Department of Health, Bureau of National Health Insurance, Taipei, Taiwan.
Am J Manag Care. 2010 Jan;16(1):65-9.
To examine the effects of a pay-for-performance (P4P) program for diabetes care in Taiwan.
A population-based natural experimental design with intervention and comparison groups.
Healthcare service and expense data were extracted from the Taiwanese Bureau of National Health Insurance claim files for 2005 and 2006. The number of essential diabetes-specific exams/tests, healthcare utilization, and pre- and post-intervention expenses were calculated for patients grouped according to P4P status. However, no clinical information was available for analysis. Difference-in-difference analysis was used in statistical regression models with proper distributions for these measures.
Patients in the P4P program (n = 12,499) received significantly more diabetes-specific exams and tests after enrollment (3.8 vs 6.4, P <.001) than patients not enrolled in the program (3.5 vs 3.6, P <.001). Patients in the intervention group had an average of 2 more physician visits for diabetes than those in the comparison group (P <.001). Conversely, the intervention group had fewer diabetes-related hospitalizations (-0.027, P = .003). Patients in the intervention group incurred higher expenses due to physician visits but lower expenses due to inpatient services, with a net increase of $104 per person per year (P <.001).
This P4P program for diabetes was associated with a significant increase in regular follow-up visits and evidence-based services, and significantly lower hospitalization costs. The overall cost of care for those in the P4P program was significantly higher, although the total incremental expense was quite small.
考察台湾糖尿病护理按绩效付费（P4P）计划的效果。
干预组和对照组的基于人群的自然实验设计。
从台湾全民健康保险理赔档案中提取 2005 年和 2006 年的医疗保健服务和费用数据。根据 P4P 状况对患者进行分组，计算必需的糖尿病特定检查/测试次数、医疗保健利用情况以及干预前后的费用。但是，没有可用于分析的临床信息。这些措施的适当分布在统计回归模型中使用差异中的差异分析。
P4P 计划中的患者（n = 12,499）在入组后接受了更多的糖尿病特定检查和测试（3.8 次比 6.4 次，P<.001），而未入组计划的患者则更少（3.5 次比 3.6 次，P<.001）。干预组的糖尿病患者平均比对照组多 2 次就诊（P<.001）。相反，干预组的糖尿病相关住院次数减少（-0.027，P =.003）。干预组因就诊而产生更高的费用，但因住院服务而产生更低的费用，每年每人净增 104 美元（P<.001）。
这项针对糖尿病的 P4P 计划与定期随访就诊和基于证据的服务显著增加以及住院费用显著降低有关。尽管总增量费用相当小，但参与 P4P 计划的患者的总体医疗费用显著更高。
