The impact of hypertension and diabetes mellitus pay-for-performance programs on complications among patients with different comorbidities
Date Issued
2011
Date
2011
Author(s)
Li, Hsuan-Wei
Abstract
Introduction: Improving the quality of care delivered to individuals with multiple chronic conditions is among the important challenges our health care system faces. While the use of pay for performance (P4P) in healthcare is increasing, little is known about the impact of these programs on persons with multiple comorbidities. In Taiwan, P4P programs for chronic diseases have been implemented for several years. Most studies evaluated the effects of these programs by measuring the performance indicators of payments, but little was undertaken to explore the impacts on complications and related medical costs.
Objectives: Hypertension and diabetes mellitus (DM) are both diseases with high prevalences, high medical expenditures and high relationship with similar management goals of diseases. Therefore, the objectives of this study were to evaluate the effects of hypertension and DM P4P programs, and explored the impact of these two programs on the incidence rates and the medical costs of related complications among patients with different comorbidities.
Methods: A retrospective analysis of the claims database of the National Health Insurance from 2001 to 2009 was performed. Propensity score matching method was applied to adjust for the characteristics to minimize the effects of selection bias. Logistic regression models, multiple linear regression models and poisson regression models were constructed separately to explore the effects of the two P4P programs on the incidence rates, the medial costs and the medical utilizations of acute coronary syndromes, heart failure, stroke and chronic renal failure.
Results: The DM P4P program decreased the incidence rates of heart failure and stroke. Although the impact on the incidence rate of acute coronary syndromes was not statistically significant, the tendency of prevention effect existed. The DM P4P program could also save the medical costs of chronic renal failure by decreasing related outpatient visits. For hypertension P4P program, it reduced the incidence rates of acute coronary syndromes and stroke, and decreased the medical cost of acute coronary syndromes. The complication prevention effects of the two P4P programs were most significant on patients comorbid with both hypertension and DM. Besides, the effect modification partially existed. The impact of hypertension P4P program on the reduction of the incidence rates and the related medical costs of complications were significant only when patients also participated in DM P4P program. However, the effect of DM P4P program could be statistically significant even when patients did not participate in hypertension P4P program.
Conclusions: Although both the hypertension and DM P4P programs present impacts on complications, the overall impact of DM P4P program was greater than that of hypertension P4P program. Our findings suggest that policy makers could continuously develop and implement related P4P program in the future.
Subjects
hypertension
diabetes mellitus
pay for performance
comorbidity
complication
propensity score
SDGs
Type
thesis
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