Improvement of tobacco-free hospitals’ cessation services with a pay-for-performance subsidy in Taiwan

Objective World Health Organization (WHO) reported that tobacco causes more than 8 million people deaths a year. It was estimated that smoking kills 27,000 people annually in Taiwan, and on average one person dies from smoking-related diseases every 20 minutes. Health Promotion Administration (HPA) in Taiwan provided a pay-for-performance subsidy to improve tobacco-free hospitals’ cessation services for helping people get rid of tobacco hazards. Methods The performance of 348 hospitals in 2018 was analyzed, including the subject number and cost of cessation services and the 7-day point prevalence abstinence rate (PPAR) at 6 month of the subjects. One hundred and nineteen hospitals were subsidized by HPA and the other 229 hospitals were not. Results Each subsidized hospital served 467 subjects (including 170 inpatients) on average for smoking cessation in 2018. They cost 225 US dollars to assist a subject to quit smoking. On the other hand, each hospital without subsidy averagely served 69 subjects (including 16 inpatients) and cost 380 US dollars to assist a subject to quit smoking. It was revealed that the hospitals with subsidy served 6.8-fold more subjects and cost 41% less for cessation services when compared with the hospitals without subsidy. The 7-day PPAR at 6 months of subjects served by hospitals with and without subsidy was 30.4% (95% CI: 29.6%-31.2%) and 28.6% (95% CI: 27.0%-30.1%), respectively. Conclusions The pay-for-performance subsidy offered by HPA facilitated tobacco-free hospitals to serve more subjects. The subsidy made them have more resources to improve cessation services, enabling them to help subjects quit smoking with more practical and more effective approaches.