Effects of pay-for-performance for primary care physicians on type 2 diabetes outcomes: Evidence from rural China

This study aims to evaluate the impact of a pay-for-performance (P4P) program on health outcomes for patients with type 2 diabetes mellitus in Chinese primary care settings.

Conducted from February to March 2019, this trial involved 1,085 participants from 19 rural villages in China. Family physicians in the intervention group received P4P incentives. We collected clinical health outcomes, including fasting blood glucose, blood pressure, and lipid levels, at baseline and after one year. A differences-in-differences model was employed to assess the P4P program's effects on these health outcomes. Additionally, a multiple regression analysis was performed to evaluate the influence of P4P on patients' health behaviors, such as self-management, doctor-patient trust, and self-rated health.

Following the intervention, the intervention group showed significant reductions in fasting plasma glucose (0.88 mmol/L), systolic blood pressure (11.10 mmHg), and total cholesterol (0.50 mmol/L) compared to the control group. The P4P program also improved control rates for fasting glucose (OR = 2.34, 95 % CI:1.57-3.48), blood pressure (OR = 7.57, 95 % CI: 4.98-11.50), and total cholesterol (OR = 2.47, 95 % CI:1.61-3.79), while enhancing self-management behaviors (OR = 0.21, 95 % CI: 0.08-0.34) and doctor-patient trust (OR = 0.75, 95 % CI: 0.39-1.11).

The P4P incentive effectively improved glycemic control and diabetes management in rural China.