OBJECTIVES

: To examine the effect of a schizophrenia pay-for-performance (P4P) program on health outcomes for patients in Taiwan.

METHODS

: This study used 5-year (2009~2013) panel data from the databases of the National Health Insurance Administration (NHIA) in Taiwan. Using the caliper matching method to match patients in the P4P (experimental) group with those in the potential comparison group on a one-to-four basis for the year 2010, generalized estimating equations (GEE) were used to estimate difference-in-differences (DID) models to examine the effects of the P4P program in the short and long terms on negative outcomes in terms of the interval of outpatient visits (interval≥30 days), mandatory admission, emergency department (ED) visits, acute ward visits, length of stay, and readmission (within 6 months).

RESULTS

: The results showed that P4P patients were less likely to visit psychiatric services (interval≥30 days) in the long run (odds ratio [OR]=0.61, P < 0.001). The schizophrenia P4P program was beneficial for patients in the short term in terms of reduced psychiatric mandatory admission visits (incidence of rate ratio [IRR]=0.12, P < 0.05), acute ward visits (IRR=0.69, P < 0.001) and length of stay (LOS) of acute ward stay (IRR=0.62, P < 0.001); however, it was not associated with a reduction in all the abovementioned negative outcomes during the continual 4-year implementation period or with ED visits and readmission.

CONCLUSIONS

: This study is the first to evaluate a schizophrenia P4P program using a national database over a longitudinal period. This study found that patient participation in the schizophrenia P4P program was beneficial for patients in the short period; however, in the long period, this program was not associated with reductions in negative outcomes. How the schizophrenia P4P program could strengthen management of disadvantaged groups to achieve better patient health outcomes was discussed in detail.