A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment.

OBJECTIVE

To examine the effects of a pay-for-performance (P4P) program for diabetes care in Taiwan.

STUDY DESIGN

A population-based natural experimental design with intervention and comparison groups.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.