Effects of pay-for-performance system on tuberculosis default cases control and treatment in Taiwan

Tsai, Wen-Chen; Kung, Pei-Tseng; Khan, Mahmud; Campbell, Claudia; Yang, Wen-Ta; Lee, Tsuey-Fong; Li, Ya-Hsin

doi:10.1016/j.jinf.2010.06.016

« Previous Next »Journal of Infection
Volume 61, Issue 3 , Pages 235-243, September 2010

Effects of pay-for-performance system on tuberculosis default cases control and treatment in Taiwan

Wen-Chen Tsai
- Department of Health Service Administration, China Medical University, Taichung, Taiwan, ROC
Pei-Tseng Kung
- Graduate Institute of Health Administration, Asia University, Taichung, Taiwan, ROC
Mahmud Khan
- Department of Health Systems Management, Tulane University, New Orleans, LA, USA
Claudia Campbell
- Department of Health Systems Management, Tulane University, New Orleans, LA, USA
Wen-Ta Yang
- Department of Internal Medicine, Taichung Hospital, Department of Health, Taichung, Taiwan
Tsuey-Fong Lee
- Centers for Disease Control, R.O.C.(Taiwan), Third Branch Chief, Taichung, Taiwan
Ya-Hsin Li
- Department of Health Policy and Management, Chung Shan Medical University and Hospital, 110, Sec 1, Jianguo N. Rd., 402 Taichung, Taiwan, ROC
- Corresponding author. Tel.: +886 4 24730022x17172; fax: +886 4 22412337.

Accepted 18 June 2010. published online 05 August 2010.

Summary

Objectives

In order to make tuberculosis (TB) treatment more effective and to lower the default rate of the disease, the Bureau of National Health Insurance (BNHI) in Taiwan implemented the “pay-for-performance on Tuberculosis” program (P4P on TB) in 2004. The purpose of this study is to investigate the effectiveness of the P4P system in terms of default rate.

Methods

This is a retrospective study. National Health Insurance Research Datasets in Taiwan from 2002 to 2005 has been used for the study. The study compared the differences of TB default rate before and after the implementation of P4P program, between participating and non-participating hospitals, and between P4P hospitals with and without case managers. Furthermore, logistic regression analysis was conducted to explore the related factors influencing TB patients default treatment after TB detected.

Results

The treatment default rate after “P4P on TB” was 11.37% compared with the 15.56% before “P4P on TB” implementation. The treatment default rate in P4P hospitals was 10.67% compared to 12.7% in non-P4P hospitals. In addition, the default rate was 10.4% in hospitals with case managers compared with 12.68% in hospitals without case managers.

Conclusions

The results of the study showed that “P4P on TB” program improved the treatment default rate for TB patients. In addition, case managers improved the treatment outcome in controlling patients’ default rate.

Keywords: Pay-for-performance system, Tuberculosis, Default rate