Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120

 

Presentation

An Evaluation of Pay-For-Performance Program for Diabetes Care under the Universal Health Insurance in Taiwan

Authors: Shou-Hsia Cheng (National Taiwan University); Tai-Ti Lee (Bureau of National Health Insurance, Taiwan)

Presenter: Shou-Hsia Cheng (National Taiwan University)

Discussant: John McConnell (Oregon Health & Science University)

Session: Diabetes

Room: Seminar E

When: Tuesday 10:30 a.m. - noon

Objective: Pay-for-performance (P4P) programs have been adopted in many countries. Taiwan's universal health insurance implemented a P4P program in 2001 for diabetes care with case-management fees and payments providing comprehensive lab test and examinations for diabetes patients. This study aimed to evaluate the effect of the P4P program for diabetes care under the National Health Insurance (NHI) in Taiwan.

Methods: This study employed NHI claim dataset of 2005 and 2006. A national representative sample was obtained with a total of 38,733 patients with diabetes mellitus. We identified diabetic patients as new enrollees to the P4P program or non-enrollees in 2006. The 7 essential examination/tests for diabetic care and related healthcare utilization and expenses in the two years were compared between the two groups. Difference-in-difference (DID) analysis was used in regression models with a Poisson distribution for the number of examination/test, a negative binominal distribution for physician visits and hospitalization, or a normal distribution for log-transformed claim expenses.

Results: We found that the P4P program for diabetes care significantly increase the essential examination/tests for patients in the enrollee group after the enrollment than in the control group with a regression coefficient for DID of 0.485 (P<0.001). While compared with their counterpart, the enrollee patients tended to have higher increase in diabetes related physician visits (DID coefficient of 0.12, P<0.001) but less increase in the number of hospitalization (DID coefficient of -0.13, P<0.01). The overall NHI claimed expenses for the enrollee group tended to be higher than that of the non-enrollee group with a DID coefficient of 0.16 (P<0.001).

Discussion and Conclusions: The pay-for-performance program showed a positive effect on the increase of necessary examination/test for monitoring diabetic patients. This program increased the out-patient visit expenses but decreased the use and expense of hospital care. The preliminary results suggested that the P4P program for diabetic care in Taiwan is successful in promoting the disease management. The cost-effectiveness of the P4P program deserves further investigation.