Pacific D
WITHDRAWN - Association of individual socioeconomic status, regional deprivation and access to the Diabetes Pay-for-Performance Program with type 2 diabetes care (307942)
Michael S. Chen, College of Medical and Health Science, Asian University*Chiachi Bonnie Lee, College of Public Health, China Medical University
Tung-Han Tsai, College of Public Health, China Medical University
Wen-Chen Tsai, College of Public Health, China Medical University
Background: Taiwan initiated the Diabetes Pay-for-Performance Program (DM-P4P) in 2001. The Participating doctors are permitted to choose which of their DM patients to be included in the P4P program. Patients might have limited opportunity to access this program due to their disadvantaged medical and social resources.
Objective: This study examined the impact of individual socio-economic status, area deprivation and access to the DM-P4P program on enrollment of the DM-P4P program, diabetes-related hospital admissions, and adherence to the DM-P4P program by DM-P4P / Non-DM-P4P in Taiwan.
Methods: This is a retrospective, longitudinal cohort study. The analysis is based on an 8-year panel of National Health Insurance claims data for health care utilization from 2007 to 2014 in Taiwan. Our sample includes 135,173 patients with newly diagnosed type 2 diabetes and aged more than 20 years in 2010. Adjusted odds ratios were used to discover any excess risk of exclusion, non-adherence, and hospital admissions.
Results: DM patients with low income (aOR=0.92), living in most deprived areas (aOR=0.89), and areas with low access to the DM-P4P physicians (aOR=0.60) were less likely to be enrolled in the DM-P4P program within 1 year after enrollment. DM-P4P patients with low income (aOR=0.85) were less likely to adhere to the program within 3 years after enrollment. DM-P4P patients with low income (aOR=1.72) and living in most deprived areas (aOR=1.71) were more likely to have hospital admission within 4 years after DM diagnosis; Non-DM-P4P patients with low income (aOR=1.85) and living in most deprived areas (aOR=1.31) were more likely to have hospital admission, but those living in middle access areas compared to those in low access to the DM-P4P physicians had a low risk (aOR=0.89).
Conclusion: Studies have suggested that the DM-P4P is effective in care quality for the DM patient on the program, our study suggested that disparity remained. The DM-P4P must make itself more accessible to the DM patients, especially in the disadvantaged medical and socio-economic areas, and those with lower incomes.