As healthcare costs for patients with non-communicable diseases such as diabetes have risen, governments and healthcare providers have sought creative measures to align financial incentives with better patient outcomes. One incentive payment system known as “pay-for-performance” (P4P), in which providers are beholden to metric-driven outcomes, represents a potential path forward for healthcare providers to improve healthcare processes, resulting in higher quality and better patient health outcomes. The evidence on the effectiveness of P4P programs, however, is mixed.

To address this uncertainty, a new study, published in The European Journal of Healthcare Economics, assesses the effectiveness, in monetary terms, of a P4P program for patients with diabetes at a hospital system in Taiwan. 

The study coauthors, including APARC’s Asia Health Policy Program Director and FSI Senior Fellow Karen Eggleston, employed new patient-level data on clinical indicators, utilization, and expenditures, combined with data from the national death registry, to better understand the costs and benefits of the P4P program. Their results show that Taiwan’s implementation of the P4P program for diabetic care yielded positive results in terms of net value, defined as the value of life years gained minus the cost of care.

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Assessing Net Value of Taiwan’s P4P

Taiwan’s Bureau of National Health Insurance (now National Health Insurance Administration) introduced P4P in 2001 and enhanced the program in 2006 with an incentive for pay-for-reporting of outcomes. Financial incentives were used to encourage continuity of care with metrics such as new patient enrollment, follow-up visits, and annual reports, each tied to a specific monetary value. The program’s features are common across P4P, so the study’s findings have implications in other settings that incorporate similar designs in their P4P programs.

The study compares two different groups of patients at a large regional hospital in Taiwan, one consisting of newly enrolled P4P patients and another using P4P patients who have been enrolled since the beginning of the program. The researchers leverage detailed clinical data not used in previous assessments of the P4P program to better identify both costs and longer-term clinical outcomes based on measured biomarkers and predicted mortality.

Using an economic cost-benefit analysis conducted from a budgetary perspective, the study is the first analysis of any P4P program that estimates changes in the quality-adjusted price index relative to usual care. The authors consider health benefits in terms of survival and predicted survival and convert them into monetary terms. This net value approach is especially useful for policymakers and healthcare administrators who implement value-based purchasing and monitor outcomes for any service delivery innovation over time.

The study finds that Taiwan’s P4P program provided a positive net value for payers and patients, ranging from $40,084 USD to $348,717 USD. These positive net value results are primarily derived from health outcomes as measured by lower mortality rates in the P4P versus non-P4P cohorts, across both newly enrolled and continuously enrolled groups of patients. According to the authors, “these encouraging findings of the positive value of quality improvement net of expenditures adds evidence to the literature that has found mixed results of P4P programs.” 

 This study develops a new model for assessing the net value of service delivery innovations like P4P programs that can be applied in other contexts globally, providing healthcare systems researchers with new tools to better understand an emergent option for incentivized care. With a more economically-translatable understanding of P4P programs, this research helps build the bridge between the oft-disparate worlds of healthcare and policy.

The following article is a guest post written by Thea Louise Dai, an alumna of the Spring 2022 China Scholars Program. In April 2022, Thea met Wendy Wen, an alumna of the Spring 2022 Stanford e-China Program. Currently, Thea Louise is a junior at Castilleja School in Palo Alto, California, and Wendy Wen is a junior at Beijing National Day School in Beijing, China.

In April 2022, I met Wendy Wen through a collaboration between the China Scholars Program (CSP) and Stanford e-China. Five months later, we are working together to prepare the first synchronous Zoom discussion at Project 17—a 501(c)(3) nonprofit organization we founded dedicated to initiating global dialogue through synchronous discussions about the 17 Sustainable Development Goals (SDGs) of the United Nations.

The CSP and Stanford e-China collaboration was no doubt my most stimulating academic experience to date. The two programs held four joint discussions on various climate issues over the course of several weeks. With the rare opportunity to bridge geographical and cultural divides, I finally had a chance to apply everything I had learned about China’s history, policies, and current events throughout the program in conversation with actual Chinese students, from whom I learned new perspectives. Although we only had to participate in one of the synchronous discussions, I found myself looking forward to each meeting and rearranging my schedule to attend all four.

Wendy recalls that she had a similarly eye-opening experience during the meetings. She noted, “I have always believed that the world’s largest challenges can be solved through global collaboration. After every discussion with the CSP, I left feeling inspired to know that such collaboration is possible, even for high school students.”

After meeting each other through a breakout room conversation, we immediately connected on the need for a global discussion platform targeted towards youth perspectives. Essentially, we hoped to capture the value of our experience with SPICE, and we wanted to make it even more accessible and on a larger scale. We also wanted to clear a pathway for participants to take the next steps to create tangible change on the SDGs after our discussions.

