As tuberculosis (TB) remains one of the most serious public health threats, new strategies are needed for better control of the spread of TB. Taiwan developed a pay-for-performance (P4P) program providing financial incentives to health providers to enhance effective management of TB patients. A research team at National Taiwan University evaluated the effects of this P4P program and found that the program increased treatment success rate with lower total health expenses. Findings from this project have been published online in the February issue of the American Journal of Managed Care.
“We know that many countries have faced weak linkage of public health authorities and healthcare providers.” says the leading author Dr. Cheng-Yi Lee, an associate research fellow at Taiwan CDC and a recent graduate from the doctoral program in Health Policy and Management at National Taiwan University, College of Public Health. “In addition, the delivery of needed care to TB patients is a serious concern due to limited public resources and/or manpower around the globe.”
In this recent study, the research team – led by Professor Shou-Hsia Cheng at the National Taiwan University, – examined the effect of the P4P program on TB patients (12,018 subjects) in Taiwan. They employed propensity score matching technique to improve the comparability between the intervention and comparison groups and difference-in-difference analysis to estimate the net effects incurred by the P4P program. They discovered that patients enrolled in the TB P4P program received more comprehensive ambulatory care than their counterparts. The P4P enrollees incurred higher TB-related ambulatory care expenses but lower TB-related hospitalization expenses and 4.6% lower total TB-related expenses.
In addition, the study indicated that patients enrolled in the P4P program were less likely to die and more likely to be treated successfully with lower total costs compared with their counterparts. “Financial incentives to healthcare institutions could be feasible models to improve the collaboration between public health authorities and health care providers for better TB control; the encouraging results from Taiwan may of value for other countries” says Professor Cheng.