A Longitudinal Examination of a Pay-for-Performance Program for Diabetes Care Evidence From a Natural Experiment
A Longitudinal Examination of a Pay-for-Performance Program for Diabetes Care Evidence From a Natural Experiment
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DOI：
10.1097/mlr.0b013e31822d5d36
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发表时间：
2012-02-01
期刊：
影响因子：
3
通讯作者：
Chen, Chi-Chen
中科院分区：
文献类型：
--
作者：
Cheng, Shou-Hsia;Lee, Tai-Ti;Chen, Chi-Chen
背景资料：许多研究已经研究了按绩效付费计划的影响，但很少有人知道他们对医疗保健费用的长期影响。Objectives：本研究旨在研究按绩效付费计划对糖尿病医疗保健利用和费用的长期影响。本研究是一项全国性的以人口为基础的自然实验，在台湾强制全民健康保险计划下进行了为期4年的随访。干预组包括2005年入组的20,934例患者，9694例患者连续参加了4年的项目。通过倾向评分匹配从同一组医生所见的患者中选择两个比较组。广义估计方程被用来估计差异中的差异模型，以检查的效果，按业绩付费program. Results：患者参加了按业绩付费计划进行了更多的糖尿病具体检查和测试后，登记的干预和对照组之间的差异逐渐下降，随着时间的推移，但仍然显着。干预组的患者在入组后的第一年内糖尿病相关的医生就诊次数显着增加，并且在随访期间糖尿病相关的住院次数较少。关于整体的医疗费用，在干预组的患者花费超过比较组在第一年，但是，连续登记花费显着低于他们的同行在随后的years. Conclusions：该计划似乎实现了其主要目标，在改善医疗保健和提供长期的成本效益。
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.