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  1. NTU Scholars
  2. 公共衛生學院
  3. 公共衛生學系
Please use this identifier to cite or link to this item: https://scholars.lib.ntu.edu.tw/handle/123456789/389530
Title: Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?
Authors: MING-CHIN YANG 
DUAN-RUNG CHEN
Keywords: Cost-effectiveness; Diabetes mellitus; Incremental cost-effectiveness ratio; Pay-for-performance
Issue Date: 2014
Journal Volume: 23
Journal Issue: 2
Start page/Pages: 689-698
Source: Quality of Life Research 
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. ? 2013 Springer Science+Business Media Dordrecht.
URI: http://www.scopus.com/inward/record.url?eid=2-s2.0-84900382051&partnerID=MN8TOARS
http://scholars.lib.ntu.edu.tw/handle/123456789/389530
DOI: 10.1007/s11136-013-0502-x
metadata.dc.subject.other: insulin; adolescent; adult; age; aged; article; child; cost benefit analysis; diabetes mellitus; economics; female; health survey; human; male; middle aged; public health; quality adjusted life year; quality of life; reimbursement; retrospective study; Taiwan; young adult; Adolescent; Adult; Age Factors; Aged; Child; Cost-Benefit Analysis; Diabetes Mellitus; Female; Health Surveys; Humans; Insulin; Male; Middle Aged; National Health Programs; Quality of Life; Quality-Adjusted Life Years; Reimbursement, Incentive; Retrospective Studies; Taiwan; Young Adult
[SDGs]SDG3
Appears in Collections:公共衛生學系

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臺大位居世界頂尖大學之列,為永久珍藏及向國際展現本校豐碩的研究成果及學術能量,圖書館整合機構典藏(NTUR)與學術庫(AH)不同功能平台,成為臺大學術典藏NTU scholars。期能整合研究能量、促進交流合作、保存學術產出、推廣研究成果。

To permanently archive and promote researcher profiles and scholarly works, Library integrates the services of “NTU Repository” with “Academic Hub” to form NTU Scholars.

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開放取用是從使用者角度提升資訊取用性的社會運動,應用在學術研究上是透過將研究著作公開供使用者自由取閱,以促進學術傳播及因應期刊訂購費用逐年攀升。同時可加速研究發展、提升研究影響力,NTU Scholars即為本校的開放取用典藏(OA Archive)平台。(點選深入了解OA)

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