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Session: Provider Incentives
Room: Chydenius Rooms
Time: Fri 14:30-15:45

Presenter: Shou-Hsia Cheng (National Taiwan University. Health Policy and Management)

Abstract

Background: Plenty of studies examined the effects of a pay-for-performance (P4P) program. However, limited studies examined the long-term effects of financial incentive programs.

Objective: To examine the long-term effects of a P4P program for diabetes care in Taiwan.

Data sources/ study setting: Longitudinal data of a 5-year panel of claims data that capture healthcare utilization from the years 2001 to 2006 under a compulsory National Health Insurance (NHI) program.

Study design: A natural experimental design complemented by longitudinal data was employed to examine the causal effects of a P4P program. Patients with diabetes who were enrolled into the P4P program were defined as the P4P group and those who had never been enrolled into the P4P program were candidates for the control group. This study used a propensity score case-control matching method with 1 to 4 matching to eliminate the bias due to observed differences between the 2 groups. Finally, 1895 patients were enrolled into the P4P program, and 7580 patients were matched in the control group.

Measures: The number of essential diabetes-specific exams/tests and diabetes-related healthcare utilization before and after the P4P program were calculated for the 2 study groups.

Empirical estimation: This study conducted differences-in-differences (DID) analyses using Generalized Estimating Equations (GEEs) approach with negative binominal distribution. The analysis took into account the correlation between repeated measures among patients and the correlation among patients within the same matched pairs.
Results: Patients in the P4P group received significantly more diabetes-specific exams/ tests than before the enrollment and more than that in the control group, and the differences declined gradually over time (β=0.418 to β=0.145; all with p<0.001). Patients in the P4P group had a significantly higher number of physician visits than control group, with a dramatic increase in the first year after enrollment and then decreased gradually (β=0.044 to β=-0.088; all with p<0.001). Conversely, the patients in the P4P group had fewer diabetes-related emergency department visits and diabetes-related hospitalizations than patients in the control group, but did not reach a significant level.

Conclusion: The P4P program for diabetes care was associated with a significant increase in regular follow-up visits and needed exam/tests. In addition, we found that these differences between the two groups decreased over time. Additional research is required to evaluate the cost-effectiveness of the program.

Key Terms

pay-for-performance, diabetes care, healthcare utilization, Taiwan

Authors:

Shou-Hsia Cheng (National Taiwan University. Health Policy and Management) , Tai-Ti Lee (Taiwan Bureau of National Health Insurance) and Chi-Chen Chen (National Taiwan University. Health Policy and Management)

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