A pay-for-performance program in Taiwan improved care for some diabetes patients, but doctors may have excluded sicker ones

Health Affairs

Volumn 31, Issue 1, 2012, Pages 93-102

  Chang, Ray E ^a   Lin, Shih Pi ^a   Aron, David Clark ^b,c  

^a NATIONAL TAIWAN UNIVERSITY   (Taiwan)

^b CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c CASE WESTERN RESERVE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CREATININE; LOW DENSITY LIPOPROTEIN CHOLESTEROL;

ALANINE AMINOTRANSFERASE BLOOD LEVEL; AMBULATORY CARE; ARTICLE; CEREBROVASCULAR DISEASE; CHOLESTEROL BLOOD LEVEL; DIABETIC PATIENT; DISEASE SEVERITY; EYE DISEASE; FOLLOW UP; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HUMAN; KIDNEY DISEASE; MEDICAL HISTORY; METABOLIC DISORDER; MICROALBUMINURIA; NATIONAL HEALTH INSURANCE; NEUROPATHY; PATIENT SELECTION; PERIPHERAL VASCULAR DISEASE; PHYSICAL EXAMINATION; PRIMARY MEDICAL CARE; RETINOPATHY; TAIWAN;

BIAS (EPIDEMIOLOGY); FEMALE; HEALTH STATUS; HUMANS; MALE; MIDDLE AGED; NATIONAL HEALTH PROGRAMS; PHYSICIANS; PROGRAM EVALUATION; QUALITY ASSURANCE, HEALTH CARE; REIMBURSEMENT, INCENTIVE; RETROSPECTIVE STUDIES; TAIWAN;

EID: 84862912028     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0402     Document Type: Article

References (49)

