Assessment of National Health Insurance－Pay for Performance Program Benefits of Asthma

• Main Authors: Ying-Cheng Lin, 林盈正
• Other Authors: heng-chia chiu
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/20523846413757717296

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 101 === Abstract Object According to the data from department of health, the death rate of asthma was been on the first place since 2002. Bureau of National Health Insurance had applied several disease management models and pay-for-performance (P4P) programs since 2001, and the hospitals begin to apply the “Pay for Performance” system; but the evaluation of the system is lack of completement. Purpose 1. To investigate the medical resource utilization and the influence fators in the asthma patients with or without the intervention of P4P program. 2. To incestigate the clinical indicators and incluence factors in the asthma patients with or without the intervention of P4P program. 3. To investigate the self-care ability and influence factors in the asthma patients with or without the intervention of P4P program. 4. To investigate the overall satisfaction and influence factors in the asthma patients with or without the intervention of P4P program. Methods This is a both retrospective and prospective study using primary and secondary data analysis. The cases in this study were asthma patients from a south medical center. In the first propose, the study time was dring January 2001to December 2002. The patients in P4P and non-P4P were extracted with propensity score matching (PSM). After matching with the same parameters, 594 patients were enrolled in this study (247 patients for each group). We used difference-in-difference to analyse the difference of medical resource utilization. The second purpose to fourth purpose, the study time was dring March 2013to May 2013. The total cases were 93 patients, 50 patients for P4P group and 43 patients for non-P4P group. The statistical tools in this study were the software SPSS 19.0 using independent t test, paired t test and linear regression; the STATA 11.0 software for difference in difference of generalized linear models (GLM). Results In average, P4P group had higher outpatient consultation (P4P vs. non-P4P: 6.1 vs. 3.2; p<0.001), lower outpatient expense (P4P vs. non-P4P: 2,574 vs. 1,476; p<0.001), higher percent of emergency (P4P vs. non-P4P: 15% vs. 11.1%), lower emergency consultation (P4P vs. non-P4P: 0.13 vs. 0.21 p=0.002), and lower total medical expense than non-P4P (P4P vs. non-P4P:17,793 vs. 8,068; p=0.008). The predictors of outpatient consultation, outpatient expence, emergency expence are age, CCI, physician performance, with or without intervention of P4P program; the predictors of emergency consultation are CCI, physician performance and with or without intervention of P4P program; the predictors of peak expiratory flow (PEF) are age, education and BMI; the predictors of Asthma Control Test (ACT) are age, allergy history and smoking history; the predictors of PACIC medical satisfaction are age and PACIC. Conclusion and Suggestion The emergency consultation and emergency expence were well controlled after intervention of P4P program in asthma patients. There is no different between the medical satisfaction in asthma patients with and without the intervention of P4P program. The disease management and medical resource utilization were well controlled after intervention of P4P program. It can be widely apply on other chronic disease in the future.