Uncontrolled diabetes and health care utilisation : A bivariate latent Markov model approach

Gil, Joan and Li Donni, Paolo and Zucchelli, Eugenio (2019) Uncontrolled diabetes and health care utilisation : A bivariate latent Markov model approach. Health Economics, 28 (11). pp. 1262-1276. ISSN 1057-9230

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Although uncontrolled diabetes (UD) or poor glycaemic control is awidespread condition with potentially life‐threatening consequences, there issparse evidence of its effects on health care utilisation. We jointly model thepropensities to consume health care and UD by employing an innovativebivariate latent Markov model that allows for dynamic unobserved heterogene-ity, movements between latent states and the endogeneity of UD. We estimatethe effects of UD on primary and secondary health care consumption using apanel dataset of rich administrative records from Spain and measure UD usinga biomarker. We find that, conditional on time‐varying unobservables,UD does not have a statistically significant direct effect on health care use.Furthermore, individuals appear to move across latent classes and increasetheir propensities to poor glycaemic control and health care use over time.Our results suggest that by ignoring time‐varying unobserved heterogeneityand the endogeneity of UD, the effects of UD on health care utilisation mightbe overestimated and this could lead to biased findings. Our approach revealsheterogeneity in behaviour beyond standard groupings of frequent versusinfrequent users of health care services. We argue that this dynamic latentMarkov approach could be used more widely to model the determinants ofhealth care use.

Item Type:
Journal Article
Journal or Publication Title:
Health Economics
Additional Information:
This is the peer reviewed version of the following article: Gil, J, Li Donni, P, Zucchelli, E. Uncontrolled diabetes and health care utilisation: A bivariate latent Markov model approach. Health Economics. 2019; 28: 1262– 1276. https://doi.org/10.1002/hec.3939 which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1002/hec.3939 This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Uncontrolled Keywords:
?? diabeteshealth care utilisationunobserved heterogeneitylatent markov modelhealth policy ??
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Deposited On:
01 Nov 2019 11:05
Last Modified:
31 Dec 2023 01:07