The Effect of Implementing Asthma Pay-for-Performance (P4P) on Healthcare Outcomes in Taiwan: A Nationwide Retrospective Cohort Analysis.

<bold>Background:</bold> Pay-for-performance (P4P) schemes, a form of Value-Based Payment (VBP), incentivize health workers with financial rewards or support based on achieving specific performance targets. In Taiwan, the Asthma P4P program has been operational since 2001, yet research on its outcomes has been scant. Our study aims to assess the effects of the Asthma P4P programs on healthcare outcomes in Taiwan, emphasizing prescription trends and results across different levels of healthcare accreditation. <bold>Methods:</bold> We conducted a nationwide retrospective analysis using data from Taiwan's National Health Insurance claims for 2016 to 2017. The data encompassed demographic details, P4P program participation, medication use, asthma care results, and characteristics of the primary care facilities. <bold>Results:</bold> We included 447,000 patients with asthma, of whom 36,934 (8.26%) were enrolled in the P4P program. Participants in the P4P initiative showed significantly fewer asthma acute exacerbations (1.61% vs. 8.90% for emergency visits; 0.73% vs. 7.35% for hospital admissions). Inhaled Corticosteroid (ICS) prescriptions were higher in the P4P group across all accreditation levels compared to the non-P4P group (17.85% vs. 11.59% in medical centers, p<0.001; 16.02% vs. 9.76% in regional hospitals, p<0.001; 13.54% vs. 6.59% in community hospitals, p<0.001; and 11.27% vs. 6.75% in clinics, p<0.001). Additionally, P4P enrollees had lower rates of acute exacerbations at each accreditation level. <bold>Conclusion:</bold> The Asthma P4P program has positively impacted care outcomes, notably enhancing ICS prescription rates and reducing asthma exacerbations across various healthcare settings.