The Cost-effectiveness of Pay-for-Performance program in Patients with Hepatitis C

• Main Authors: Cheng Chong Li, 李承昌
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/9cwe7m

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 102 === Background and Purpose 「Pay-for-Performacne」is a actively promoting medical payment for the worlds. It encourages medical providers provide high quality service to patients through financial incentive. Taiwan advanced pay-for-performance programs since 2001, but「Hepatitis B and C pay-for-performance program」was started in 2010. It’s a recent program. Currently few researches investigate patients with hepatitis B or C participated pay-for-performance. The aims for the study are investigated hepatitis patients survival, medical utilization, and cost-effectiveness under the pay-for-performance program. Methods The study is a quasi-experimental research design and analyze by secondary database. The study also used propensity score matching by 1:1 sample matching approach, and according to the characteristics of the P4P group to find high homogeneity Non-P4P group. Source is hepatitis C related outpatient, emergency, or hospitalization records in National Health Insurance Research database during 2008/1/1-2012/12/31. Patients conform enrolled condition and participated who are P4P groups (N=29,180), patients conform but not participated who are Non-P4P groups (N=284,604). After excluding hepatitis B and B plus C patients, and keep only hepatitis C patients as study sample. The final samples: 8,014 P4P patients and 87,332 Non-P4P patients. After propensity score matching, both P4P and Non-P4P groups are 8,011 patients. The research tools include SPSS19.0 and SAS13.0, and using Chi-square test, T-test, Mutinomial logistic regression, GEE regression, Kaplan-Meier survival analysis, and Cox regression to analyze data and verify the hypothesis. Results The study found P4P groups with decompensated cirhosis and hepatocellular carcinoma risk were Non-P4P groups 0.72 times and 0.71 times. The cumulative mortality within three years of Non-P4P groups were 7.71% that significantly higher than P4P groups 2.93%. In patients with hepatocellular carcinoma, the cumulative mortality within three years of Non-P4P groups were 34.7% that significantly higher than P4P groups 21.6%. The P4P group overall risk of death were Non-P4P groups 0.58 times. In medical utilization, P4P groups outpatient cost were decreasing NT631 more than Non-P4P groups in the Post2years, emergency cost were increasing NT97 less than Non-P4P in the Post2years, and increase NT330 hospitalization cost less than Non-P4P in the Post2years. In cost-effectiveness analysis, the intervention cost of P4P more than Non-P4P NT21,515, but the total medical cost of P4P less than Non-P4P NT40,131. With the incremental cost-effectiveness ratio, the intervention cost of P4P more than Non-P4P NT121,860 per QALY, but the total medical cost of P4P less than Non-P4P NT227,300 per QALY. The Return On Investment are 1.86 times. Conclusion and recommendations 「Hepatitis B and C pay-for-performance program」are intervention of medical policy. The policy does improve the quality of life in patients with hepatitis C and increse the life years of patients. In the part of utilization, pay-for-performance does use less outpatient cost to reduce more emergency cost and hospitalization cost. From the cost-effectiveness point of view, pay-for-performance not only extends life years of patients but reduce medical cost. 「Pay-for-performance」make hepatitis C patients live longer, upgrade the medical quality, and save more medical cost. It brings positive impact of cost-effectiveness for hospitals. The study found that hepatitis C patients participate the program or not was a significant impact factor of patient with decompensated cirhosis and hepatocellular carcinoma risk. Therefore we suggest the National Health Insurance Administration in addition to encurge patient to regular follow-up, also provide more prevention examination of cirrhosis and hepatocellular carcinoma into pay-for-performance program. At the same time, keep the related test implementation rate, accuracy, treatments, and related health education to accomplish the effect of program.