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Gandjour A. Modelling the cost-effectiveness and budget impact of pay-for-performance programs in health care. BMC Health Serv Res 2024; 24:1484. [PMID: 39604997 PMCID: PMC11603998 DOI: 10.1186/s12913-024-11796-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/18/2024] [Indexed: 11/29/2024] Open
Abstract
INTRODUCTION With an upward trend in adoption by industrialized nations, pay-for-performance (P4P) mechanisms are increasingly recognized for fostering quality improvement in healthcare. P4P programs conventionally reward providers with supplemental payments upon achieving predefined performance targets. This study aims to utilize decision modelling to determine the cost-effectiveness and maximum incentive levels of P4P programs. METHODS A decision model, grounded in previously published models exploring the cost-effectiveness of implementation programs, was developed. The model evaluates the cost-effectiveness of P4P programs for an exogenous reward size under varied reward mechanisms and also in scenarios with and without a budget or time constraint. RESULTS In instances where P4P programs do not substitute other healthcare programs, their incremental cost-effectiveness ratio (ICER) is deterministically set and ranges from treatment ICER to infinity, irrespective of the reward mechanism. With a budget or time constraint in play, the P4P program is incentivized up to the point where its population cost or ICER aligns with that of the program being replaced. CONCLUSION The proposed decision model effectively calculates the cost-effectiveness and budget impact of P4P programs, accommodating various reward mechanisms and scenarios, both with and without budget or time constraints.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance & Management, Adickesallee 32-34, Frankfurt am Main, 60322, Germany.
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Kang KT, Chang RE, Lin MT, Chen YC. Pay-for-performance in Taiwan: A systematic review and meta-analysis of the empirical literature. Public Health 2024; 236:328-337. [PMID: 39299087 DOI: 10.1016/j.puhe.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/27/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. STUDY DESIGN This was a systematic review and meta-analysis. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Kun-Tai Kang
- 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
| | - Ray-E Chang
- 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.
| | - Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Changhua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
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Ho YC, Wang CT, Weng TC, Ho CH, Tsai KT, Hsu CC, Lin HJ, Chen HC, Huang CC. Impact of the Home-Based Medical Integrated Program on Health Outcomes and Medical Resource Utilization in Home Healthcare Patients in Taiwan. Clin Interv Aging 2024; 19:1437-1444. [PMID: 39165906 PMCID: PMC11333557 DOI: 10.2147/cia.s457281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 08/01/2024] [Indexed: 08/22/2024] Open
Abstract
Purpose The home-based medical integrated program (HMIP) is a novel model for home healthcare (HHC) in Taiwan, initiated in 2016 to enhance care quality. However, the outcomes of this program on health outcomes and medical resource utilization in HHC patients remain unclear. Thus, we conducted this study to clarify it. Patients and Methods The authors utilized the Taiwan National Health Insurance Research Database to identify HHC patients who received HMIP and those who did not between January 2015 and December 2017. A retrospective cohort study design was used. Convenience sampling was employed to select patients who met the inclusion criteria: being part of the HHC program and having complete data for analysis. Results A total of 4982 HHC patients in the HMIP group and 10,447 patients in the non-HMIP group were identified for this study. The mean age in the HMIP group and non-HMIP group was 77.6 years and 76.1 years, respectively. Compared with the non-HMIP group, the HMIP group had lower total medical costs for HHC, fewer outpatient department visits and lower medical costs, lower medical costs for emergency department visits, fewer hospitalizations, and a lower mortality rate (34.6% vs 41.2%, p<0.001). Conclusion The HMIP is a promising model for improving care quality and reducing medical resource utilization in HHC patients. While this suggests that the non-HMIP model should be replaced, it's important to note that both non-HMIP and HMIP models currently coexist. The HMIP may serve as an important reference for other nations seeking to improve care quality and reduce medical resource utilization in their own HHC systems.
