Did the Raise on Financial Incentives of NHI Pay for Quality Improvement Initiative Increase the Participation of the Providers for Asthmatic Patients with Asthma?

• Main Authors: Ya-Hui Shih, 石雅慧
• Other Authors: Yue-Chune Lee
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/64429708763733182984

碩士 === 國立陽明大學 === 衛生福利研究所 === 95 === On November 2001, the Bureau of National Health Insurance (BNHI) in Taiwan adapted Pay for quality payment system based on disease management model and noncompetitive reward. Asthma was one of the conditions been chosen by BNHI. On January 2004, BNHI raised the financial incentives and simplified the paperwork. The research questions of this study were: (1) Did the raise on financial incentives of National Health Insurance (NHI) improvement initiative increase the rate of participation? (2) Did the raise on financial incentives of National Health Insurance (NHI) pay for quality improvement initiative decrease the rate of incompletion? Using the interrupted time-series design, we conducted a quasi-experiment before-after study to determine the changes in the rate of participation and incomplete care. We consider the intervention as the revision of financial incentives on January 2004.Because patients’ attitude also change on influence participation, we conduct our analysis based on two levels, hospitals and patients. The independent variable was financial incentives. The control variable were demographics (age, gender, severity of illness, and the situation of participation), organizations (branches of BNHI, level of medical organization, ownership, rate of participation at baseline, and volume of asthmatic patients), environments (urbanization and Herfindahl-Hirschman Index), and years factors. The dependent variables in hospital-level ware the probability of participation, change on rate of participations, and the rate of incomplete care. The dependent variables in patient-level were the probability of participation and rate of incomplete care. Data source was the BNHI administrative claims database during 2002~2004. We applied X2 test, trend test, ANOVA, Pearson correlation and Generalized Estimating Equation to analyze the data. The results indicate that the raise on financial incentives of pay for quality program increase the probability of participations, change on the rate of participations in hospitals, and reduced the probability of incomplete care of the patients, but the rate of incomplete care on hospital did not have a significant change. However, this study had the following limitations: had no control group, using secondary data, didn’t consider non-financial incentives, other organization characteristics, and patients’ attitude. We recommend that BNHI should enhance the implementation and increase the coverage of this pay for quality program. Further study may extend the duration of evaluation, and evaluate the new policy which reduces the financial incentives. Key wards: asthma, pay for quality, pay for performance, financial incentives, healthcare quality improvement program, the rate of participation, the rate of incomplete care.