| Summary: | 碩士 === 長庚大學 === 商管專業學院碩士學位學程在職專班醫務管理組 === 101 === The Bureau of National Health Insurance implemented the "Pay-for-
Performance Program for Diabetes" project in November 2001. The purpose of this project is to control medical cost by giving a holistic care for patients with diabetes under professional teams. Another primary goal of the intervention program is to reduce or postpone the occurrence of related complications. The effectiveness assessment of the current program is placed on the medical utilization and prognoses, however, limited studies are found so far. This study aims to examine the impacts of the intervention program on the related complications and medical consumptions of patients with type 2 diabetes. The findings of this study are to be referenced by health care decision makers to develop health care
models for type 2 diabetes patients.
This Study collected 149,888 incident patients with type II diabetes from National health Insurance database during 2002 to 2006 and conducted longitudinal analysis on their prognoses and medical utilizations until the end of 2012. Chi-square test, Cox-Regression Survival Analysis, and General Linear Model were used to examine the effects among three groups of diabetes patients,including "full participation" ,"incomplete participation" and" non-participation ".
The main conclusions are as follows:
1、 The full participants in the intervention program for diabetic care have lower risk of hospitalization due to related complications (HR = 0.762,95% CI = 0.723 ~ 0.803) and a lower risk of death (HR = 0.399,95% CI = 0.382 ~ 0.416).The effects of delay hospitalization and death were also observed. Comparing with the "incomplete participation" and "non-participation" groups, the "incomplete participation group has a higher risk of hospitalization for related
complications. (HR = 1.095,95% CI = 1.033 ~ 1.161 ).
2、 The "full participation" group in the intervention program has higher medical consumptions in number of outpatient visits (relative elevation = 1.0570, P <0.0001)and outpatient medical expenses (relative elevation = 1.1154, P <0.0001), but the length of hospital days (relative elevation = 0.9760, P <0.0001) and medical expenses (relative elevation = 0.9709, P <0.0001) are decreased.
3、 The diabetic inpatients with complications are at higher risk of death (HR = 1.524,95% CI = 1.454 ~ 1.596), and the number of outpatient medical consumption index (relative elevation = 1.1095, P <0.0001), outpatient medical points (relative elevation = 1.2609, P <0.0001), hospitalization days (relative elevation = 1.2820, P <0.0001), inpatient and outpatient medical point (relative elevation = 1.7928, P <0.0001) and total medical points (relative elevation =
1.5028, P <0.0001),than those without complications.
The results suggested that the "Pay-for-Performance Program for Diabetes" project is effective in reducing hospitalizations and poor prognoses of patients with diabetes. However ,it didnot reduce the total medical costs. Accordingly, this study suggests health policy makers to reassess the overall effectiveness of "Pay-for-Performance Program for Diabetes" project. Appropriate adjustments on the payment system should be made to reach a higher goal of health care guality and efficiency. From the perspectives of holistic care for patients with diabetes, a comprehensive treatment protocal to prevent patient, exposed to polypharmacy and to provide a continuous quality of care is the most
beneficiary to the patient care.
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