本文旨在探討「糖尿病論質計酬試辦計畫」之政策效果，資料來源為全民健保資料庫的2000 年承保抽樣歸人檔，從2002-2003 年挑選第一次加入糖尿病試辦計畫且往後三年皆參與此計畫的病患作為實驗組，而對照組即為未參與此計畫的病患，但因為比較過程中存在樣本選擇問題，因此利用傾向分數配對法(Propensity Score Matching，PSM)，從對照組中配對出像似於實驗組特性的配對組，以消除基礎點的差異，並利用差異中的差異(Difference-in-Difference，DD)法說明政策效，評估目前的論質計酬制度下，糖尿病試辦計畫實施後能否有效減緩糖尿病的醫療費用。
研究實證結果顯示，糖尿病人持續加入論質計酬試辦計畫三年後，門診利用次數顯著減少，住院利用亦顯著減少；醫療費用部分，糖尿病人在加入計畫第一年，總醫療費用顯著增加，而第二年及第三年的總醫療費用皆顯著減少，但若以累計糖尿病總醫療費用可發現，實驗組持續就醫三年總醫療費用顯著減少，住院費用也顯著減少，顯示完整照護計畫以及持續且固定回診是照護成效的重要關鍵。

This article aims to explore the policy effect of “diabetes on the pay-for-performance program” using the data of National Health Insurance from National Health Research Institute. I construct two sample groups: the experimental group includes the patients enrolled this program for first time during 2002-2003 and continued for the further three years while the control group includes the patients that are out of this program. To avoid potential sample selection problem, I use the propensity score matching method (PSM) and arrange the samples from two groups into comparable pairs. At last, we want to assess whether this program effectively reduce the medical expenses in diabetes or not.
The empirical results show that patients enrolled three years in the pay-for-performance program had a significantly lower number of diabetes-related physician visits, and also is the diabetes-related hospitalizations. Patients in the experimental group spend significantly more than the matched group in the first year；
the continual enrollees spent significantly less than their counterparts in the subsequent years. Patients enrolled three years in the diabetes program spend significantly lower the matched group, and also is the hospitalizations costs. Therefore, the key point of care plan is continuous clinic care.

