title: Effect of the pay-for-performance program for breast cancer care in Taiwan.
abstract: OBJECTIVE
  To evaluate the impact of the nationwide pay-for-performance (P4P) program for breast cancer care (BC-P4P) in Taiwan on care quality, patient survival, and recurrence.
  
  
  METHODS
  A population-based observational study with cross-sectional design.
  
  
  METHODS
  Retrospective analysis of population based cancer registration and claims data was used in this study. A total of 4528 patients with stage I or II breast cancer diagnosed in 2002 or 2003 who received curative surgery were observed until the end of 2008. This study applied multivariate linear regression to explore the association between BC-P4P enrollment and quality of care. Cox regression was applied to examine the effect of BC-P4P enrollment on 5-year recurrence and overall survival among patients with breast cancer.
  
  
  RESULTS
  After controlling for age, stage, type of surgery, and other factors, BC-P4P enrollees were found to have received better quality care than nonenrollees (P = .001). Cox regression models also indicated that after controlling for patient characteristics, quality of care was related to better 5-year overall survival (odds ratio [OR], 0.212; P = .001) and recurrence (OR, 0.289; P <.001). Even when controlled by quality of care provided to patients and its interaction with status of BC-P4P enrollment, BC-P4P enrollment remained statistically significant regarding 5-year overall survival (OR, 0.167; P <.001) and recurrence (OR, 0.370; P = .002).
  
  
  CONCLUSIONS
  Patients with breast cancer enrolled in the BC-P4P program received better quality care and had better outcome than nonenrolled patients. Evidence from this study indicates that financial incentives in the payment design had a positive impact on outcome of breast cancer care.
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, Taipei City, Taiwan.
authors.forename: Raymond N C
authors.initials: RN
authors.lastname: Kuo
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000191:economics*; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D013624:Taiwan