A Five-year Evaluation of the Pay-for-Performance Program for Diabetes under National Health Insurance in Taiwan

• Main Authors: Ming-Chan Sung, 宋銘展
• Other Authors: 鄭守夏
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/28490876461989932080

碩士 === 國立臺灣大學 === 衛生政策與管理研究所 === 97 === Background: The Bureau of the National Health Insurance (BNHI) implemented ''The Pay for Performance Program for Diabetes'' in October 2001. This program aimed to encourage medical provider to supply better quality of health care through additional incentive payments. The effects of this program are mostly evaluated on short-term and regional levels. The main objective of this study is to investigate whether there is continuous improvement on patient’s medical utilization and expenses after doing this program for five years. This study can also provide the long-term effect of this program via evidence-based data and give suggestions for the government in the future. Methods: This study used BNHI claim data during 1999 to 2006 and a quasi-experimental design was used to assess the impact of the program. Diabetic patients who participated in this program fist time in 2001 were identified as the study group and diabetic patients who never participated in this program were defined as the control group. A propensity score method was used to match cases and controls. Finally, 2,134 cases and 8,536 controls were recruited in this study. Difference in difference method and multiple regression models were used to analyze the difference of healthcare utilization and expenses between baseline data in 2001 and follow-up data during 2002 to 2006. Furthermore, the case group was separated into two sub-groups. 581 cases who just participated in the program in 2002 were classed as the single intervention group and 1,393 cases who participated in every year from 2002 to 2006 were classed as the continuous intervention group. We evaluated the program’s effect on medical utilization and expenses in diabetes patients by comparing the length of intervention. Results: Several significant findings of this study were summarized as follows. (1) Patients in the case group tented to have higher frequency in completeness of the 7 important examinations for diabetes. The frequency was from 3.51 times in 2001 to more than about 5 times in following year. However, Urinalysis and Ophthalmoscopic examination did not reach the standard which should be examined at least one time per year. (2)After controlling the baseline difference in the model, we found that patients in the case group had smaller growing slope on the number of outpatient visits、the number of emergency visits and emergency expenditure by using difference in difference analysis.(3)The multiple regression model analysis showed that the case group had fewer emergency visits and emergency expenditure than the control group during observation period except 2006. Similarly, the number of inpatient visits and inpatient expenditure were fewer in the case group than the control group during observation period. (4) We found that the program effect on increasing frequency of completing the 7 important examinations for diabetes, decreasing of emergency visit and expenditure, decreasing of inpatient length and expenditure of single intervention group maintained for one or two years. Oppositely, program effect on continuous intervention group has been preserved during observation period. Conclusions: This study suggest that the ''The Pay for Performance Program for Diabetes'' continually have improvement on diabetes-related emergency and inpatient utilization, and make the growing expenditure under control. The key point of the program sustained its effect on patients is that whether the same patient could enroll the program in the successive years or not. We suggest that program should adjust the payment on some indicators, Urinalysis and Ophthalmoscopic examination, which didn’t make progress to the standard over years. The program can be revised on providing incentives to promote the implement of Diabetes Self-management Education. Further study can focus on analyzing the program effect of patient’s clinical examination value and cost-benefit analysis for the program.