OBJECTIVES: A number of studies have examined the impacts of pay-for-performance programs on quality of care, but little is known about long-term effects of these programs on the health care outcomes. This study aimed at examine the effects of the pay-for-performance program for type 2 diabetes patients on diabetes-related complications under the National Health Insurance in Taiwan. METHODS: A longitudinal cohort study with 5-year follow-up was used to evaluate the effects of the pay-for-performance program on diabetes-related complications. Research materials came from claims files of the Longitudinal Health Insurance Database (LHID) 2005 released by the National Health Research Institute in Taiwan. Patients newly diagnosed as diabetes in 2004-2006 were included in the study. Patients joined the pay-for-performance program and received the comprehensive care over 12 months during 2004 to 2010 were categorized as the case group. Patients never joined the pay-for-performance program during follow-up period were categorized as control group. Since patients who enrolled in the pay-for-performance program or not is not randomization, we applied the propensity score matching (PSM) to increase the comparatives between these two groups. The outcomes were the incidences of cardiovascular diseases. RESULTS: Patients in the case group experienced cardiovascular event significantly later than control group. The marginal hazard ratios of different propensity score method ranged from 0.60 to 0.63. Patients in the case group also had significant lower risks of heart failure, myocardial infarction and stroke between than patients in the control group. CONCLUSIONS: The pay-for-performance program may have reduced the incidence of cardiovascular events among patients newly diagnosed with diabetes who participated in the program for over 12 months.