中文文獻
1. 中央健康保險局(2001)，「全民健康保險糖尿病醫療服務改善方案試辦計畫
支付標準 第一版」，中央健康保險局。
2. 行政院衛生署國民健康局網站。Uhttp://www.bhp.doh.gov.tw/BHPnet/Portal/U
3. 向紅丁(2000)，「中西醫會診：糖尿病」，書泉出版社。
4. 李玉春(2002)，「建立全民健保以共同照護模式為基礎的糖尿病人疾病管理
計畫先導性研究(III) 」，行政院衛生署九十一委託計畫，計畫編號
DOH91-NH-1002。
5. 林文德、謝其政、邱尚志、吳慧俞、黃一展（2010），「以傾向分數配對法
評估糖尿病論質計酬方案之成效」，台灣衛誌，29（1），54-63頁。
6. 林士弼(2008)，「探討糖尿病醫療給付改善方案之病患選擇」，國立台灣大
學公共衛生學院衛生政策與管理研究所 碩士論文。
7. 徐慧君、翁慧卿、林育慈、陳淑銘、李佩儒、李集美等(2004)，「糖尿病患介
入疾病管理在經濟面、臨床面及滿意度成效評估之初探－以南部某區域醫院
糖尿病病患為例」，醫務管理期刊，5(2)，222-242 頁。
8. 連賢明(2008)，「如何使用健保資料進行經濟研究」，經濟論文叢刊，115-143
頁。
9. 國家衛生研究院全民健康保險研究資料庫譯碼簿。
10. 陳明君、陳啟禎、錢慶文(2003)，「論質計酬制度對糖尿病患門診醫療費用之
可能影響評估」，醫務管理期刊，4(4)，14-26 頁。
11. 黃三桂、王悅萍、錢慶文(2002)，「疾病管理對糖尿病患醫療資源耗用之影響」，醫務管理期刊，3(2)，35-48。
12. 黃月桂(1997)，「全民健保預防保健服務之利用與成本效益分析」，中央健康
保險局。
13. 賴美淑、邱淑媞(2002)，「糖尿病共同照護網之概念與內涵」，台灣醫學，6：
55 560-568頁。
英文文獻
1. American Diabetes Association. Uhttp://www.diabetes.org/U
2. American Diabetes Association. 2003. "Economic Costs of Diabetes in the U.S. in 2002." , Diabetes Care, 26:917–932.
3. Chang, R.E., Lin, S.P., and Swei, S.C. 2008. "Patient selection under a performance-based care improvement program. In: Proceedings of the First Annual Meeting on Center of Health Insurance Research.", Taipei, Taiwan:
Center of Health Insurance Research.
4. Donabedian Avedis. "Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment.", Ann Arbor: Health Administration Press, 1980.
5. Ettaro Lorraine, Songer Thomas, Zhang Ping, and Engelgau, M.M. 2004. "Cost-of-Illness Studies in Diabetes Mellitus." Pharmacoeconomics, 22(3):149-164.
6. Fu Alex, Dow Willian, and Liu Gordon. 2007. "Propensity Score and Difference-in-Difference Methods: A Study of Second-Generation Antidepressant Use in Patients with Bipolar Disorder." Health Services Outcomes Research Methodology, 7:23-38.
7. Hickman Matthew, Drummond Neil, and Grimshaw Jeremy. 1994. "The Operation of Shared Care for Chronic Disease.", Health Bull, 52:118-126.
8. Lee, T.T., Cheng, S.H., Chen, C.C., and Lai, M.S. 2010. "A Pay-for-Performance Program for Diabetes Care in Taiwan: A Preliminary Assessment.", Am J Manag Care, 16(1):65-69.
9. Sidorov Jaan, Shull Robert, Tomcavage Janet, Girolami Sabrina, Lawton Nadine, and Harris Ronald. 2002. "Does Diabetes Disease Management Save Money and Improve Outcomes?" Diabetes Care, 25:684-689.
10. Schmitt-Koopmann Irmgard, Schwenkglenks Matthias, Spinas, G.A., and Szucs, T.D. 2004. "Direct Medical Costs of Type 2 Diabetes and Its Complications in Switzerland."
European Journal Public Health, 14(1):3-9.
11. Mushkin, S.J., Collings, F.d’A. 1959. "Economic Costs of Disease and Injury." Public Health Reports, 74:795-809.
12. Niefeld, M.R., Braunstein, J.B., Wu, A.W., Saudek, C.D., Weller, W.E., and Anderson, G.F. 2003. "Preventable Hospitalization among Elderly Medicare Beneficiaries with
Type 2 Diabetes." Diabetes Care, 26:1344-1349.
13. Rosenbaum, P.R., and Rubin, D.B. 1983. "The Central Role of the Propensity Score in Observational Studies for Causal Effects." Biometrika, 70(1):41-55.
14. Rosenthal, M.B., Frank, R.G., Li Zhonghe, and Epstein, A.M. 2005. "Early Experience with Pay-for-Performance: from Concept to Practice." JAMA, 294:1788-1793.
15. The CDC Diabetes Cost-Effectiveness Group. 2002. Cost-effectiveness of Intensive Glycemic Control, Intensified Hypertension Control, and Serum Cholesterol Level Reduction for Type 2 Diabetes. JAMA, 287(19):2542–2551.
16. Sherman Folland, Goodman, A.C., and Miron Stano. 2004. "The Economics of Health and Health Care", 4th ed., Prentice Hall.
17. World Health Organization, Uhttp://www.who.int/en/U
18. Young, B.A., Lin Elizabeth, Von Korff, M., Simon Greg, Ciechanowski Paul, Ludman, E.J., Everson Stewart, S., Kinder Leslie, Oliver Malia, Boyko E.J., and Katon W.J. 2008. "Diabetes Complications Severity Index and Risk of Mortality, Hospitalization, and Healthcare Utilization." The American Journal of Managed Care, 14:15-24.