The Difference in Health Status of Diabetes and a Preliminary Study of Pay-For-Performance Programe for Diabetes
Date Issued
2009
Date
2009
Author(s)
Chou, Yi-Ling
Abstract
Pay-for-performance program for diabetes has been put into practice sinece November 1,2001. Goal of the program conducts health care providers to supply the integrity of diabetes care services, thereby enhancing quality of medical care and control the disease. Method of the program pay bonus to health care providers, and link their performance as a basis for payment. Health care providers may convern about the profit under the prospective payment. The physicians possible select patients with lower expenditure and better health statuse. This situation will seriously distort the intention of this programme for enhancing the quality of care and disease control.The purpose of this research is to evaluate the selection bias of P4P programe for diabetes and to measure the chage of healthe statuse, expenditure and utilization of enrollees , compared with non-enrollees, by 2 years data after enrollment.he samples were from National Health Insurance Research Database of claimed data .This study group were the diabetes who were enrolled in the programe during 2001 to 2003, and the control group were the non-enrolled diabetes during 2001 to 2005, received medical care for diabetes at enrollment hospitals.Logistic regression was used to analyse the correlation between the possibility of enrollment and prior CCI, emergency expenditure, inpatient expenditure and utilization. Generalized estimating equation (GEE) model was used to meature the tend of post-enrollment CCI, totel expenditure, outpatient expenditure, outpatient visits, emergency expenditure, emergency visits, inpatient expenditure, inpatient visits, the length of stay and the probability of inpatient stay. All of the measurments were analysed by each level of Taiwan medical institutions.he main findings of this study:. After controlling hospital’ and patients’ characteristics,logistic regression analysis indicated favorable selection associated increase as prior CCI decreases, emergency expenditure decreases , and more than 1 inpatient services were. There was no significant favorable selection in the local hospitals..The GEE model indicated that the increase of outpatient visit, emergency expenditure, length of stay and the probability of inpatient stay among enrollees were less than non-enrollees in the first year postenrollment.In the second year posenrollment the increase of CCI, outpatient visit, emergency expenditure, inpatient expenditure, length of stay and the probability of inpatient stay among enrollees were less than non-enrollees..In the medical centers, the increase of CCI, outpatient visit, emergency expenditure and the probability of inpatient stay among enrollees were less than non-enrollees in the first year postenrollment. In the second year postenrollment, the increase of outpatient visit, inpatient expenditure and inpatient utilization among enrollees were less than non-enrollees. In the regional hospitals, the increase of outpatient visit, emergency expenditure and visit, inpatient expenditure, leghth of inpatient stay and the probability of inpatient stay among enrollees were less than non-enrollees in the first year postenrollment. In the second year postenrollment, the increase of CCI, inpatient expenditure and inpatient utilization among enrollees were less than non-enrollees. In the district hospitals, the increases of the probability of inpatient stay were less among enrollees than non-enrollees in the first and second year postenrollment. In the clinics, the increases of emergency visit and the probability of inpatient stay among enrollees were more than non-enrollees.Based on the results of this study, a few suggestions were proposed as the following:. To suggest this program use a severity of illness adjusted model.. To limit the enrollment date in one year could avoid the bias from the environment.. 3 year may be too short of study period to gauge the inpact of the closures.The longer study period, the more will be found.
Subjects
Pay-for-performance for diabetes
Favorable selection
Logistic regression
Generalized estimating equation
SDGs
Type
thesis
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