Sung Ming-Chan, Chung Kuo-Piao, Cheng Shou-Hsia
Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
Population Health Research Center, National Taiwan University, 17, Xu-Zhou Road, Taipei, 100, Taiwan.
Cost Eff Resour Alloc. 2023 Jul 6;21(1):41. doi: 10.1186/s12962-023-00450-y.
Diabetes is one of the most prevalent chronic diseases with subsequent complications. The positive effects of diabetes pay-for-performance (P4P) programs on treatment outcomes have been reported. The program provides financial incentives based on physiological care indicators, but common mental disorder complications such as depression are not covered.
This study employed a natural experimental design to examine the spillover effects of diabetes P4P program on patients with nonincentivized depressive symptoms. The intervention group consisted of diabetes patients enrolled in the DM P4P program from 2010 to 2015. Unenrolled patients were selected by propensity score matching to form the comparison group. Difference-in-differences analyses were conducted to evaluate the effects of P4P programs. We employed generalized estimating equation (GEE) models, difference-in-differences analyses and difference-in-difference-in-differences analyses to evaluate the net effect of diabetes P4P programs. Changes in medical expenses (outpatient and total health care costs) over time were analysed for the treatment and comparison groups.
The results showed that enrolled patients had a higher incidence of depressive symptoms than unenrolled patients. The outpatient and total care expenses of diabetes patients with depressive symptoms were lower in the intervention group than in the comparison group. Diabetes patients with depressive symptoms enrolled in the DM P4P program had lower expenses for depression-related care than those not enrolled in the program.
The DM P4P program benefits diabetes patients by screening for depressive symptoms and lowering accompanying health care expenses. These positive spillover effects may be an important aspect of physical and mental health in patients with chronic disease enrolled in disease management programs while contributing to the control of health care expenses for chronic diseases.
糖尿病是最常见的慢性病之一，会引发一系列并发症。已有报道称糖尿病绩效付费（P4P）项目对治疗结果有积极影响。该项目根据生理护理指标提供经济激励，但诸如抑郁症等常见精神障碍并发症未被涵盖。
本研究采用自然实验设计，以检验糖尿病P4P项目对有非激励性抑郁症状患者的溢出效应。干预组由2010年至2015年参加糖尿病P4P项目的糖尿病患者组成。通过倾向得分匹配选择未参保患者以形成对照组。进行差分分析以评估P4P项目的效果。我们采用广义估计方程（GEE）模型、差分分析和双重差分分析来评估糖尿病P4P项目的净效应。分析了治疗组和对照组随时间推移的医疗费用（门诊和总医疗费用）变化。
结果显示，参保患者的抑郁症状发生率高于未参保患者。干预组中伴有抑郁症状的糖尿病患者的门诊和总护理费用低于对照组。参加糖尿病P4P项目的伴有抑郁症状的糖尿病患者的抑郁症相关护理费用低于未参加该项目的患者。
糖尿病P4P项目通过筛查抑郁症状并降低相关医疗费用，使糖尿病患者受益。这些积极的溢出效应可能是参加疾病管理项目的慢性病患者身心健康的一个重要方面，同时有助于控制慢性病的医疗费用。
