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    Rights statement: 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.

    Accepted author manuscript, 419 KB, PDF document

    Embargo ends: 9/09/20

    Available under license: CC BY-NC: Creative Commons Attribution-NonCommercial 4.0 International License

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

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<mark>Journal publication date</mark>1/11/2019
<mark>Journal</mark>Health Economics
Issue number11
Volume28
Number of pages15
Pages (from-to)1262-1276
Publication statusPublished
Early online date9/09/19
Original languageEnglish

Abstract

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.

Bibliographic note

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.