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Quality of Life Research
Gepubliceerd in:

01-03-2014

Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?

Auteurs: Elise Chia-Hui Tan, Raoh-Fang Pwu, Duan-Rung Chen, Ming-Chin Yang

Gepubliceerd in: Quality of Life Research | Uitgave 2/2014

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Abstract

Purpose

In October 2001, a pay-for-performance (P4P) program for diabetes was implemented by the National Health Insurance (NHI), a single-payer program, in Taiwan. However, only limited information is available regarding the influence of this program on the patient’s health-related quality of life. The aim of this study was to estimate the costs and consequences of enrolling patients in the P4P program from a single-payer perspective.

Methods

A retrospective observational study of 529 diabetic patients was conducted between 2004 and 2005. The data used in the study were obtained from the National Health Interview Survey (NHIS) in Taiwan. Direct cost data were obtained from NHI claims data, which were linked to respondents in the NHIS using scrambled individual identification. The generic SF36 health instrument was employed to measure the quality-of-life-related health status and transformed into a utility index. Patients enrolled in the P4P program for at least 3 months were categorized as the P4P group. Following propensity score matching, 260 patients were included in the study. Outcomes included life-years, quality-adjusted life-years (QALYs), diabetes-related medical costs, overall medical costs, and incremental cost-effectiveness ratios (ICERs). A single-payer perspective was assumed, and costs were expressed in US dollars. Nonparametric bootstrapping was conducted to estimate confidence intervals for cost-effectiveness ratios.

Results

Following matching, no significant difference was noted between two groups with regard to the patients’ age, gender, education, family income, smoking status, BMI, or whether insulin was used. The P4P group had an increase of 0.08 (95 % CI 0.077–0.080) in QALYs, and the additional diabetes-related medical cost was US$422.74 (95 % CI US$413.58–US$435.05), yielding an ICER of US$5413.93 (95 % CI US$5226.83–US$5562.97) per QALY gained.

Conclusions

Our results provides decision makers with valuable information regarding the impact of the P4P program of diabetes care through a direct comparison of equivalent groups of patients receiving regular care. Under the single-payer NHI system, the use of financial incentives under the DM-P4P program may be an effective means to ensure the quality of follow-up treatment.
vorige artikel How do clinical and psychological variables relate to quality of life in end-stage renal disease? Validating a proximal–distal model
volgende artikel Consequences of visual height intolerance for quality of life: a qualitative study
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Metagegevens
Titel
Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?
Auteurs
Elise Chia-Hui Tan
Raoh-Fang Pwu
Duan-Rung Chen
Ming-Chin Yang
Publicatiedatum
01-03-2014
Uitgeverij
Springer International Publishing
Gepubliceerd in
Quality of Life Research / Uitgave 2/2014
Print ISSN: 0962-9343
Elektronisch ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-013-0502-x

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