Application of Pay for Performance in Tuberculosis Care–The Taiwan Experience
Cheng-Yi Lee1,2、Ting-Yi Chiang3、Hsiu-Yun Lo1、Jen-Hsiang Chuang1,4、Yi-Chun Wu5、Shiang-Lin Yang1
2012 Vol.28 NO.19
Correspondence Author： Cheng-Yi Lee
Since the inception of national health insurance in 1995, it has almost covered 99% of population in Taiwan now. Although the life expectancy is increasing year by year, there is still substantial improvable space for medical service quality. Pay for performance is a term that describes healthcare payment system offering financial incentives to promote health care quality. Since 2001, the Bureau of National Health Insurance (BNHI) has implemented the trial programs in improving medical payment on Tuberculosis (TB), diabetes and others. The goal of these programs is to improve the outcome and effectiveness of healthcare through the integration of healthcare providers and payment system. The Taiwan Centers for Disease Control (TCDC) has collaborated with BNHI in TB control since 2004. The pay for performance has included TB into the health care facilities, which lead to the increase of participation rate. Since 2008, TB has been added into the Part 10 “Quality payment service” of the Standard of Medical Payment, which is also the only disease transferred from trial program into the official standard payment system. Until 2010, a total of 351 hospitals at district level or above and 117 clinics have participated in pay for performance program; and under this program, treatment success exceeds over 10,000 patients each year. The overall outcome and the collaboration with the public health have received positive feedback, but more empirical cases should be accumulated in order to present its effectiveness. Furthermore, workloads of case managers and patients who do not enroll in this program should be addressed. Taiwan’s experience of implementing TB control and pay for performance can be served as a reference for other countries for the cooperation of health insurance, healthcare providers as well as infectious diseases control.