title: A longitudinal examination of a pay-for-performance program for diabetes care: evidence from a natural experiment.
abstract: BACKGROUND
  Numerous studies have examined the impacts of pay-for-performance programs, yet little is known about their long-term effects on health care expenses.
  
  
  OBJECTIVE
  This study aimed to examine the long-term effects of a pay-for-performance program for diabetes care on health care utilization and expenses.
  
  
  METHODS
  This study represents a nationwide population-based natural experiment with a 4-year follow-up period under a compulsory universal health insurance program in Taiwan. The intervention groups consisted of 20,934 patients enrolled in the program in 2005, and 9694 patients continuously participated in the program for 4 years. Two comparison groups were selected by propensity score matching from patients seen by the same group of physicians. Generalized estimating equations were used to estimate differences-in-differences models to examine the effects of the pay-for-performance program.
  
  
  RESULTS
  Patients enrolled in the pay-for-performance program underwent significantly more diabetes specific examinations and tests after enrollment; the differences between the intervention and comparison groups declined gradually over time but remained significant. Patients in the intervention groups had a significantly higher number of diabetes-related physician visits in only the first year after enrollment and had fewer diabetes-related hospitalizations in the follow-up period. Concerning overall health care expenses, patients in the intervention groups spent more than the comparison group in the first year; however, the continual enrollees spent significantly less than their counterparts in the subsequent years.
  
  
  CONCLUSIONS
  The program seemed to achieve its primary goal in improving health care and providing long-term cost benefits.
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan. shcheng@ntu.edu.tw
authors.forename: Shou-Hsia
authors.initials: SH
authors.lastname: Cheng
authors.forename: Tai-Ti
authors.initials: TT
authors.lastname: Lee
authors.forename: Chi-Chen
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000517:prevention & control / Q000628:therapy; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration; D016012:Poisson Distribution; D057216:Propensity Score; D012052:Reimbursement, Incentive / Q000191:economics; D013624:Taiwan