1. Cromwell J, Trisolini MG, Pope GC, Mitchell JB, Greenwald LM. Pay for performance in health care: methods and approaches. Research Triangle Park (NC): RTI Press; 2011. (Pub. No. BK-0002-1103).
2. Institute of Medicine. Rewarding provider performance: aligning incentives in Medicare. Washington (DC): National Academies Press; 2007.
3. Boxall A. Should we expand the use of pay-for-performance in health care? [Internet]. Canberra: Parliament of Australia; 2009 Nov 23 [cited 2011 Dec 8]. (Research Paper No. 12 2009-10). Available from: http://www.aph.gov.au/library/pubs/rp/2009-10/10rp12.htm
4. Damberg CL, Raube K, Teleki SS, Dela Cruz E. Taking stock of pay-forperformance: a candid assessment from the front lines. Health Aff (Millwood). 2009;28(2):517-25.
5. Greene SE, Nash DB. Pay for performance: an overview of the litera-ture. Am J Med Qual. 2009;24(2): 140-63.
6. McDonald R, White J, Marmor TR. Paying for performance in primary medical care: learning about and learning from "success"and "failure"in England and California. J Health Polit Policy Law. 2009; 34(5):747-76.
7. Casalino L, Alexander GC, Jin L, Konetzka RT. General internists' views on pay-for-performance and public reporting of quality scores: a national survey. Health Aff (Millwood). 2007;26(2):492-9.
8. Choe HM, Bernstein SJ, Standiford CJ, Hayward RA. New diabetes HEDIS blood pressure quality measure: potential for overtreatment. Am J Manag Care. 2010; 16(1):19-24.
9. Fisher ES. Paying for performance- risks and recommendations. N Engl J Med. 2006;355(18):1845-7.
10. Hayward RA, Kent DM. 6 EZ steps to improving your performance (or how to make P4P pay 4U!). JAMA. 2008;300(3):255-6.
11. McDonald R, Roland M. Pay for performance in primary care in England and California: comparison of unintended consequences. Ann Fam Med. 2009;7(2):121-7.
12. Tinetti ME, Bogardus ST Jr., Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004;351:2870-4.
13. Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. JAMA. 2005;293:1239-44.
14. Courty P, Marschke G. An empirical investigation of gaming responses to explicit performance incentives. J Labor Econ. 2004;22(1):23-56.
15. Mears A, Webley P. Gaming of performance measurement in health care: parallels with tax compliance. J Health Serv Res Policy. 2010;15(4): 236-42.
16. Bridges to Excellence [home page on the Internet]. Newton (CT): Care Incentives Improvement Institute; c2009-10 [cited 2011 Dec 28]. Available from: http://www.bridgestoexcellence.org/
17. Rosenthal MB, de Brantes FS, Sinaiko AD, Frankel M, Robbins RD, Young S. Bridges to Excellence- recognizing high-quality care: analysis of physician quality and resource use. Am J Manag Care. 2008;14(10):670-7.
18. Doran T, Fullwood C, Gravelle H, Reeves D, Kontopantelis E, Hiroeh U, et al. Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med. 2006;355:375-84.
19. Doran T, Fullwood C, Reeves D, Gravelle H, Roland M. Exclusion of patients from pay-for-performance targets by English physicians. N Engl J Med. 2008;359:274-84.
20. Cheng TM. Taiwan's new National Health Insurance program: genesis and experience so far. Health Aff (Millwood). 2003;22(3):61-76.
21. Lee TT, Cheng SH, Chen CC, Lai MS. A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment. Am J Manag Care. 2010;16(1):65-9.
22. Peterson CL, Burton R. U.S. health care spending: comparisons with other OECD countries [Internet]. Washington (DC): Congressional Research Service; 2007 Sep 17 [cited 2011 Dec 19]. (Report for Congress, Order Code: RL34175). Available from: http://digitalcommons.ilr.cornell.edu/key_workplace/311/
23. Chen TJ, Chou LF, Hwang SJ. Patterns of ambulatory care utilization in Taiwan. BMC Health Serv Res. 2006;6:54.
24. Huang AT, Wang CHJ, Yaung CL. Insuring Taiwan's health. McKinsey Q. 2001;(4):13-16.
25. Wang MJ, Lin SP. Study on doctor shopping behavior: insight from patients with upper respiratory tract infection in Taiwan. Health Policy. 2010;94:61-7.
26. Chen CC, Cheng SH. Better continuity of care reduces costs for diabetic patients. Am J Manag Care. 2011;17(6):420-7.
27. Selby JV, Karter AJ, Ackerson LM, Ferrara A, Liu J. Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population with diabetes. Diabetes Care. 2001;24(9): 1547-55.
28. Young BA, Lin E, Von Korff M, Simon G, Ciechanowski P, Ludman EJ, et al. Diabetes Complications Severity Index and risk of mortality, hospitalization, and healthcare utilization. Am J Manag Care. 2008;14(1):15-24.
29. DiClemente RJ, Wingood GM, Harrington KE, Lang DL, Davies SL, Hook EW 3rd, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA. 2004;292(2):171-9.
30. Goldman HH, Frank RG, Burnam MA, Huskamp HA, Ridgely MS, Normand SL, et al. Behavioral health insurance parity for federal employees. N Engl J Med. 2006;354(13):1378-86.
31. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1): 13-22.
32. To access the Appendix, click on the Appendix link in the box to the right of the article online
33. American Diabetes Association. Executive summary: standards of medical care in diabetes-2011. Diabetes Care. 2011;34(Suppl 1):S4-10.
34. American Diabetes Association. Standards of medical care in diabetes- 2006. Diabetes Care. 2006; 29(Suppl 1):S4-42.
35. Fleetcroft R, Steel N, Cookson R, Howe A. "Mind the gap!"Evaluation of the performance gap attributable to exception reporting and target thresholds in the new GMS contract: national database analysis. BMC Health Serv Res. 2008;8:131.
36. Gravelle H, Sutton M, Ma A. Doctor behaviour under a pay for performance contract: evidence from the Quality and Outcomes Framework [Internet]. York: University of York, Centre for Health Economics; 2007 [cited 2011 Dec 8]. (Research Paper No. 28). Available from: http://www.york.ac.uk/media/che/documents/papers/researchpapers/rp28_doctor_behaviour_under_a_pay_for_performance_contract.pdf
37. Gravelle H, Sutton M, Ma A. Doctor behaviour under a pay for performance contract: further evidence from the Quality and Outcomes Framework. York: University of York, Centre for Health Economics; 2008 [cited 2011 Dec 18]. (Research Paper No. 34). Available from: http://www.york.ac.uk/media/che/documents/papers/researchpapers/rp34_doctor_behavior_under_a_pay_for_performance_contract_further_evidence.pdf
38. McLean G, Sutton M, Guthrie B. Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK Quality and Outcomes Framework. J Epidemiol Community Health. 2006;60(11):917-22.
39. Sigfrid LA, Turner C, Crook D, Ray S. Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management. J Public Health (Oxf). 2006;28(3):221-5.
40. Pogach LM, Tiwari A, Maney M, Rajan M, Miller DR, Aron D. Should mitigating comorbidities be considered in assessing healthcare plan performance in achieving optimal glycemic control? Am J Manag Care. 2007;13(3):133-40.
41. Aron DC, Pogach LM. One size does not fit all: a continuous measure for glycemic control in diabetes: the need for a new approach to assessing glycemic control. Jt Comm J Qual Patient Saf. 2007;33(10):636-43.
42. Hayward RA. All-or-nothing treatment targets make bad performance measures. Am J Manag Care. 2007; 13(3):126-8.
43. Pogach L, Engelgau M, Aron D. Measuring progress towards achieving hemoglobin A1c goals: pass/fail or partial credit. JAMA. 2007; 297(5):520-3.
44. Dracup K, DeBusk RF, De Mots H, Gaile EH Sr., Norton JB Jr., Rudy EB. Task Force 3: Partnerships in delivery of cardiovascular care. J Am Coll Cardiol. 1994;24(2):296-304.
45. Nikolaus T, Kruse W, Bach M, Specht-Leible N, Oster P, Schlierf G. Elderly patients' problems with medication. An in-hospital and follow-up study. Eur J Clin Pharmacol. 1996;49(4):255-9.
46. Frolich A, Talavera JA, Broadhead P, Dudley RA. A behavioral model of clinician responses to incentives to improve quality. Health Policy. 2007;80(1):179-93.
47. Pogach LM, Rajan M, Maney M, Tseng CL, Aron DC. Hidden complexities in assessment of glycemic outcomes: are quality rankings aligned with treatment? Diabetes Care. 2010;33(10):2133-9.
48. Pogach L, Aron DC. Sudden acceleration of diabetes quality measures. JAMA. 2011;305(7):709-10.
49. Courty P, Marschke G. Dynamics of performance-measurement systems. Oxford Rev Econ Pol. 2003;19(2): 268-84.