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Affiliation(s)
- Yu-Chieh Ho
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Ti Wang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Tzu-Chieh Weng
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Kang-Ting Tsai
- Department of Senior Welfare and Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Chin Chen
- Department of Senior Welfare and Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Lai YC, Chen YS, Jiang YD, Wang CS, Wang IC, Huang HF, Peng HY, Chen HC, Chang TJ, Chuang LM. Diabetes self-management education on the sustainability of metabolic control in type 2 diabetes patients: Diabetes share care program in Taiwan. J Formos Med Assoc 2024; 123:283-292. [PMID: 37798146 DOI: 10.1016/j.jfma.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Diabetes self-management education (DSME) improves glycemic and metabolic control. However, the frequency, duration and sustainability of DSME for improving metabolic control have not been well studied. METHODS The Diabetes Share Care Program (DSCP) stage 1 provided DSME every 3 months. If participants entering DSCP stage 1 ≥ 2 years and HbA1c < 7%, they can be transferred to stage 2 (DSME frequency: once a year). Three-to-one matching between DSCP stage 1 and stage 2 groups based on the propensity score method to match the two groups in terms of HbA1c and diabetes duration. We identified 311 people living with type 2 diabetes in DSCP stage 1 and 86 in stage 2 and evaluated their metabolic control and healthy behaviors annually for 5 years. RESULTS In the first year, HbA1c in the DSCP stage 2 group was significantly lower than that in the stage 1 group. In the first and the fifth years, the percentage of patients achieving HbA1c < 7% was significantly higher in the DSCP stage 2 group than the stage 1 group. There was no significant difference in other metabolic parameters between the two groups during the 5-year follow-up. Self-monitoring of blood glucose (SMBG) frequency was associated with a reduced HbA1c after 5 years (95% CI: -0.0665 to -0.0004). CONCLUSION We demonstrated sustainable effects of at least 2-year DSME on achieving better glycemic control for at least 1 year. SMBG contributed to improved glycemic control. The results may be applied to the reimbursement strategy in diabetes education.
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Affiliation(s)
- Ying-Chuen Lai
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Rm733, Bldg.Lab.Med., NTU Hospital, No.1, Chang-Te St., Taipei City 100229, Taiwan, ROC; School of Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei City 100233, Taiwan, ROC
| | - Yi-Shuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC
| | - Yi-Der Jiang
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC
| | - Chiou-Shiang Wang
- Department of Nursing, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC
| | - I-Ching Wang
- Department of Nursing, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC
| | - Hsiu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC
| | - Hui-Yu Peng
- Department of Dietetics, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC
| | - Hui-Chuen Chen
- Department of Dietetics, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC
| | - Tien-Jyun Chang
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC; School of Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei City 100233, Taiwan, ROC.
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan, ROC; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Rm733, Bldg.Lab.Med., NTU Hospital, No.1, Chang-Te St., Taipei City 100229, Taiwan, ROC; School of Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei City 100233, Taiwan, ROC; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Room 501, No.17, Xu-Zhou Road, Taipei City 100025, Taiwan, ROC
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Kuo WY, Tsai WC, Kung PT. Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program. Healthcare (Basel) 2023; 11:2742. [PMID: 37893816 PMCID: PMC10606631 DOI: 10.3390/healthcare11202742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES This study's objectives were to compare the participation rates of people with and without disabilities who had type 2 diabetes in a diabetes pay-for-performance (DM P4P) program, as well as their care outcomes after participation. METHODS This was a retrospective cohort study. The data came from the disability registry file, cause of death file, and national health insurance research database of Taiwan. The subjects included patients newly diagnosed with type 2 diabetes between 2001 and 2013 who were followed up with until 2014 and categorized as disabled and non-disabled patients. The propensity score matching method was used to match the disabled with the non-disabled patients at a 1:1 ratio. Conditional logistic regression analysis was used to determine the odds ratio between the disabled and non-disabled patients who joined the P4P program. The Cox hazard model was used to compare the risk of dialysis and death between the disabled and non-disabled patients participating in the P4P program. RESULTS There were 110,645 disabled and 110,645 non-disabled individuals after matching. After controlling for confounding factors, it was found that the disabled individuals were significantly less likely (odds ratio = 0.89) to be enrolled in the P4P program than the non-disabled individuals. The risk of dialysis was 1.08 times higher for people with disabilities than those without, regardless of their participation in the P4P program. After enrollment in the P4P program, the risk of death for people with disabilities decreased from 1.32 to 1.16 times that of persons without disabilities. Among the people with disabilities, the risk of death for those enrolled in the P4P program was 0.41 times higher than that of those not enrolled. The risk of death was reduced to a greater extent for people with disabilities than for those without disabilities upon enrollment in the DM P4P program. CONCLUSION People with disabilities are less likely to be enrolled in the P4P program in Taiwan and have unequal access to care. However, the P4P program was more effective at reducing mortality among people with disabilities than among those without.
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Affiliation(s)
- Wei-Yin Kuo
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-Y.K.); (W.-C.T.)
| | - Wen-Chen Tsai
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-Y.K.); (W.-C.T.)
