A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment.

Objective: To examine the effects of a pay-for-performance (P4P) program for diabetes care in Taiwan.
Study Design: A population-based natural experimental design with intervention and comparison groups.
Methods: Healthcare service and expense data were extracted from the Taiwanese Bureau of National Health Insurance claim files for 2005 and 2006. The number of essential diabetes-specific exams/tests, healthcare utilization, and pre- and post-intervention expenses were calculated for patients grouped according to P4P status. However, no clinical information was available for analysis. Difference-in-difference analysis was used in statistical regression models with proper distributions for these measures.
Results: Patients in the P4P program (n = 12,499) received significantly more diabetes-specific exams and tests after enrollment (3.8 vs 6.4, P <.001) than patients not enrolled in the program (3.5 vs 3.6, P <.001). Patients in the intervention group had an average of 2 more physician visits for diabetes than those in the comparison group (P <.001). Conversely, the intervention group had fewer diabetes-related hospitalizations (-0.027, P = .003). Patients in the intervention group incurred higher expenses due to physician visits but lower expenses due to inpatient services, with a net increase of $104 per person per year (P <.001).
Conclusions: This P4P program for diabetes was associated with a significant increase in regular follow-up visits and evidence-based services, and significantly lower hospitalization costs. The overall cost of care for those in the P4P program was significantly higher, although the total incremental expense was quite small.