Available online 14 May 2024, 105079

Diabetes is one of the most prevalent chronic disease in high-income countries.

Improving the management of diabetic patients is a high priority objective.

We examined the relationship between primary care services and emergency department visits.

Some primary care services (preventive assessment visits) reduce emergency department visits significantly.

Special attention should be devoted to vulnerable groups with low substitution response

Improving the management of diabetic patients is receiving increasing attention in the health policy agenda due to increasing prevalence in the population and raising pressure on healthcare resources. This paper examines the determinants of healthcare services utilisation in patients with type-2 diabetes, investigating the potential substitution effect of general practice visits on the utilisation of emergency department visits. By using rich longitudinal data from Denmark and a bivariate econometric model, our analysis highlights primary care services that are more effective in preventing emergency department visits and socioeconomic groups of patients with a weak substitution response. Our results suggest that empowering primary care services, such as preventive assessment visits, may contribute to reducing emergency department visits significantly. Moreover, special attention should be devoted to vulnerable groups, such as patients from low socioeconomic background and older patients, who may find more difficult achieving a large substitution response.

primary care

secondary care

diabetes

hidden Markov models

C33

I11

D63

I14

© 2024 The Author(s). Published by Elsevier B.V.