Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Department of Information Systems and Operations Management, College of Business Administration, University of Texas at Arlington, Arlington, Texas, USA.
Public Health. 2024 Nov;236:328-337. doi: 10.1016/j.puhe.2024.09.005. Epub 2024 Sep 19.
This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan.
This was a systematic review and meta-analysis.
A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model.
The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48-0.73) and CKD (OR = 0.73; 95% CI = 0.67-0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014.
P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities.
本研究旨在评估按绩效付费（P4P）计划对台湾医疗保健的影响。
这是一项系统评价和荟萃分析。
系统检索 PubMed、Medline、Embase、Cochrane 评价、Scopus、Web of Science 和 PsycINFO 数据库，检索时间截至 2023 年 7 月。使用随机效应模型对可用结局进行荟萃分析。
检索到 85 项研究，其中 58 项研究糖尿病（DM）方案，8 项研究慢性肾脏病（CKD）方案，其余研究分别考察乳腺癌、结核病、精神分裂症和慢性阻塞性肺疾病方案。DM P4P 方案是一种具有成本效益的策略，与降低住院率和随后的并发症有关。CKD P4P 与启动透析的风险降低相关。P4P 方案还改善了乳腺癌的结局、结核病的治愈率、降低了精神分裂症的入院率和减少了慢性阻塞性肺疾病的急性加重。荟萃分析显示，DM（比值比 [OR] = 0.59；95%置信区间 [CI] = 0.48-0.73）和 CKD（OR = 0.73；95% CI = 0.67-0.81）的 P4P 方案显著降低了死亡率风险。然而，2014 年 DM P4P 方案的参与率仅为 19%。
台湾的 P4P 计划改善了医疗保健质量。然而，参与是自愿的，参与率非常低，这引发了人们对医生选择性招募参与者（即“择优录取”行为）的担忧。未来的方案改革应侧重于精心设计的方案，以减少医疗保健差距。
