Effect of the Pay-for-Performance Program for Breast Cancer Care in Taiwan

Purpose: To evaluate the impact of the nationwide pay-for-performance (P4P) program for breast cancer care (BC-P4P) in Taiwan on care quality patient survival and recurrence. Study Design: A population-based observational study with cross-sectional design. Methods: Retrospective analysis of population-based cancer registration and claims data was used in this study. A total of 4,528 patients with stage I or II breast cancer diagnosed in 2002 or 2003 who received curative surgery were observed until the end of 2008. This study applied multivariate linear regression to explore the association between BC-P4P enrollment and quality of care. Cox regression was applied to examine the effect of BC-P4P enrollment on 5-year recurrence and overall survival among patients with breast cancer. Results: After controlling for age, stage, type of surgery, and other factors BC-P4P enrollees were found to have received better quality care than nonenrollees (P = .001). Cox regression models also indicated that after controlling for patient characteristics quality of care was related to better 5-year overall survival (odds ratio [OR] 0.212 P = .001) and recurrence (OR 0.289 P < .001). Even when controlled by quality of care provided to patients and its interaction with status of BC-P4P enrollment BC-P4P enrollment remained statistically significant regarding 5-year overall survival (OR 0.167 P = .001) and recurrence (OR 0.370 P = .002). Conclusion: Patients with breast cancer enrolled in the BC-P4P program received better quality care and had better outcome than nonenrolled patients. Evidence from this study indicates that financial incentives in the payment design had a positive impact on outcome of breast cancer care.