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World J Diabetes. May 15, 2021; 12(5): 578-589
Published online May 15, 2021. doi: 10.4239/wjd.v12.i5.578
Chronic care model in the diabetes pay-for-performance program in Taiwan: Benefits, challenges and future directions
Tsung-Tai Chen, Brian Oldenburg, Ya-Seng Hsueh
Tsung-Tai Chen, Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
Brian Oldenburg, Noncommunicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
Ya-Seng Hsueh, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
Author contributions: Chen TT and Oldenburg B designed the review; Chen TT and Hsueh YS wrote the review; Oldenburg B modified the review.
Supported by Ministry of Science and Technology in Taipei, No. 106-2918-I-030-002.
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsung-Tai Chen, PhD, Associate Professor, Department of Public Health, College of Medicine, Fu Jen Catholic University, No. 510 Zhongzheng Road, New Taipei 24205, Taiwan. 084907@mail.fju.edu.tw
Received: December 26, 2020
Peer-review started: December 26, 2020
First decision: January 18, 2021
Revised: February 8, 2021
Accepted: April 5, 2021
Article in press: April 5, 2021
Published online: May 15, 2021
Abstract

In this review, we discuss the chronic care model (CCM) in relation to the diabetes pay-for-performance (P4P) program in Taiwan. We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan, mapping them onto the 6 components of the CCM. For each CCM component, the following three topics are described: the definition of the CCM component, the general activities implemented related to this component, and practical and empirical practices based on hospital or local government cases. We then conclude by describing the possible successful features of this P4P program and its challenges and future directions. We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives (i.e., shared care network), physician-led P4P and the implementation of activities based on the CCM components. However, due to the low rate of P4P program coverage, approximately 50% of patients with diabetes cannot enjoy the benefits of CCM-related activities or receive necessary examinations. In addition, most of these CCM-related activities are not allotted an adequate amount of incentives, and these activities are mainly implemented in hospitals, which compared with primary care providers, are unable to execute these activities flexibly. All of these issues, as well as insufficient implementation of the e-CCM model, could hinder the advanced improvement of diabetes care in Taiwan.

Keywords: Chronic care model, Diabetes, Pay-for-performance, Shared care, Diabetes care

Core Tip: Most studies have shown that pay-for-performance (P4P) can reduce diabetes-related complications. The successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives (i.e., shared care network), physician-led P4P and the implementation of activities based on the chronic care model components. However, the P4P coverage rate should be steadily improved, and Taiwanese government should invest more in primary care to help these facilities participate in the P4P program and have the capacity to implement chronic care model -related activities.