Perception and Willingness to Maintain Continuity of Care by Parents of Children with Asthma in Taiwan.

To investigate caregivers' attitudes toward continuity of care (COC) and their willingness to maintain continuity for their children with asthma under a national health insurance (NHI) system without strict referral management. We sampled 825 individuals from six pediatric outpatient departments in different parts of Taiwan from 2017 to 2018. We used a contingent valuation with a payment card method. Post-stratification weighting adjustment and coarsened exact matching were utilized. Multiple logistic regression was used to compare the willingness to pay and spend extra time maintaining continuity by parents. More than 80% of caregivers in the asthma group believed having a primary pediatrician was important for children's health. Only 27.5% and 15.8% of caregivers in the asthma and control groups, respectively, believed changing pediatricians would negatively affect therapeutic outcomes. Regression analysis showed that the predicted willingness to pay for the asthma and non-asthma groups were NT$508 (SD = 196) and NT$402 (SD = 172), respectively, and there was a significant positive dose-response relationship between household income and willingness to pay for maintaining health care provider continuity. Caregivers' free choices among health care providers may reduce willingness to spend extra effort to maintain high COC. Caregivers should be educated on the importance of COC.

Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study.

BACKGROUND: The diabetes patients enrolled in the pay-for-performance (P4P) program demonstrate reduced risk of death. Body mass index (BMI) is a risk factor of all-cause death. This study investigates the effects of BMI and P4P on the risk of death in type 2 diabetes patients. METHODS: This is a retrospective cohort study. The study population includes the 3-wave National Health Interview Survey in Taiwan. A total of 6354 patients with diabetes aged ≥ 20 years were enrolled and followed up until the end of 2014. RESULTS: The highest mortality rate per 1000 person-years was 61.05 in the underweight patients with diabetes. A lower crude death rate was observed in the P4P participants than non-P4P participants. The risk of death was 1.86 times higher in the underweight patients with diabetes than that in the normal weight group (95% CI: 1.37-2.53) and was lower in the P4P participants, as compared to the non-participants (HR: 0.55, 95% CI: 0.44-0.69). The most significant effect of joining the P4P program in reducing death risk was found in the underweight patients with diabetes (HR: 0.11, 95% CI: 0.04-0.38), followed by the obesity group (HR: 0.30, 95% CI: 0.17-0.52). CONCLUSIONS: Different effects of joining the P4P program on reducing death risk were observed in the underweight and obesity groups. We strongly recommend that patients with diabetes and without healthy BMIs participate in the P4P program.