As a result, we conceptualized Project 17 in part to partner with the chapter system of the United Nation Association of the USA (UNA-USA) so that high school and college students have the unique opportunity to connect with UNA-USA officials and members across the United States. Our vision is for all participants to be able to share their perspectives on the SDGs to inform the UNA-USA chapter system. We’re also working with Stanford e-China Instructor Carey Moncaster and CSP Instructor Tanya Lee of SPICE to publish the SDG-related research and reflections of participants on larger platforms.

Project 17 hosts four annual synchronous Zoom discussions, each focused on a particular group of SDGs: Planet, People, Prosperity, and Peace & Partnership. Our first discussion about the planet will take place in November 2022 and run for two hours. Interested students can complete the registration form on the Project 17 website to apply for an opportunity to hear from SDG advocates, learn from NGO leaders, and participate in breakout room discussions with youth leaders around the world. High school and college students based in any country are eligible to participate.

Project 17 discussion structure; photo courtesy Thea Louise Dai

In the span of four months, Project 17’s outreach efforts have reached 51 cities, 47 schools, and five different countries. Participants will build connections with students from different backgrounds and develop a global mindset by engaging with new perspectives. In addition, participants can contribute to asynchronous discussion boards and the Project 17 blog, receive bimonthly newsletters about the SDGs, and receive certified service hours eligible for the President’s Volunteer Service Award.

By incorporating these opportunities into our organization, we hope to create an experience similar to the invaluable experiences that Wendy and I had through the CSP and Stanford e-China. Inspired by SPICE’s impact, we are incredibly excited to start an initiative similarly promoting international and cross-cultural collaboration. Please note that Project 17 is not a Stanford SPICE program.

For more information, visit Project 17’s website (projectseventeen.org) or contact Project 17 at contact@projectseventeen.org.

The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite applications for a suite of fellowships in contemporary Asia studies to begin fall quarter 2023.

The Center offers postdoctoral fellowships that promote multidisciplinary research on contemporary Japan and contemporary Asia broadly defined, inaugural postdoctoral fellowships and visiting scholar positions as part of the newly launched Stanford Next Asia Policy Lab, and a fellowship for experts on Southeast Asia. Learn more about each opportunity and its eligibility and specific application requirements:

Postdoctoral Fellowship on Contemporary Japan

Hosted by the Japan Program at APARC, the fellowship supports research on contemporary Japan in a broad range of disciplines including political science, economics, sociology, law, policy studies, and international relations. Appointments are for one year beginning in fall quarter 2023. The application deadline is December 1, 2022.
 

This article was originally published in The Stanford Daily on August 22, 2022

Since then, Jensen said, the program has grown significantly, thanks to the generous support of Bill Draper and Ingrid von Mangoldt Hills, with even “more faculty who wanted to participate than we could accommodate.”

According to Fukuyama, Draper Hills has become an important forum for training democratic leaders around the world. 

“We try to provide a mixture of practical skills, networking tools and a stronger intellectual foundation so they can think about their future careers to determine the most strategically impactful way they can behave and act in the present,” he said.

In recent years, the program has shifted its focus toward technology, global warming, and poverty, which increasingly figure large roles in the fight for democracy, according to Jensen. Case studies, panels, and guest lectures from international experts fill the fellows’ three weeks on campus.

Outside of their classes in the Bechtel Center, the fellows tour San Francisco landmarks and enjoy group dinners hosted by the core faculty. In previous years, for example, fellows have visited local technology firms like Twitter, Google, and Facebook to explore “how democracies and autocracies can use technology to promote their goals,” Stoner said.

With help from the program, Draper Hills Fellows have consistently become leaders in law, politics, civil society organizations, and international development after graduation, with a growing alumni network of almost 400. Renchinnyam Amarjargalis, the former Prime Minister of Mongolia, was a fellow in 2005, along with other alumni who have risen to international prominence. 

Diamond added that the Foreign Affairs Minister of the government in exile of Myanmar, Zin Mar Aung, is also a former Draper Hills Fellow and has become “one of the most important leaders of the opposition in Burma fighting for democracy.”

The Draper Hills program gives its fellows more confidence and tools to see their work and struggles in a larger context, according to Diamond.

“Once you realize it’s part of a global pattern, you don’t feel that your national situation is quite so cursed,” he said. “You can draw strength from this solidarity and the sharing of experiences.”

Beyond the three weeks of the program, fellows remain connected to one another through on-campus gatherings, WhatsApp channels, and regional workshops around the world.

“As fellows, we are part of a very great network that always reminds us that, as activists for democracy and human rights, we are not alone,” said former Peruvian Minister of Education and current Draper Hills Fellow Daniel Alfaro. “There are others like us who are great fighters.” 

Participants, many of whom are already rising leaders in international democratic movements, are starting to see how valuable the program will be for their future work.

“Draper Hills has already expanded my horizons in terms of the roles that I can play in Mexican society to promote change, and provided many important allies and a network that can support these changes,” said current fellow Mariela Saldivar Villalobos, a Mexican activist and politician. “I feel deeply honored to have this opportunity. And I hope one day, Stanford will feel proud of investing its time and talent in me.”