Effects of individual and neighborhood social risks on diabetes pay-for-performance program under a single-payer health system

Wen-Chen Tsai; Kuang-Hua Huang; Pei-Chun Chen; Yu-Chia Chang; Michael S Chen; Chiachi Bonnie Lee

doi:10.1016/j.socscimed.2023.115930

Effects of individual and neighborhood social risks on diabetes pay-for-performance program under a single-payer health system

Soc Sci Med. 2023 Jun:326:115930. doi: 10.1016/j.socscimed.2023.115930. Epub 2023 Apr 26.

Authors

Wen-Chen Tsai¹, Kuang-Hua Huang¹, Pei-Chun Chen², Yu-Chia Chang³, Michael S Chen⁴, Chiachi Bonnie Lee⁵

Affiliations

¹ Department of Health Services Administration, College of Public Health, China Medical University, 100 Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan.
² International Master Program for Public Health, China Medical University, 100 Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan.
³ Department of Long Term Care, National Quemoy University, 1 University Rd., Jinning Township, Kinmen County, 892009, Kinmen, Taiwan; Department of Healthcare Administration, Asia University, 500, Lioufeng Rd., Wufeng, Taichung City, 41354, Taiwan.
⁴ Department of Social Welfare, National Chung Cheng University, 168 Section 1, University Rd., Minhsiung, Chiayi, 621301, Taiwan.
⁵ Department of Health Services Administration, College of Public Health, China Medical University, 100 Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan. Electronic address: bonnielee@mail.cmu.edu.tw.

PMID: 37146356
DOI: 10.1016/j.socscimed.2023.115930

Abstract

Background: Enrollment in and adherence to a diabetes pay-for-performance (P4P) program can lead to desirable processes and outcomes of diabetes care. However, knowledge is limited on the potential exclusion of patients with individual or neighborhood social risks or interruption of services in the disease-specific P4P program without mandatory participation under a single-payer health system.

Objective: To investigate the impact of individual and neighborhood social risks on exclusion from and adherence to the diabetes P4P program of patients with type 2 diabetes (T2D) in Taiwan.

Methods: This study used data from Taiwan's 2009-2017 population-based National Health Insurance Research Database, 2010 Population and Housing Census, and 2010 Income Tax Statistics. A retrospective cohort study was conducted, and study populations were identified from 2012 to 2014. The first cohort comprised 183,806 patients with newly diagnosed T2D, who had undergone follow up for 1 year; the second cohort consisted of 78,602 P4P patients who had undergone follow up for 2 years after P4P enrollment. Binary logistic regression models were used to examine the associations of social risks with exclusion from and adherence to the diabetes P4P program.

Results: T2D patients with higher individual social risks were more likely to be excluded from the P4P program, but those with higher neighborhood-level social risks were slightly less likely to be excluded. T2D patients with the higher individual- or neighborhood-level social risks showed less likelihood of adhering to the program, and the person-level coefficient was stronger in magnitude than the neighborhood-level one.

Conclusions: Our results indicate the importance of individual social risk adjustment and special financial incentives in disease-specific P4P programs. Strategies for improving program adherence should consider individual and neighborhood social risks.

Keywords: Adherence; Diabetes pay‐for‐performance; Incentive design; Neighborhood disadvantage; Social risk selection; Socio-economic status.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Diabetes Mellitus* / therapy
Female
Humans
Male
Middle Aged
National Health Programs* / organization & administration
Regression Analysis
Reimbursement, Incentive*
Retrospective Studies
Risk Factors
Single-Payer System* / organization & administration
Taiwan
Young Adult