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan
| | - Pei-Tseng Kung
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Healthcare Administration, Asia University, Taichung 413305, Taiwan
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Lin PC, Lin CC, Li CI, Wang TC, Peng YH, Chang TT, Lin CY, Li TC, Hsieh CL. TCM as adjunctive therapy improves risks of respiratory hospitalizations in persons with type 2 diabetes: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e33318. [PMID: 36961191 PMCID: PMC10036058 DOI: 10.1097/md.0000000000033318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
Patients with type 2 diabetes are at a higher risk of chronic obstructive pulmonary disease (COPD) and asthma than the general population. In addition, emerging evidence suggests that traditional Chinese medicine (TCM) might be beneficial for patients with type 2 diabetes. We investigated whether TCM use was associated with a reduced risk of respiratory hospitalizations in patients with type 2 diabetes. Conducting a retrospective cohort study, we used data retrieved from the NDCMP database. Among 56,035 patients, 5226 were classified as TCM users; 50,809 were classified as TCM nonusers. Both groups were analyzed until the end of 2011 to examine the incidence of respiratory hospitalizations by using a Cox proportional hazards model to evaluate effects of TCM use on respiratory hospitalizations. During the 6-year study follow-up period, the incidence density rates of COPD- and asthma-related hospitalization were estimated to be 13.03 and 4.47 per 10,000 patient-years for TCM nonusers and 10.08 and 3.28 per 10,000 patient-years for TCM users, respectively. The HR of COPD-related hospitalization in TCM users was 0.88 (95% CI = 0.79-0.99); and the HR of asthma-related hospitalization in TCM users was 0.81 (95% CI = 0.66-1.00). Stratified analyses revealed that effects of TCM use were stronger among individuals who had diabetes for <3 years. As a part of Integrative Medicine, our study results demonstrate that TCM use was associated with a significant reduced risk of respiratory hospitalizations, especially in patients with diabetes for <3 years.
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Affiliation(s)
- Pei-Chun Lin
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan, Republic of China
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Tang-Chuan Wang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan, Republic of China
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, Republic of China
| | - Yi-Hao Peng
- Department of Respiratory Therapy, Asia University Hospital, Asia University, Taichung, Taiwan, Republic of China
| | - Tung-Ti Chang
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chin-Yi Lin
- PhD Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan, Republic of China
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan, Republic of China
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan, Republic of China
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Lian WC, Livneh H, Huang HJ, Lu MC, Guo HR, Tsai TY. Adding Pay-for-Performance Program to Routine Care Was Related to a Lower Risk of Depression Among Type 2 Diabetes Patients in Taiwan. Front Public Health 2021; 9:650452. [PMID: 34722429 PMCID: PMC8548469 DOI: 10.3389/fpubh.2021.650452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with type 2 diabetes (T2DM) often experience depression during treatment, negatively influencing their treatment compliance and clinical outcomes. Recently, the pay-for-performance (P4P) program for chronic diseases, with high-cost and high-risk feature, such as T2DM, has been implemented and has been operational for several years. Nevertheless, its effect on the risk of developing depression among T2DM cases is unknown. This study aims to explore the association of P4P use with the subsequent risk of developing depression among these patients. Methods: This cohort study used a nationwide health insurance database to identify patients 20-70 years of age newly diagnosed with T2DM who enrolled in the P4P program between 2001 and 2010. From this group, we enrolled 17,022 P4P users and then 17,022 non-P4P users who were randomly selected using propensity-score-matching. Enrolled patients were followed until the end of 2012 to record the occurrence of depression. The Cox proportional hazards regression was utilized to obtain the adjusted hazard ratio (aHR) for P4P use. Results: During the study period, a total of 588 P4P users and 1,075 non-P4P users developed depression at incidence rates of 5.89 and 8.41 per 1,000 person-years, respectively. P4P users had a lower depression risk than did non-P4P users (aHR, 0.73; 95% Confidence Interval, 0.65-0.80). This positive effect was particularly prominent in those receiving high-intensity use of the P4P program. Conclusion: Integrating P4P into routine care for patients with T2DM may have beneficial effects on curtailing the subsequent risk of depression.
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Affiliation(s)
- Wei-Cheng Lian
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, Portland, OR, United States
| | - Hui-Ju Huang
- Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - Ming-Chi Lu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Tzung-Yi Tsai
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.,Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
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Chen TT, Oldenburg B, Hsueh YS. Chronic care model in the diabetes pay-for-performance program in Taiwan: Benefits, challenges and future directions. World J Diabetes 2021; 12:578-589. [PMID: 33995846 PMCID: PMC8107979 DOI: 10.4239/wjd.v12.i5.578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/08/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
