Tsung-Tai Chen1, Tao-Hsin Tung2, Ya-Seng Arthur Hsueh3, Ming-Han Tsai4, Hsiu-Mei Liang4, Kay-Lun Li5, Kuo-Piao Chung6, Chao-Hsiun Tang7. 1. Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. Electronic address: 084907@mail.fju.edu.tw. 2. Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Medical Research and Education, Cheng Hsin General Hospital, Taipei City, Taiwan. 3. Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. 4. Division of Endocrinology Metabolism, Min-Sheng General Hospital, Taoyuan City, Taiwan. 5. Division of Metabolism and Endocrinology, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan. 6. Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan. 7. School of Health Care Administration, Taipei Medical University, Taipei City, Taiwan.
Abstract
OBJECTIVE: To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method. METHODS: The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes. RESULTS: The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%. CONCLUSIONS: Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics.
OBJECTIVE: To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method. METHODS: The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes. RESULTS: The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%. CONCLUSIONS:Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics.
Authors: Joachim Marti; Marcus Bachhuber; Jordyn Feingold; David Meads; Michael Richards; Sean Hennessy Journal: BMJ Open Date: 2017-10-06 Impact factor: 2.692