<p>About 339&#xa0;million people worldwide have asthma, and its prevalence is increasing. The asthma pay-for-performance (P4P) program was implemented, but the effectiveness of P4P programs is still controversial. The study evaluated the relationship between participation in the pay-for-performance (P4P) program and emergency service utilization and hospital admission utilization among asthma patients. This population-based cohort study included those who were newly diagnosed asthma patients from 2011 to 2016 and were followed until the end of 2018. The data were from the National Health Insurance Database of Taiwan. A propensity score matching method was applied to match asthma patients who joined the P4P program to non-P4P patients, ratio 1:1. The Cox proportional hazards model was applied to analyze the relationship between P4P participation status and emergency service utilization and hospital admission utilization. We also conducted alternative analysis using Poisson regression. After matching, 73,117 people who joined and 73,117 who did not join were included for analyses. It was found that asthma patients who joined P4P had a lower risk of emergency service utilization than those who did not join P4P (HR = 0.57, 95% CI = 0.55–0.59). We also found that asthma patients enrolled in the P4P program had a significantly lower risk of hospital admission utilization (HR = 0.58, 95% CI = 0.54–0.62). The Poisson regression analysis showed a high level of consistency with the results mentioned above. Our data showed that participation in the P4P program was associated with emergency service utilization and hospital admission utilization among asthma patients.</p>