Investigating Patient Selection in the Pay-for-Performance Program for Diabetes

• Main Authors: Shih-Pi Lin, 林士弼
• Other Authors: Ray-E Chang
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/58275859974932276692

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 97 === In recent years, diabetes care has drawn much attention domestically and all over the world. Therefore, a pay-for-performance program for diabetes was implemented. 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. However, according to physician behavior theory that the physician for the pursuit of profit maximization, the physician possible select patients of low severity, This situation will seriously distort the intention of this programme for enhancing the quality of care and disease control. Therefore, under this program, whether physicians tend to select patients of low severity needs to be further discussed. The samples selected from National Health Insurance Research Database of claimed data during 2002 to 2005. Accede to pay-for-performance program for diabetes, there were total 220 physicians in 2002, 413 physicians in 2003, 620 physicians in 2004 and 810 physicians in 2005. This study use DCSI to evaluate the severity of patients and understand the difference of severity between patient participating and not patient participating under this program. These results will inference whether physicians tend to select patients of low severity and provide government organization with suggestions when making medical quality policy. The main findings of the study were concluded as below： 1. The averages that the means of DCSI scores of the patient participating in this program or not are 2.977 and 6.176 in 2002, 2.655 and 6.037 in 2003, 2.334 and 5.998 in 2004, 2.325 and 6.186 in 2005 respectively. This result indicates that patient selection of physicians behaviors. 2. The difference of average that the means of DCSI scores of the patient participating in this program is 3.199 in 2002, 3.382 in 2003, 3.663 in 2004, 3.862 in 2005. This result indicates that physicians tend to select patients of low severity. 3. After controlling hospital’ and physician’ characteristics, the averages of DCSI scores of the the patient not participating in this program is significant higher 2.62 in 2002, 2.89 in 2003, 2.99 in 2004 and 3.03 in 2005 than the patient participating.This result indicates that after controlling hospital’ and physician’ characteristics, physicians tend to select patients of low severity. In addition, hospital’ and physician’ characteristics are not significant but patients have lower DCSI scores in private medical institutions than public medical institutions. This result indicates that private medical institutions tend to select patients of low severity. Overall, under this program, hospital’ and physician’ characteristics do not have significant influence on patient selection of physicians behaviors. Based on the results of this study, a few suggestions were proposed as the following: 1. Effectiveness of pay-for-performance program for diabetes for paitents should be evaluated carefully. This is because the most patient with diabetes were not included in this program and these patients with high severity. Therefore, policy should provide these patients comprehensive medical care to enhance the quality of care. 2. To suggest this program use a severity of illness adjusted model. Higher severity of patients should be given a larger payment to health care providers to encourage their to supply the integrity of diabetes care to higher severity of the diabetic patients, thereby enhancing quality of medical care and control medical costs. 3. To suggest this program should simplify administrative processes to improve physicians treated patients of high severity. 4. To raise the patients’ compliance to improve physicians treated patients of high severity.