In this review, we discuss the chronic care model (CCM) in relation to the diabetes pay-for-performance (P4P) program in Taiwan. We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan, mapping them onto the 6 components of the CCM. For each CCM component, the following three topics are described: the definition of the CCM component, the general activities implemented related to this component, and practical and empirical practices based on hospital or local government cases. We then conclude by describing the possible successful features of this P4P program and its challenges and future directions. We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives (i.e., shared care network), physician-led P4P and the implementation of activities based on the CCM components. However, due to the low rate of P4P program coverage, approximately 50% of patients with diabetes cannot enjoy the benefits of CCM-related activities or receive necessary examinations. In addition, most of these CCM-related activities are not allotted an adequate amount of incentives, and these activities are mainly implemented in hospitals, which compared with primary care providers, are unable to execute these activities flexibly. All of these issues, as well as insufficient implementation of the e-CCM model, could hinder the advanced improvement of diabetes care in Taiwan.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Brian Oldenburg
- Noncommunicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
| | - Ya-Seng Hsueh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
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Huang HL, Kung CY, Wang SM, Kung PT, Lin YH, Chiu LT, Tsai WC. Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094648. [PMID: 33925667 PMCID: PMC8125714 DOI: 10.3390/ijerph18094648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
Background: The diabetes patients enrolled in the pay-for-performance (P4P) program demonstrate reduced risk of death. Body mass index (BMI) is a risk factor of all-cause death. This study investigates the effects of BMI and P4P on the risk of death in type 2 diabetes patients. Methods: This is a retrospective cohort study. The study population includes the 3-wave National Health Interview Survey in Taiwan. A total of 6354 patients with diabetes aged ≥ 20 years were enrolled and followed up until the end of 2014. Results: The highest mortality rate per 1000 person-years was 61.05 in the underweight patients with diabetes. A lower crude death rate was observed in the P4P participants than non-P4P participants. The risk of death was 1.86 times higher in the underweight patients with diabetes than that in the normal weight group (95% CI: 1.37–2.53) and was lower in the P4P participants, as compared to the non-participants (HR: 0.55, 95% CI: 0.44–0.69). The most significant effect of joining the P4P program in reducing death risk was found in the underweight patients with diabetes (HR: 0.11, 95% CI: 0.04–0.38), followed by the obesity group (HR: 0.30, 95% CI: 0.17–0.52). Conclusions: Different effects of joining the P4P program on reducing death risk were observed in the underweight and obesity groups. We strongly recommend that patients with diabetes and without healthy BMIs participate in the P4P program.
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Affiliation(s)
- Hsiu-Ling Huang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan; (H.-L.H.); (S.-M.W.)
| | - Chuan-Yu Kung
- Department of Nursing, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan;
| | - Shun-Mu Wang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan; (H.-L.H.); (S.-M.W.)
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung City 41354, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City 40402, Taiwan
| | - Yen-Hsiung Lin
- Department of Pediatrics, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan;
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan;
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan;
- Correspondence: ; Tel.: +886-422994045; Fax: +886-422993643
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Liang YW, Chang HF, Lin YH. Effects of health-information-based diabetes shared care program participation on preventable hospitalizations in Taiwan. BMC Health Serv Res 2019; 19:890. [PMID: 31771584 PMCID: PMC6880543 DOI: 10.1186/s12913-019-4738-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Taiwan's Diabetes Shared Care Program has been implemented since 2012, and the health information system plays a vital role in supporting most services of this program. However, little is known regarding the effectiveness of this information-based program. Therefore, this study investigated the effects of the participation of the Diabetes Shared Care Program on preventable hospitalizations. METHODS This longitudinal study examined the data of health-care claims from 2011 to 2014 obtained from the diabetes mellitus health database. Patients with diabetes aged ≥18 years were included. Preventable hospitalizations were identified on the basis of prevention quality indicators developed for administrative data by the US Agency for Healthcare Research and Quality. A multilevel logistic regression was performed to examine the effects of the participation of the Diabetes Shared Care Program on preventable hospitalizations after adjustment for other variables. Analyses were conducted in late 2018. RESULTS A medium level of participation (p = 0.05), age between 40 and 64 years(p < 0.0001), and absence of a catastrophic illness(p < 0.0001) were associated with a lower probability of having a preventable hospitalization. Male sex(p < 0.0001), age ≥ 65 years(p = 0.0203), low income level(p < 0.0001), living in the Southern division(p = 0.0106), and presence of many comorbidities(p < 0.0001) were associated with a higher probability of having a preventable hospitalization after adjustment for characteristics at the individual and county levels. CONCLUSIONS The health information system records patients' medical history, monitors quality of care, schedules patient follow-ups, and reminds case managers to provide timely health education. This health-information-based Diabetes Shared Care Program is associated with better quality care of ambulatory, so it should be promoted on a broader scale.
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Affiliation(s)
- Yia-Wun Liang
- Department of Senior Citizen Services Management, National Taichung University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Hsiao-Feng Chang
- Department of Nursing, Chung-Kang Branch, Cheng Ching Hospital, Taichung, Taiwan, Republic of China
| | - Yu-Hsiu Lin
- Graduate Institute and Department of Information Management/Graduate Institute of Healthcare Information Management, Center for Innovative Research on Aging Society (CIRAS), 168, Sec. 1, University Road, Min-Hsiung, Chiayi, 62102, Taiwan, Republic of China.
