論質計酬支付對於糖尿病照護城鄉差距之影響

李耿德

doi:10.6342/NTU201701510

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論質計酬支付對於糖尿病照護城鄉差距之影響

Impact of Pay for Performance on Rural-Urban Differences in Diabetes Care

李耿德 , Masters　　Advisor：董鈺琪　　

繁體中文 DOI： 10.6342/NTU201701510

糖尿病；論質計酬；城鄉差距； Diabetes ； pay-for-performance ； rural-urban dfferences

Abstract │ Reference (97) │ Altmetrics

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Background: Diabetes ranks fifth among the top 10 causes of death in Taiwan. To improve care, Taiwan introduced the “National Health Insurance Diabetes Medical Payment Improvement Program” in 2001 as an incentivized payment system to allow diabetes patients to obtain continued and complete care. Currently, Taiwan is focused on studies to improve this program, and there have been few investigations on utilization and effects of care and rural–urban differences, if any.
Purpose: To investigate the introduction of the “National Health Insurance Diabetes Medical Payment Improvement Program,” whether rural–urban differences exist among diabetes patients in this pay-for-performance program, and differences in the utilization and results of intervention with this program.
Methods: This study analyzed diabetes patients in the 2005 Longitudinal Health Insurance Database of the National Health Insurance Research Database (NHIRD). The difference-in-difference (DID) and difference-in-difference-in-difference (DDD) methods were used to investigate results before and after implementation of the pay-for-performance program, rural–urban differences in diabetes-related care utilization, and the effect of results.
Results: After implementation of the diabetes pay-for-performance program, the number of examinations among diabetes patients who participated in the program was significantly increased, diabetes-related medical costs were significantly decreased, and the number of diabetes-related medical visits was significantly decreased. Compared to urban diabetes patients, the number of avoidable diabetes-related hospitalizations among rural diabetes patients was significantly decreased.
Conclusions: After implementing of the pay-for-performance program, there were improvements in diabetes care utilization and results. Rural residents had lower avoidable hospitalization due to diabetes compared to urban residents.

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