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The effects of a schizophrenia pay-forperformance program on patient outcomes in Taiwan

Objective: To examine the effects of a schizophrenia payforperformance (P4P) program on the health outcomes of patients in Taiwan.

Data Sources: Seven years (20072013) of data from the National Health Insurance Administration (NHIA) databases were examined.

Study Design: P4P patients included those who were treated at participating facilities and consecutively included in the regular group (classified by the NHIA). NonP4P patients were treated at nonparticipating facilities and never included in the regular group. The caliper matching method and a generalized estimating equation were used to estimate differenceindifferences models (baseline year 2009) and examine the short and longterm effects of the P4P program on adverse outcomes.

Principal Findings: The schizophrenia P4P program was associated with decreases in unscheduled outpatient visits (OR: 0.69, P < 0.001) and compulsory admissions (incidence rate ratio: 0.33, P < 0.05). However, this program was not associated with decreases in other outcomes including emergency department visits for any disease, admissions to an acute psychiatric ward, and readmission within 6 months.

Conclusions: Although the disease management component of the P4P program can be beneficial for compulsory admissions, more sophisticated activities, such as health promotion targeting disadvantaged patients, could be implemented to reduce the occurrence of complicated adverse outcomes.

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