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11
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Lee IT, Hsu CC, Sheu WHH, Su SL, Wu YL, Lin SY. Pay-for-performance for shared care of diabetes in Taiwan. J Formos Med Assoc 2019; 118 Suppl 2:S122-S129. [PMID: 31471222 DOI: 10.1016/j.jfma.2019.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/04/2019] [Accepted: 08/12/2019] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND/PURPOSE Comprehensive and continuous care is crucial for patients with diabetes. The diabetes pay-for-performance (P4P) program launched by the National Health Insurance (NHI) administration in Taiwan provides a financial incentive to facilitate this goal. In this study, we explored the characteristics of patients in the P4P program between 2005 and 2014. METHODS Data of patients with diabetes enrolled in the NHI program between 2005 and 2014 were extracted from the NHI research database. Patients were classed as having diabetes if they had three or more outpatient visits within 365 calendar days with an International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code of 250 or hospitalization one or more times with such a diagnosis. The trends of participating in the P4P program were analyzed. RESULTS Participation rate of the P4P program increased from 12.1% to 19% between 2005 and 2014. Participants were younger and more likely to be female than those not participating in the program. Lower risks of cancer-related mortality, annual mortality and heart failure were seen in patients participating in the P4P program than in those not participating. CONCLUSION Older, male patients with a high disease severity may be less likely to enroll in the P4P program. Although participation rate is increasing, a broad enrollment is expected.
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Affiliation(s)
- I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; College of Science, Tunghai University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shih-Li Su
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Ling Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Shih-Yi Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
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12
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Tsai YS, Kung PT, Ku MC, Wang YH, Tsai WC. Effects of pay for performance on risk incidence of infection and of revision after total knee arthroplasty in type 2 diabetic patients: A nationwide matched cohort study. PLoS One 2018; 13:e0206797. [PMID: 30388167 PMCID: PMC6214551 DOI: 10.1371/journal.pone.0206797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 10/19/2018] [Indexed: 12/31/2022] Open
Abstract
As the world's population ages, the number of people receiving total knee arthroplasty (TKA) has been on the rise. Although patients with diabetes mellitus are known to face greater risks of TKA postoperative infection and revision TKA owing to diabetic complications, studies on whether such patients' participation in pay for performance (P4P) programs influences the incidence rates of TKA postoperative infection or revision TKA are still lacking. This study examined the 2002-2012 data of Taiwan's National Health Insurance Research Database to conduct a retrospective cohort analysis of diabetic patients over 50 years old who have received TKA. To reduce any selection bias between patients joining and not joining the P4P program, propensity score matching was applied. The Cox proportional hazards model was used to examine the influence of the P4P program on TKA postoperative infection and revision TKA, and the results indicate that joining P4P lowered the risk of postoperative infection (HR = 0.91, 95% CI: 0.77-1.08), however, which was not statistically significant, and significantly lowered the risk of revision TKA (HR = 0.53, 95% CI: 0.39-0.72). Being younger and male, having multiple comorbid conditions or greater diabetic severity, receiving care at regional or public hospitals, and not having a diagnosis of degenerative or rheumatoid arthritis were identified as factors for higher risk of TKA postoperative infection for patients with diabetes. As for the risk of revision TKA, postoperative infection and being younger were identified as factors for a significantly higher risk (p < 0.05).
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Affiliation(s)
- Yi-Shiun Tsai
- Department of Orthopedics, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, ROC
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Ming-Chou Ku
- Department of Orthopedics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan, ROC
| | - Yeuh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- * E-mail:
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Cheng SW, Wang CY, Chen JH, Ko Y. Healthcare costs and utilization of diabetes-related complications in Taiwan: A claims database analysis. Medicine (Baltimore) 2018; 97:e11602. [PMID: 30075532 PMCID: PMC6081128 DOI: 10.1097/md.0000000000011602] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To estimate the healthcare utilization and costs of major diabetes mellitus (DM)-related complications in Taiwan in the year of first occurrence and in subsequent years.This study is a retrospective claim database analysis using the longitudinal cohort of diabetes patients (LHDB) with 2012 as the base year. Occurrences of 8 DM-related complications of interest were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Annual healthcare costs and utilization of these DM-related complications in the LHDB cohorts of the years 2004 to 2009 were examined, and the generalized linear model was used to estimate annual total healthcare costs for each complication.DM patients with complications were more likely to have at least 1 emergency room (ER) visit and at least 1 hospitalization (both P < .001), and they also had more outpatient visits, higher hospitalization costs, higher outpatient costs, and higher ER costs (all P < .001) than those without. The mean annual total healthcare cost of the patients with DM-related complications was US $4189, whereas the mean annual cost of those patients without complication was $1424 (P < .001). The complications with the greatest event costs were amputation ($7877; 95% confidence interval [CI]: $6628-$9322) and fatal MI ($4067; 95% CI: $3001-$5396) while the complication with the greatest state costs was end-stage renal disease (ESRD) ($2228; 95% CI: $2155 to $2302).DM-related complications could significantly increase healthcare utilization and costs. The results of this study provide data that are useful for local economic evaluations of DM treatments.
