Inequalities in healthcare utilisation among adults with type 2 diabetes.

AIMS: To examine inequality in dentist, ophthalmologist, and podiatrist attendance among adults with type 2 diabetes in a country with varying degrees of co-payment. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study with a population of 41,181 people with type 2 diabetes resident in the Central Denmark Region in 2019, identified through Danish registers using a prespecified diabetes algorithm. Descriptive statistics and multiple logistic regression were used to examine the attendance at dentist, ophthalmologist, and podiatrist, controlling for sociodemographic and clinical factors. Attendance at dentist, ophthalmologist, and podiatrist were examined separately. RESULTS: The majority (59.7 %) had attended the ophthalmologist at least once in the preceding year, whereas 46.5 % and 34.2 % had visited the dentist/dental hygienist and podiatrist, respectively. Disposable household income increased attendance significantly, with a clear gradient in the OR of attending the dentist (p < 0.001), whereas age significantly magnified the OR of podiatrist and ophthalmologist attendance (p < 0.001). CONCLUSIONS: This study provides circumstantial evidence that co-payment can increase inequality in health care attendance, especially for dental attendance, and it further shows that there is significant sociodemographic inequality in healthcare utilisation among people with type 2 diabetes.

Can the Easter break induce a long-term break of exercise routines? An analysis of Danish gym data using a regression discontinuity design.

OBJECTIVES: Many sedentary individuals are aware of the health benefits of regular physical activity and start becoming more physically active. Yet, despite good intentions, many struggle to keep up initial exercise levels and experience a decline in exercise frequency. A possible explanation is that it is hard to establish habits or routines, and that such routines-once established-might be easy to break. In this paper, we analyse whether a break in habitual/routine behaviour-induced by the Easter holidays-results in individuals exercising less after the break. METHODS: The study included a sample of 1210 members of a Danish chain of fitness centres who were gym members at least since the preceding New Year's Day. Participants granted access to gym attendance data, which were automatically recorded when entering the gym. We use a regression discontinuity design encompassing a time period of 10 weeks prior to and 10 weeks after Easter. RESULTS: We found a significant and relevant discretionary drop in exercise frequency right after the Easter holidays of 0.24 times per week (p=0.001) corresponding to a fall of 12.25% compared with the week prior to the Easter holidays. The effect was especially profound for individuals below retirement age and for individuals who had attended the gym with a higher frequency (twice a week or more) in the 6 weeks prior to the Easter break. DISCUSSION: This information is potentially relevant for helping individuals maintain an exercise habit. Motivational support should focus on the time period after normative breaks, such as Easter or other holidays.

Different domains - Different time preferences?

The vast majority of studies examining the relation between time preferences and health behavior have applied a measure of preferences in the financial rather than in the health domain. Most studies find a small but significant correlation. If time preferences for health and money are not the same, this can have substantial consequences for the reliability of these results. In the present paper, we set out to examine potential differences in time preferences between the two domains - money and health. Preferences over time were elicited using a stated preference matching method. Using a split sample design, the health domain was described in the context of back pain. Individuals were to match a certain sooner shorter period of pain relief against a later longer period of pain relief in the health domain, while the match in the financial domain was described as a match between a sooner smaller monetary reward and a larger later monetary reward. Data was collected through an online survey, distributed to a sample of members of fitness dk on the 7th of February 2016 and the 6th of March 2016 yielding a sample of 1687 members. In the analyses we assume quasi-hyperbolic discounting which allows us to estimate both a parameter measuring present bias and a parameter measuring impatience at an individual level. Our results demonstrate remarkably similar time preference estimates for both long term discounting and present biasedness. When analyzing differences between subgroups we observe small but significant differences between time preferences for women, retirees and individuals with a longer education. Our results shows that time preferences measured in the money and health domain in our sample are close to identical but that small differences occur in certain subgroups.