The Unintended Consequence of Diabetes Mellitus Pay-for-Performance (P4P) Program in Taiwan: Are Patients with More Comorbidities or More Severe Conditions Likely to Be Excluded from the P4P Program?
The Unintended Consequence of Diabetes Mellitus Pay-for-Performance (P4P) Program in Taiwan: Are Patients with More Comorbidities or More Severe Conditions Likely to Be Excluded from the P4P Program?
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DOI：
10.1111/j.1475-6773.2010.01182.x
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发表时间：
2011-02-01
影响因子：
3.4
通讯作者：
Lai, Mei-Shu
中科院分区：
文献类型：
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作者：
Chen, Tsung-Tai;Chung, Kuo-Piao;Lai, Mei-Shu
台湾已为糖尿病(DM)患者制定了按绩效付费(P4P)计划，部分根据DM患者的结果来奖励医生。医生被允许选择哪些糖尿病患者被包括在P4P计划中。我们测试重症糖尿病患者是否不成比例地被排除在P4P计划之外。数据来源/研究设置这项研究利用了台湾国家健康保险(NHI)数据库2007年1月至2007年12月的数据。我们的样本包括146,481名DM-P4P患者(占总数的16.56%)和737,971名非DM-P4P患者。数据收集/提取方法我们使用Logistic和多水平模型来估计患者和医院特征对P4P选择的影响。主要发现结果显示，年龄较大的患者和合并更多或更严重的患者更容易被排除在P4P计划之外。结论我们发现DM患者被排除在P4P计划之外的比例不成比例。我们的结果指出了强制参与和风险调整措施在P4P计划中的重要性。
ObjectiveTaiwan has instituted a pay-for-performance (P4P) program for diabetes mellitus (DM) patients that rewards doctors based in part on outcomes for their DM patients. Doctors are permitted to choose which of their DM patients are included in the P4P program. We test whether seriously ill DM patients are disproportionately excluded from the P4P program.Data Source/Study SettingThis study utilizes data from the National Health Insurance (NHI) database in Taiwan for the period of January 2007 to December 2007. Our sample includes 146,481 DM-P4P patients (16.56 percent of the total) and 737,971 non-DM-P4P patients.Data Collection/Extraction MethodsWe use logistic and multilevel models to estimate the effects of patient and hospital characteristics on P4P selection.Principal FindingsThe results show that older patients and patients with more comorbidities or more severe conditions are prone to be excluded from P4P programs.ConclusionsWe found that DM patients are disproportionately excluded from P4P programs. Our results point to the importance of mandated participation and risk adjustment measures in P4P programs.