Effects of a Schizophrenia Pay-for-Performance Program on Health Care Resource Utilization

This study aims to assess the impacts of a pay-for-performance (P4P) program on health care resource utilization for patients with schizophrenia in Taiwan.

This study employed a difference-in-differences (DID) approach to compare outcome measures between the exposed (P4P program enrollees) and unexposed cohorts across 2 time points (pre and post intervention). Patients were selected from Taiwan's National Health Insurance Research Database between 2009 and 2017, then divided into the exposed and the unexposed cohorts using the double propensity score adjustment technique with a ratio of 1 patient in the exposed cohort to 4 patients in the unexposed cohort, based on the matching criteria of age, sex, and the index date.

Generalized estimating equation with a Poisson distribution and a negative binomial distribution, along with the DID technique, was utilized to estimate the effects of the P4P program on health care resource utilization among enrollees.

Patients in the exposed cohort were less likely to have outpatient visits than their counterparts, indicating a reduced demand for outpatient health care (incidence rate ratio [IRR], 0.8357; P  < .0001). However, the P4P program was not effective in reducing emergency department visits (IRR, 1.0234; P  = .6687), hospital admissions (IRR, 0.9146; P  = .3728), or lengths of hospital stay (IRR, 1.1253; P  = .2128).

The study demonstrated that the P4P program had mixed effects on health care resource utilization for patients with schizophrenia, particularly regarding the program's effectiveness in reducing reliance on inpatient and emergency services, which was not significant.