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Affiliation(s)
- Ssu-Wei Cheng
- Department of Pharmacy, Shin Kong Wu Ho-Su Memorial Hospital
| | - Chin-Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital
| | - Jin-Hua Chen
- Biostatistics Center/Masters Program in Big Data Technology and Management, College of Management
| | - Yu Ko
- Department of Pharmacy
- Research Center of Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Chen CH, Ma SH, Hu SY, Chang CM, Chiang JH, Hsieh VCR, Yen DHT, How CK, Hsieh MS. Diabetes Shared Care Program (DSCP) and risk of infection mortality: a nationwide cohort study using administrative claims data in Taiwan. BMJ Open 2018; 8:e021382. [PMID: 30002011 PMCID: PMC6082473 DOI: 10.1136/bmjopen-2017-021382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan that has been proven to improve the care quality of patients with diabetes. We aimed to evaluate the efficacy of DSCP in decreasing the hospital mortality of infectious diseases. METHODS From 1 662 929 patients with type 2 diabetes newly diagnosed between 1999 and 2013, we retrieved a total of 919 patients who participated in the DSCP with the first hospitalisation for an infectious disease as the study cohort and 9190 propensity score-matched patients with type 2 diabetes who did not participate as the comparison.The efficacy of DSCP was evaluated via the following comparisons between the DSCP and non-DSCP cohorts: hospital mortality, 1-year medical cost prior to and during the hospitalisation, and complications, such as receiving mechanical ventilation and intensive care unit admission. The ratio (OR) for hospital mortality of the DSCP participants was calculated by logistical regression. Further stratification analyses were conducted to examine which group of patients with type 2 diabetes benefited the most from the DSCP during hospitalisation for infectious diseases. RESULTS The DSCP cohort had a lower hospital mortality rate than the non-DSCP participants (2.18% vs 4.82%, p<0.001). The total medical cost during the hospitalisation was lower in the DSCP cohort than in the non-DSCP cohort (NT$72 454±30 429 vs NT$86 385±29 350) (p=0.006). In the logistical regression model, the DSCP participants exhibited a significantly decreased adjusted OR for hospital mortality (adjusted OR=0.42, 95% CI 0.26 to 0.66, p=0.0002). The efficacy of the DSCP was much more prominent in male patients with type 2 diabetes and in patients with lower incomes. CONCLUSION Participation in the DSCP was associated with a lower risk of hospital mortality for infectious diseases.
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Affiliation(s)
- Cheng-Han Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hsiang Ma
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- YongLin Healthcare Foundation, Taipei, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Ming Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University, Taichung, Taiwan
| | - Vivian Chia-Rong Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - David Hung-Tsang Yen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
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15
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Disease-specific Pay-for-Performance Programs: Do the P4P Effects Differ Between Diabetic Patients With and Without Multiple Chronic Conditions? Med Care 2017; 54:977-983. [PMID: 27547944 DOI: 10.1097/mlr.0000000000000598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Several studies have investigated the effects of pay-for-performance (P4P) initiatives. However, little is known about whether patients with multiple chronic conditions (MCC) would benefit from P4P initiatives similarly to patients without MCC. OBJECTIVES The objective of this study was to compare the effects of the diabetes mellitus pay-for-performance (DM-P4P) program on the quality of diabetic care between type 2 diabetic patients with and without MCC. METHODS This study used data from Taiwan's Longitudinal Health Insurance Database 2005. Of this cohort, 52,276 diabetic patients were identified. To address potential selection bias between the intervention and comparison groups, the propensity score matching method was used. Generalized estimating equations were applied to analyze the difference-in-difference model to examine the effect of the intervention, the DM-P4P program. RESULTS The disease-specific DM-P4P program had positive impacts on process and outcome indicators of health care quality regardless of patients' MCC status. Diabetic patients with MCC experienced a significantly larger decrease in the admission rate of diabetes-related ambulatory care sensitive conditions after the P4P enrollment over time compared with patients without MCC. CONCLUSIONS The positive impacts on use of diabetes-related services were comparable between diabetic patients with and without MCC. Most importantly, for MCC patients, the disease-specific DM-P4P program had a stronger positive impact on health outcomes. Hence, the commonly observed phenomenon of "cherry picking" in implementing P4P strategies may lead to disparities in the quality of diabetic care between diabetic patients with and without MCC.
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16
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Stanworth JO, Hsu RS, Warden CA. Validation of a Measure of Chinese Outpatients' Satisfaction in the Taiwan Setting. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958016688979. [PMID: 28140760 PMCID: PMC5798716 DOI: 10.1177/0046958016688979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/13/2016] [Accepted: 11/26/2016] [Indexed: 11/16/2022]
Abstract
The medical services market is rapidly expanding around the world, following the experience of the industrialized Western economies. Cultural differences make existing assumptions about health care quality risky to export, leading to an increasing interest in understanding patient satisfaction with care within non-Western contexts. Within the Greater China region, both Western and traditional Chinese medicine coexist, yet there is a lack of research instruments that include distinct values of Chinese patients. This article reports the development of a measure of Chinese patient satisfaction with outpatient care. We describe the foundation of the scale in a qualitative report that includes 8 dimensions of Chinese patient satisfaction. A sample of 400 Chinese patients completed the final instrument. A quantitative analytical procedure leads to a 6-dimension and 27-item instrument to measure Chinese patients' satisfaction with outpatient care. Our proposed instrument has good internal consistency supporting the use of the instrument in contexts where Chinese patients are being treated.
