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In October 2001, a pay-for-performance (P4P) program for diabetes was implemented by the National Health Insurance (NHI), a single-payer program, in Taiwan. However, only limited information is available regarding the influence of this program on the patient’s health-related quality of life. The aim of this study was to estimate the costs and consequences of enrolling patients in the P4P program from a single-payer perspective.
A retrospective observational study of 529 diabetic patients was conducted between 2004 and 2005. The data used in the study were obtained from the National Health Interview Survey (NHIS) in Taiwan. Direct cost data were obtained from NHI claims data, which were linked to respondents in the NHIS using scrambled individual identification. The generic SF36 health instrument was employed to measure the quality-of-life-related health status and transformed into a utility index. Patients enrolled in the P4P program for at least 3 months were categorized as the P4P group. Following propensity score matching, 260 patients were included in the study. Outcomes included life-years, quality-adjusted life-years (QALYs), diabetes-related medical costs, overall medical costs, and incremental cost-effectiveness ratios (ICERs). A single-payer perspective was assumed, and costs were expressed in US dollars. Nonparametric bootstrapping was conducted to estimate confidence intervals for cost-effectiveness ratios.
Following matching, no significant difference was noted between two groups with regard to the patients’ age, gender, education, family income, smoking status, BMI, or whether insulin was used. The P4P group had an increase of 0.08 (95 % CI 0.077–0.080) in QALYs, and the additional diabetes-related medical cost was US$422.74 (95 % CI US$413.58–US$435.05), yielding an ICER of US$5413.93 (95 % CI US$5226.83–US$5562.97) per QALY gained.
Our results provides decision makers with valuable information regarding the impact of the P4P program of diabetes care through a direct comparison of equivalent groups of patients receiving regular care. Under the single-payer NHI system, the use of financial incentives under the DM-P4P program may be an effective means to ensure the quality of follow-up treatment.
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Institute of Medicine. (2001). Crossing the Quality Chasm: A new Health System for the 21st Century. Washington, DC: National Academies Press.
Chen, J. Y., Tian, H., Taira Juarez, D., Hodges, K. A., Brand, J. C., Chung, R. S., et al. (2010). The effect of a PPO pay-for-performance program on patients with diabetes. American Journal of Managed Care, 16(1), e11–e19. PubMed
Lee, T. T., Cheng, S. H., Chen, C. C., & Lai, M. S. (2010). A pay-for-performance program for diabetes care in Taiwan: A preliminary assessment. American Journal of Managed Care, 16(1), 65–69. PubMed
Fagan, P. J., Schuster, A. B., Boyd, C., Marsteller, J. A., Griswold, M., Murphy, S. M. E., et al. (2010). Chronic care improvement in primary care: Evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes. Health Services Research, 45(6), 1763–1782. PubMedCentralPubMedCrossRef
Department of Health, E. Y., R.O.C. (Taiwan) (2010). 2009 Statistic of Cause of Death. Taipei City.
Bureau of National Health Insurance, D. o. H., Executive Yuan, R.O.C. (Taiwan). (2010). The 2009 National Health Insurance Annual Health Statistical Report. Taipei City.
Chiou, S. T., Lin, H. D., Yu, N. C., Hseuh, H. K., Lin, L. H., Lin, L. T., et al. (2001). An initial assessment of the feasibility and effectiveness of implementing diabetes shared care system in Taiwan—some experiences from I-Lan County. Diabetes Research and Clinical Practice, 54(Suppl 1), S67–S73. PubMedCrossRef
Bureau of National Health Insurance. National Health Insurance Pay-for-Performance Program for Diabetes [in Chinese]. Retrieved June 20, 2011, from http://www.nhi.gov.tw/webdata/webdata.aspx?menu=18&menu_id=703&webdata_id=3862&WD_ID=941.
Lee, T–. T., Cheng, S.-H., Chen, C–. C., & Lai, M.-S. (2010). A pay-for-performance program for diabetes care in Taiwan: A preliminary assessment. American Journal of Managed Care, 16(1), 65–69. PubMed
Gold, M. R., Sigegl, J. E., Russell, L. B., & Weinstein, M. C. (1996). Cost Effectiveness in Health and Medicine. New York: Oxford University Press.
Weng, W. S., Liu, C. Y., Chen, Y. J., Chang, H. Y., Liang, K. Y., & Chuang, Y. L. (2006). The sampling design for the 2005 National Health Interview Survey in Taiwan. NHIS Research Brief, 2, 1–16. CrossRef
National Health Research Institute. National Health Interview Survey. Retrieved June 16, 2011, from http://nhis.nhri.org.tw/2005nhis.html.
Wu, W. C., Chang, H. Y., Kuo, K. N., Chen, C. Y., Tu, Y. C., & Yang, Y. H. (2011). Psychosocial problems in children with allergic diseases: A population study in Taiwan. Child: Care, Health and Development, 37, 662.
Lin, C. C., Lai, M. S., Syu, C. Y., Chang, S. C., & Tseng, F. Y. (2005). Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. Journal of the Formosan Medical Association, 104(3), 157–163. PubMed
Miller, C. K., Kristeller, J. L., Headings, A., Nagaraja, H., & Miser, W. F. (2012). Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A pilot study. Journal of the Academy of Nutrition and Dietetics, 112(11), 1835–1842. PubMedCentralPubMedCrossRef
Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55. CrossRef
Knox, S. (2013). Sample size calculation in economic evaluation. Australia: The Centre for Health Economic Research and Evaluation (CHERE).
Glick, H. A. (2011). Sample size and power for cost-effectiveness analysis (Part 2) the effect of maximum willingness to pay. Pharmacoeconomics, 29(4), 287–296. PubMed
Curtin, K., Beckman, H., Pankow, G., Milillo, Y., & Green, R. A. (2006). Return on investment in pay for performance: A diabetes case study. Journal of Healthcare Management, 51(6), 365–374. PubMed
Chen, T. T., Chung, K. P., Lin, I. C., & Lai, M. S. (2011). The unintended consequence of diabetes mellitus pay-for-performance (P4P) program in Taiwan: Are patients with more comorbidities or more severe conditions likely to be excluded from the P4P program? Health Services Research, 46(1 Pt 1), 47–60. PubMedCentralPubMedCrossRef
Solli, O., Stavem, K., & Kristiansen, I. S. (2010). Health-related quality of life in diabetes: The associations of complications with EQ-5D scores. Health and Quality of Life Outcomes, 8(18), 1–8.
- Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?
Elise Chia-Hui Tan
- Springer International Publishing