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Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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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Abbreviations

DM:

Diabetes mellitus

P4P:

Pay-for-performance

NHI:

National Health Insurance

IOM:

Institute Of Medicine

BNHI:

Bureau of National Health Insurance

NHIS:

National Health Interview Survey

NHRI:

National Health Research Institute

NHIRD:

National Health Insurance Research Database

PVD:

Peripheral vascular disease

BMI:

Body mass index

PSM:

Propensity score matching

NT$:

New Taiwan Dollars

US$:

United State Dollars

QALYs:

Quality-adjusted life-years

ICER:

Incremental cost-effectiveness ratio

CEAC:

Cost-effectiveness acceptability curve

QALY:

Quality-adjusted life-year

CI:

Confidence interval

GDP:

Gross domestic product

NE:

North east

SE:

South east

HbA1C:

Hemoglobin A1c

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Authors and Affiliations

  1. Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan

    Elise Chia-Hui Tan, Duan-Rung Chen & Ming-Chin Yang

  2. Center for Drug Evaluation, Taipei, Taiwan

    Raoh-Fang Pwu

  3. School of Health Care Administration, Taipei Medical University, Taipei, Taiwan

    Raoh-Fang Pwu

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  1. Elise Chia-Hui Tan
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  2. Raoh-Fang Pwu
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  3. Duan-Rung Chen
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  4. Ming-Chin Yang
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Correspondence to Ming-Chin Yang.

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Tan, E.CH., Pwu, RF., Chen, DR. et al. Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?. Qual Life Res 23, 687–696 (2014). https://doi.org/10.1007/s11136-013-0502-x

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