Financing policy, service distribution and abstinent outcomes of Taiwan Cessation Treatment Services in primary care
 
Chih-Kuan Lai, M.D., M. Sc.
 
Department of Family Medicine, Taipei Veterans General Hospital
 
Introduction:
Since September 2002, Taiwan has funded a nationwide Taiwan Cessation Treatment Service (TACTS) by the cigarettes surtax to offer behavioral counseling and pharmacotherapy for adult smokers intending to quit. This service initially covered physician counseling and reimbursed pharmacotherapy 250 TWD/week with a copayment ranging from 150 to 800 TWD/week for a maximum of 8 weeks. A novel subsidizing program –Smoking Cessation Payment Scheme-2 (SCPS-2) was introduced in Mar 2012, markedly reducing the out-of-pocket payment to less than 20% of medication cost. Additionally, the government implemented a series of tobacco control policies during this period, including stepped upturn of cigarette surtax (10 and 20 TWD per pack in Feb 2006 and Jun 2009 respectively) and stricter legislation of smoke-free public place (Jan 2009). This study aimed to explore the distribution and long-term cessation outcome of the TACTS with adjustment of possible confounders.

Material and Methods:
This study used TACTS Dataset, a secondary dataset including claim data of all enrollees as well as telephone follow-up surveillance of cessation status for a random sample between Sep 2002 and Dec 2014. The follow-up sample was composed of randomly selected 600-700 subjects per month, whose self-reported 7-day point prevalence abstinence (PPA) at 6 months was used for analysis. We employed multiple imputation for those subjects with missing variable of abstinent outcome.

Results
There were 5,216 physicians, including 2,924 (58.3%) primary care physicians, eligible to provide TACTS at the end of 2014. A total of 611,814 adult smokers attempting to quit have received cessation service between Sep 2002 and June 2014. Most of them (98.6%) received pharmacotherapy. In average, the total duration of anti-smoking medications dispensed by each participant increased from 2.3 weeks in 2002 to 4.1 weeks in 2014. After imputation, the 6-month PPA significantly increased from 22.8% (95% CI: 21.9%-23.7%) in 2003 to 28.0% (95% CI: 27.1%-28.9%) in 2014. The SCPS-2 was a positive factor promoting cessation treatment utilization and long-term abstinence outcome among adult smokers

Conclusion
Primary care plays an important role providing cessation treatment service to adult smokers intending to quit. Reducing out-of-pocket payment is a critical strategy to recruit more attempted smokers to receive effective treatment and in turn enhances the abstinence outcome. ​