provider: https://edirc.repec.org/data/deyoruk.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.