Cost-Effectiveness of Diabetes Pay-for-Performance Incentive Designs. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Hsieh, Hui-Min; Tsai, Shu-Ling; Shin, Shyi-Jang; Mau, Lih-Wen; Chiu, Herng-Chia
• Is Part Of: Medical care. Volume 53:Issue 2(2015)
• Publication Date: 2015-02
• Subjects: Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000264
• Languages: English
• ISSNs: 0025-7079

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>Taiwan's National Health Insurance (NHI) Program implemented a diabetes pay-for-performance program (P4P) based on process-of-care measures in 2001. In late 2006, that P4P program was revised to also include achievement of intermediate health outcomes.</p> </sec> <sec> <title>Objectives:</title> <p>This study examined to what extent these 2 P4P incentive designs have been cost-effective and what the difference in effect may have been.</p> </sec> <sec> <title>Research Design and Method:</title> <p>Analyzing data using 3 population-based longitudinal databases (NHI's P4P dataset, NHI's claims database, and Taiwan's death registry), we compared costs and effectiveness between P4P and non-P4P diabetes patient groups in each phase. Propensity score matching was used to match comparable control groups for intervention groups. Outcomes included life-years, quality-adjusted life-years (QALYs), program intervention costs, cost-savings, and incremental cost-effectiveness ratios.</p> </sec> <sec> <title>Results:</title> <p>QALYs for P4P patients and non-P4P patients were 2.08 and 1.99 in phase 1 and 2.08 and 2.02 in phase 2. The average incremental intervention costs per QALYs was TWD$335, 546 in phase 1 and TWD$298, 606 in phase 2. The average incremental all-cause medical costs saved by the P4P program per QALYs were TWD$602, 167 in phase 1 and TWD$661, 163 in phase 2. The findings indicated that both P4P programs were cost-effective and the resulting return on investment was 1.8:1 in phase 1 and 2.0:1 in phase 2.</p> </sec> <sec> <title>Conclusions:</title> <p>We conclude that the diabetes P4P program in both phases enabled the long-term cost-effective use of resources and cost-savings regardless of whether a bonus for intermediate outcome improvement was added to a process-based P4P incentive design.</p> </sec> </abstract>