Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 6;21(1):41.
doi: 10.1186/s12962-023-00450-y.

Impact of a diabetes pay-for-performance program on nonincentivized mental disorders: a panel study based on claims database analysis

Ming-Chan Sung  1 , Kuo-Piao Chung  2 , Shou-Hsia Cheng  3   4
Affiliations

Impact of a diabetes pay-for-performance program on nonincentivized mental disorders: a panel study based on claims database analysis

Ming-Chan Sung et al. Cost Eff Resour Alloc. .

Abstract

Background: Diabetes is one of the most prevalent chronic diseases with subsequent complications. The positive effects of diabetes pay-for-performance (P4P) programs on treatment outcomes have been reported. The program provides financial incentives based on physiological care indicators, but common mental disorder complications such as depression are not covered.

Methods: This study employed a natural experimental design to examine the spillover effects of diabetes P4P program on patients with nonincentivized depressive symptoms. The intervention group consisted of diabetes patients enrolled in the DM P4P program from 2010 to 2015. Unenrolled patients were selected by propensity score matching to form the comparison group. Difference-in-differences analyses were conducted to evaluate the effects of P4P programs. We employed generalized estimating equation (GEE) models, difference-in-differences analyses and difference-in-difference-in-differences analyses to evaluate the net effect of diabetes P4P programs. Changes in medical expenses (outpatient and total health care costs) over time were analysed for the treatment and comparison groups.

Results: The results showed that enrolled patients had a higher incidence of depressive symptoms than unenrolled patients. The outpatient and total care expenses of diabetes patients with depressive symptoms were lower in the intervention group than in the comparison group. Diabetes patients with depressive symptoms enrolled in the DM P4P program had lower expenses for depression-related care than those not enrolled in the program.

Conclusions: The DM P4P program benefits diabetes patients by screening for depressive symptoms and lowering accompanying health care expenses. These positive spillover effects may be an important aspect of physical and mental health in patients with chronic disease enrolled in disease management programs while contributing to the control of health care expenses for chronic diseases.

Keywords: Depression; Diabetes; Disease management; Pay-for-performance; Spillover effect.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

References

    1. Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Bärnighausen T, et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care. 2018;41(5):963–70. doi: 10.2337/dc17-1962. - DOI - PubMed
    1. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254–64. doi: 10.2522/ptj.20080020. - DOI - PMC - PubMed
    1. Kung FP, Tsai CF, Lu CL, Huang LC, Lu CH. Diabetes pay-for-performance program can reduce all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Med (Baltim) 2020;99(7):e19139. doi: 10.1097/MD.0000000000019139. - DOI - PMC - PubMed
    1. Chen YC, Lee CTC, Lin BJ, Chang YY, Shi HY. Impact of pay-for-performance on mortality in diabetes patients in Taiwan: a population-based study. Med (Baltim) 2016;95(27):e4197. doi: 10.1097/MD.0000000000004197. - DOI - PMC - PubMed
    1. Wu YF, Chen MY, Chen TH, Wang PC, Peng YS, Lin MS. The effect of pay-for-performance program on infection events and mortality rate in diabetic patients: a nationwide population-based cohort study. BMC Health Serv Res. 2021;21(1):1–10. doi: 10.1186/s12913-021-06091-2. - DOI - PMC - PubMed

LinkOut - more resources