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17
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Borghi J, Little R, Binyaruka P, Patouillard E, Kuwawenaruwa A. In Tanzania, the many costs of pay-for-performance leave open to debate whether the strategy is cost-effective. Health Aff (Millwood) 2016; 34:406-14. [PMID: 25732490 DOI: 10.1377/hlthaff.2014.0608] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pay-for-performance programs in health care are widespread in low- and middle-income countries. However, there are no studies of these programs' costs or cost-effectiveness. We conducted a cost-effectiveness analysis of a pay-for-performance pilot program in Tanzania and modeled costs of its national expansion. We reviewed project accounts and reports, interviewed key stakeholders, and derived outcomes from a controlled before-and-after study. In 2012 US dollars, the financial cost of the pay-for-performance pilot was $1.2 million, and the economic cost was $2.3 million. The incremental cost per additional facility-based birth ranged from $540 to $907 in the pilot and from $94 to $261 for a national program. In a low-income setting, the costs of managing the program and generating and verifying performance data were substantial. Pay-for-performance programs can stimulate the generation and use of health information by health workers and managers for strategic planning purposes, but the time involved could divert attention from service delivery. Pay-for-performance programs may become more cost-effective when integrated into routine systems over time.
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Affiliation(s)
- Josephine Borghi
- Josephine Borghi is a senior lecturer in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine
| | - Richard Little
- Richard Little is a consultant health economist in Cambridge, England
| | - Peter Binyaruka
- Peter Binyaruka is a research scientist at the Ifakara Health Institute
| | - Edith Patouillard
- Edith Patouillard is a senior scientific collaborator in the Epidemiology and Public Health Department, Health Intervention Unit, Swiss Tropical and Public Health Institute, in Basel; the University of Basel; and the World Health Organization Global Malaria Programme, in Geneva, Switzerland
| | - August Kuwawenaruwa
- August Kuwawenaruwa is a research scientist at the Ifakara Health Institute, in Dar es Salaam, Tanzania
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18
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Abstract
This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared with using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive outcomes.
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Affiliation(s)
- Anthony Scott
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Miao Liu
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Jongsay Yong
- The University of Melbourne, Melbourne, Victoria, Australia
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19
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Chi MJ, Chou KR, Pei D, Hwang JS, Quinn L, Chung MH, Liao YM. Effects and Factors Related to Adherence to A Diabetes Pay-for-Performance Program: Analyses of a National Health Insurance Claims Database. J Am Med Dir Assoc 2016; 17:613-9. [DOI: 10.1016/j.jamda.2016.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 01/02/2023]
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20
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Michel-Lepage A, Ventelou B. The true impact of the French pay-for-performance program on physicians' benzodiazepines prescription behavior. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:723-732. [PMID: 26304210 DOI: 10.1007/s10198-015-0717-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 07/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The French pay-for-performance (P4P) contract CAPI implemented by the national health insurance included a target-goal which aims at reducing benzodiazepines prescriptions. In this investigation, we would like to assess whether: (1) the general practitioners (GPs) having signed P4P contract obtain better results regarding the target-goal than non-signatories; (2) (part of) this progression is due to the CAPI contract itself (tentative measurement of a "causal effect"); (3) (part of) the money spent on this P4P incentive can be self-financed with the amount of pharmaceuticals saved. METHODS We matched cross-sectional and longitudinal data including 4622 French GPs from June 2011 to December 2012. A treatment effect model using instrumental variables was performed to take into account potential self-selection issue in signing. After having identified the NET impact of the P4P, we calculate the cost of an avoided benzodiazepines treatment. RESULTS In our study, GPs who have signed the CAPI contract (36 % of the sample) are more numerous in achieving benzodiazepines target goal than non-signatories: 90.7 vs. 85.5 %. After controlling for the self-selection bias, the propensity of GPs to achieve the benzodiazepines target is only 0.31 % higher for signatories than for their non-signing counterparts-estimate for June 2012, which yields a statistically significant gap. Our economic analysis demonstrates that the CAPI contract does not allow savings, but presents in 2012 a NET cost of 93.6€ per avoided benzodiazepines treatment (291€ in 2011). CONCLUSIONS The P4P contract has a positive but modest impact on the achievement of GPs regarding benzodiazepines indicator.
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Affiliation(s)
- Audrey Michel-Lepage
- Aix Marseille Université (Aix Marseille School of Economics, SESSTIM UMR912), Marseille, France.
