| Summary: | 碩士 === 長榮大學 === 醫務管理學系碩士班 === 100 === Background: Breast cancer is the most common cancer and the fourth leading cause of cancer death among women in Taiwan, imposing a great threat on women’ health. Meanwhile, as breast cancers among most women are often diagnosed at the second or a later stage, they are more difficult to be cured. If breast cancers can be diagnosed and treated properly at an earlier stage, the recurrence rate and mortality can be reduced effectively. As a result, the Bureau of National Health Insurance (NHI) launched the pay-for-performance program for breast cancer in 2001, in hopes of providing patients with the most suitable care by medical teams and of utilizing medical resources more efficiently. Unfortunately, only seven hospitals have participated in the program since it was launched. In the meantime, no long-term analyses but only annual reports have been conducted regarding the effectiveness of this program.
Objectives: This study aims to discuss the differences in short- and mid-term utilization of medical resources as well as care results between patients who participate in the pay-for-performance program for breast cancer and who do not, and to conduct a cost-effectiveness analysis.
Research Method: Based on Aday’s behavioral healthcare model, this study was designed to be a quasi-experimental research. The experimental group included patients who had participated in the pay-for-performance program for breast cancer while the control group included patients who had not. For the research data, 13 sets of panel claims data in 2005 were extracted from the National Health Insurance Research Database established by the National Health Research Institute. Breast cancer patients who were diagnosed of it for the first time and received treatments at regional hospitals or medical centers, and whose entire treatments were covered by one single payment program were recruited as the research subjects, resulting in 109 patients in the experimental group and 413 patients in the control group. Statistic methods such as a t-test, chi-square test, multiple regression analysis, survival analysis, Cox regression analysis and a cost-effectiveness analysis were adopted.
Research Results:
1.In terms of using medical resources, most utilization of medical resources of breast cancer patients occurred in the first year after diagnosis. The t-test and Chi-square test of a single year show that, in the first year, patients who had participated in the pay-for-performance program for breast cancer had more operations, a higher total cost for examinations and a higher cost for follow-up checks than patients who had not participated in the program. In the second year, program participants contributed to fewer outpatient visits and a lower cost for other treatments than patients outside of the program. In the third year, the total cost for examinations of patients in the program was lower than the non-participants while no other difference was found on the utilization of other medical resources.
2.Considering the total medical expense, when other variables were controlled, the total costs of outpatient visits, of hospitalization, and of the entire medical service for patients who participated in the program were all higher than the non-participants in the first and the third year.
3.In terms of care results, although breast cancer patients who participated in the pay-for-performance program showed a lower recurrence rate and mortality, as well as a later recurrence and death than patients outside of the program, all differences were not significant. The result did not change after other variables were controlled.
4.As no significant difference was found on the effectiveness of care results by the cost-effectiveness analysis, a cost-minimization analysis was conducted instead. Breast cancer patients participating in the pay-for-performance program contributed to a higher total medical expense than patients not participating in the program.
Conclusion: Breast cancer patients participating in the pay-for-performance program contributed to higher short- (the first year) and mid-term (three years) costs of total outpatient visits, of total hospitalization and of total medical services than patients not participating in the program. In terms of the effectiveness of preventing recurrence and death, no significant difference was found between the two groups. As a result, the cost-effectiveness analysis shows that the pay-for-performance program for breast cancer is not better than the traditional payment method.
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