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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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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DOI: https://doi.org/10.1007/s11136-013-0502-x