A Longitudinal Examination of a Pay-for-Performance Program for Diabetes Care
- 1 February 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Medical Care
- Vol. 50 (2), 109-116
- https://doi.org/10.1097/mlr.0b013e31822d5d36
Abstract
Background: Numerous studies have examined the impacts of pay-for-performance programs, yet little is known about their long-term effects on health care expenses. Objectives: This study aimed to examine the long-term effects of a pay-for-performance program for diabetes care on health care utilization and expenses. Methods: This study represents a nationwide population-based natural experiment with a 4-year follow-up period under a compulsory universal health insurance program in Taiwan. The intervention groups consisted of 20,934 patients enrolled in the program in 2005, and 9694 patients continuously participated in the program for 4 years. Two comparison groups were selected by propensity score matching from patients seen by the same group of physicians. Generalized estimating equations were used to estimate differences-in-differences models to examine the effects of the pay-for-performance program. Results: Patients enrolled in the pay-for-performance program underwent significantly more diabetes specific examinations and tests after enrollment; the differences between the intervention and comparison groups declined gradually over time but remained significant. Patients in the intervention groups had a significantly higher number of diabetes-related physician visits in only the first year after enrollment and had fewer diabetes-related hospitalizations in the follow-up period. Concerning overall health care expenses, patients in the intervention groups spent more than the comparison group in the first year; however, the continual enrollees spent significantly less than their counterparts in the subsequent years. Conclusions: The program seemed to achieve its primary goal in improving health care and providing long-term cost benefits.Keywords
This publication has 21 references indexed in Scilit:
- Lessons From Evaluations of Purchaser Pay-for-Performance ProgramsMedical Care Research and Review, 2008
- Measuring Quality in Pay-for-Performance ProgramsDisease Management and Health Outcomes, 2008
- Early Experience With Pay-for-PerformanceJAMA, 2005
- Support for Smoking Cessation Interventions in Physician OrganizationsMedical Care, 2003
- The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelinesPreventive Medicine, 2003
- The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed CarePublished by American Academy of Pediatrics (AAP) ,1999
- The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.American Journal of Public Health, 1999
- Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care.American Journal of Public Health, 1998
- Performance-based physician reimbursement and influenza immunization rates in the elderlyAmerican Journal of Preventive Medicine, 1998
- Enhancing Mammography Referral in Primary CarePreventive Medicine, 1997