title: Measuring Preferences for a Diabetes Pay-for-Performance for Patient (P4P4P) Program using a Discrete Choice Experiment.
abstract: OBJECTIVE
  To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method.
  
  
  METHODS
  The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes.
  
  
  RESULTS
  The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%.
  
  
  CONCLUSIONS
  Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics.
authors: Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. Electronic address: 084907@mail.fju.edu.tw.
authors: Tsung-Tai
authors: TT
authors: Chen
authors: Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Medical Research and Education, Cheng Hsin General Hospital, Taipei City, Taiwan.
authors: Tao-Hsin
authors: TH
authors: Tung
authors: Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors: Ya-Seng Arthur
authors: YS
authors: Hsueh
authors: Division of Endocrinology Metabolism, Min-Sheng General Hospital, Taoyuan City, Taiwan.
authors: Ming-Han
authors: MH
authors: Tsai
authors: Division of Endocrinology Metabolism, Min-Sheng General Hospital, Taoyuan City, Taiwan.
authors: Hsiu-Mei
authors: HM
authors: Liang
authors: Division of Metabolism and Endocrinology, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan.
authors: Kay-Lun
authors: KL
authors: Li
authors: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan.
authors: Kuo-Piao
authors: KP
authors: Chung
authors: School of Health Care Administration, Taipei Medical University, Taipei City, Taiwan.
authors: Chao-Hsiun
authors: CH
authors: Tang
mesh_terms: D000368:Aged; D002755:Choice Behavior; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D004032:Diet; D015444:Exercise; D005260:Female; D005382:Financing, Personal; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000191:economics*; D057240:Patient Preference / Q000191:economics*; D010361:Patients / Q000523:psychology*; D016730:Program Development; D012052:Reimbursement, Incentive / Q000191:economics*; D012201:Reward; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: diabetes; discrete choice experiment; pay-for-performance for patient (P4P4P); willingness to accept