Department of Health Care Administration, Chung-Hwa University of Medical Technology, Tainan, Taiwan.
BMC Health Serv Res. 2012 Sep 25;12:339. doi: 10.1186/1472-6963-12-339.
The Taiwan government adopted National Health Insurance (NHI) in 1995, providing universal health care to all citizens. It was financed by mandatory premium contributions made by employers, employees, and the government. Since then, the government has faced increasing challenges to control NHI expenditures. The aim of this study was to determine trends in the provision of dental services in Taiwan after the implementation of global budgeting in 1998 and to identify areas of possible concern.
This longitudinal before/after study was based on data from the National Health Insurance Research Database from 1996 to 2001. These data were subjected to logistic regression analysis. Linear regression analysis was used to examine changes in delivery of specific services after global budgeting implementation. Utilization of hospital and clinic services was compared.
Reimbursement for dental services increased significantly while the number of visits per patient remained steady in both hospitals and clinics. In hospitals, visits for root canal procedures, ionomer restoration, tooth extraction and tooth scaling increased significantly. In dental clinics, visits for amalgam restoration decreased significantly while those for ionomer restoration, tooth extraction, and tooth scaling increased significantly. After the adoption of global budgeting, expenditures for dental services increased dramatically while the number of visits per patient did not, indicating a possible shift in patients to hospital facilities that received additional National Health Insurance funding.
The identified trends indicate increased utilization of dental services and uneven distribution of care and dentists. These trends may be compromising the quality of dental care delivered in Taiwan.
台湾政府于 1995 年推行全民健康保险（NHI），为所有公民提供全民健康保险。它由雇主、员工和政府共同缴纳的强制性保费来资助。从那时起，政府在控制医疗保险支出方面面临越来越多的挑战。本研究旨在确定 1998 年实施全球预算后台湾牙科服务提供的趋势，并确定可能关注的领域。
这项纵向的前后研究基于 1996 年至 2001 年国家健康保险研究数据库的数据。这些数据经过逻辑回归分析。线性回归分析用于检查全球预算实施后特定服务的提供变化。比较了医院和诊所服务的利用率。
在全球预算实施后，牙科服务的报销显著增加，而每位患者的就诊次数保持稳定，无论是在医院还是诊所。在医院，根管治疗、离子体修复、拔牙和牙齿洁治的就诊次数显著增加。在牙科诊所，汞合金修复的就诊次数显著减少，而离子体修复、拔牙和牙齿洁治的就诊次数显著增加。在采用全球预算后，牙科服务的支出大幅增加，而每位患者的就诊次数没有增加，这表明患者可能转向获得额外国家健康保险资金的医院设施。
确定的趋势表明牙科服务的利用率增加，护理和牙医的分布不均。这些趋势可能会影响台湾提供的牙科护理质量。
