# Does asthma pay-for-performance program really improve the quality of asthma care: a nationwide retrospective cohort analysis in Taiwan

## TL;DR

This study examines whether a pay-for-performance program in Taiwan improves asthma care quality by analyzing patient data from 2010 to 2019.

## Contribution

The study provides empirical evidence on the impact of P4P programs on asthma care quality in a national healthcare system.

## Key findings

- P4P-enrolled patients had higher inhaled corticosteroid prescription rates and fewer hospital admissions.
- Demographic factors influenced P4P enrollment, with disparities increasing over time.
- Hospital accreditation levels affected the program's impact on care quality.

## Abstract

Asthma is a prevalent noncommunicable disease worldwide, imposing significant burdens and diminishing the quality of life for those affected. Pay-for-Performance (P4P) programs are reimbursement models that offer incentives to healthcare providers based on their performance metrics. While P4P initiatives have been implemented across various medical conditions, their specific impact on asthma care remains uncertain. This study aims to compare the characteristics and quality of asthma care between patients enrolled in the P4P program and those who are not. Additionally, we will examine trends in these characteristics and care quality over time.

This study utilized a multiple cross-sectional design to analyze asthma patients diagnosed in 2010 and 2019, drawing data from Taiwan’s National Health Insurance claims database. We collected information on demographic characteristics, P4P program enrollment, medication usage, healthcare service utilization, and attributes of both patients and their primary treatment hospitals. To address the study objectives, we employed logistic regression models and applied 1:1 propensity score matching to mitigate selection bias.

A total of 811,177 individuals diagnosed with asthma were identified, comprising 317,669 in 2010 and 493,508 in 2019. Our findings indicate that patients enrolled in the P4P program had higher prescription rates for inhaled corticosteroids (ICS) and experienced lower rates of hospital admissions and emergency department visits for acute asthma exacerbations compared to non-enrolled patients. We also observed that demographic characteristics influenced P4P enrollment, with these impacts evolving over time. Furthermore, the effects of the P4P program varied across different levels of hospital accreditation.

This study demonstrates that the P4P program positively influences the quality of asthma care. However, variations between P4P and non-P4P enrollers persist and have widened over time. Health authorities should address these disparities to ensure equitable care for all asthma patients.

Protocol #202203101RINC.

The online version contains supplementary material available at 10.1186/s12890-025-03673-2.