Using financial incentives to improve the care of tuberculosis patients

Am J Manag Care. 2015 Jan 1;21(1):e35-42.


Objectives: Tuberculosis (TB) is a serious public health concern, and Taiwan has implemented a pay-for-performance (P4P) program to incentivize healthcare professionals to provide comprehensive care to TB patients. This study aims to examine the effects of the TB P4P program on treatment outcomes and related expenses.

Study design: A population-based natural experimental design with intervention and comparison groups.

Methods: Propensity score matching was conducted to increase the comparability between the P4P and non-P4P group. A total of 12,018 subjects were included in the analysis, with 6009 cases in each group. Generalized linear models and multinomial logistic regression were employed to examine the effects of the P4P program.

Results: The regression models indicated that patients enrolled in the P4P program had 14% more ambulatory visits than non-P4P patients (P < .001), but there were no differences in hospitalization rates. On average, P4P enrollees spent $215 (4.6%) less on TB-related expenses than their counterparts. In addition, P4P enrollees had a higher likelihood of being successfully treated (odds ratio, 1.56; P < .001) and were less likely to die compared with nonenrollees.

Conclusions: Patients in the P4P program were less likely to die, were more likely to be treated successfully, and incurred lower costs. Providing financial incentives to healthcare institutions could be a feasible model for better TB control.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Health Care Costs
  • Humans
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • National Health Programs / economics
  • Outcome Assessment, Health Care*
  • Propensity Score
  • Quality Improvement
  • Reimbursement, Incentive / economics*
  • Retrospective Studies
  • Severity of Illness Index
  • Taiwan
  • Tuberculosis / diagnosis
  • Tuberculosis / economics*
  • Tuberculosis / epidemiology
  • Tuberculosis / therapy*