- IHU, Fondation Méditerranée Infection, Marseille, France.
| | - Bruno Ventelou
- Aix Marseille Université (Aix Marseille School of Economics, GREQAM UMR7316), Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 23 rue Stanislas Torrent, 13006, Marseille, France
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21
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Cheng LJ, Chen JH, Lin MY, Chen LC, Lao CH, Luh H, Hwang SJ. A competing risk analysis of sequential complication development in Asian type 2 diabetes mellitus patients. Sci Rep 2015; 5:15687. [PMID: 26507664 PMCID: PMC4623532 DOI: 10.1038/srep15687] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/23/2015] [Indexed: 01/05/2023] Open
Abstract
This retrospective cohort study investigated the progression risk of sequential complication in Asian type 2 diabetes (T2D) patients using the Taiwan Pay-for-Performance Diabetes Registry and claim data from November 2003 to February 2009. 226,310 adult T2D patients without complication were followed from diagnosis to complications, including myocardial infarction (MI), other ischemic heart disease (IHD), congestive heart failure (CHF), stroke, chronic kidney disease (CKD), retinopathy, amputation, death or to the end of study. Cumulative incidences (CIs) of first and second complications were analyzed in 30 and 4 years using the cumulative incidence competing risk method. IHD (29.8%), CKD (24.5%) and stroke (16.0%) are the most common first complications. The further development of T2D complications depends on a patient’s existing complication profiles. Patients who initially developed cardiovascular complications had a higher risk (9.2% to 24.4%) of developing IHD or CKD, respectively. All-cause mortality was the most likely consequence for patients with a prior MI (12.0%), so as stroke in patients with a prior MI (10.8%) or IHD (8.9%). Patients with CKD had higher risk of developing IHD (16.3%), stroke (8.9%) and all-cause mortality (8.7%) than end-stage renal disease (4.0%). Following an amputation, patients had a considerable risk of all-cause mortality (42.1%).
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Affiliation(s)
- Li-Jen Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jeng-Huei Chen
- Department of Mathematical Sciences, National Chengchi University, Taipei, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,National Applied Research Laboratories, Instrument Technology Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Chia Chen
- Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.,Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Huan Lao
- Waikato Clinical School, The University of Auckland, Hamilton, New Zealand
| | - Hsing Luh
- Department of Mathematical Sciences, National Chengchi University, Taipei, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faulty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Population Sciences, National Health Research Institute, Miaoli, Taiwan
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22
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Hsieh HM, Gu SM, Shin SJ, Kao HY, Lin YC, Chiu HC. Cost-Effectiveness of a Diabetes Pay-For-Performance Program in Diabetes Patients with Multiple Chronic Conditions. PLoS One 2015; 10:e0133163. [PMID: 26173086 PMCID: PMC4501765 DOI: 10.1371/journal.pone.0133163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/23/2015] [Indexed: 01/02/2023] Open
Abstract
Pay for performance (P4P) has been used as a strategy to improve quality for patients with chronic illness. Little was known whether care provided to individuals with multiple chronic conditions in a P4P program were cost-effective. This study investigated cost effectiveness of a diabetes P4P program for caring patients with diabetes alone (DM alone) and diabetes with comorbid hypertension and hyperlipidemia (DMHH) from a single payer perspective in Taiwan. Analyzing data using population-based longitudinal databases, we compared costs and effectiveness between P4P and non-P4P diabetes patient groups in two cohorts. Propensity score matching (PSM) was used to match comparable control groups for intervention groups. Outcomes included life-years, quality-adjusted life-years (QALYs), program intervention costs, cost-savings and incremental cost-effectiveness ratios (ICERs). QALYs for P4P patients and non-P4P patients were 2.80 and 2.71 for the DM alone cohort and 2.74 and 2.66 for the DMHH patient cohort. The average incremental intervention costs per QALYs was TWD$167,251 in the DM alone cohort and TWD$145,474 in the DMHH cohort. The average incremental all-cause medical costs saved by the P4P program per QALYs were TWD$434,815 in DM alone cohort and TWD$506,199 in the DMHH cohort. The findings indicated that the P4P program for both cohorts were cost-effective and the resulting return on investment (ROI) was 2.60:1 in the DM alone cohort and 3.48:1 in the DMHH cohort. We conclude that the diabetes P4P program in both cohorts enabled the long-term cost-effective use of resources and cost-savings, especially for patients with multiple comorbid conditions.
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Affiliation(s)
- Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Song-Mao Gu
- Division of HIV/AIDS and TB, Centers for Disease Control, Taipei, Taiwan
| | - Shyi-Jang Shin
- Center for Lipid and Glycomedicine Research and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hao-Yun Kao
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chieh Lin
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Business Administration, National Sun Yat-Sen University, Kaohsiung, Taiwan
- * E-mail:
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