The Effects of Pay-for-Performance Program on Health Services Utilization of Diabetic Foot Patients

• Main Authors: Yu-An Chen, 陳祐安
• Other Authors: 楊銘欽
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/31407888148586698594

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 98 === Diabetic foot is a common complication of diabetes. There has been a steady increase in the prevalence of diabetic foot in both developing and developed countries. The purpose of this study was to examine the health services utilization of diabetic foot patients and to analyze the effects of Pay for Performance Program on diabetic foot patients’ health services utilization. The source of the data came from claims data of 100 million sampled registry of groups 1 to 25 from Taiwan National Health Insurance Research Database. The research targets were patients having the diagnoses of diabetes and foot ulcers from 2005 to 2007. Totally 641 outpatients and 189 inpatients were identified from the data. Among them, 86 outpatients participated in the Pay for Performance Program (13.4%). The average outpatient medical expense of diabetic foot was 41,234.76 points on the Relative Value Scale (RVS), and the average inpatient medical expense was 133,334.78 points. The number of inpatient admissions was statistically lower for patients who participated in the Pay for Performance Program than those who did not. Factors associated with patients’ health services utilization were Diabetes Complications Severity Index (DCSI) of patients, ownership of providers, contracted category of providers, and branch bureaus. Patients who received care from hospitals affiliated to medical care corporate and central bureau of National Health Insurance intended participating in the Pay for Performance Program. The multivariate regression analyses results indicate that the outpatient utilization was associated with DCSI, propensity score, catastrophic illness, ownership of providers, contracted category of providers, branch bureaus, doctors’ gender, doctors’ age, and doctors’ years of practice. The inpatient utilization was associated with patients’ age, DCSI, propensity score, contracted category of providers, branch bureaus, and doctors’ years of practice. This study found that diabetic foot patients who participated in the Pay for Performance Program had a significantly lower number of inpatient admissions. Patients with higher propensity score had significantly higher outpatient expenses and lower inpatient expenses. We suggest that the Bureau of National Health Insurance could promote the Pay for Performance Program more actively, and the providers could refer more patients into the program. Keywords: Diabetic Foot, Propensity Score, Pay for Performance Program, Health Services Utilization, National Health Insurance