Use of selected ambulatory dental services in Taiwan before and after global budgeting: a longitudinal study to identify trends in hospital and clinic-based services

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• 作者：Chienhung Lin (1)
  Hailun Chao (1)
  
• 关键词：Global budgeting ; National health insurance ; Taiwan ; Dental services
• 刊名：BMC Health Services Research
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：12
• 期：1
• 全文大小：352KB
• 参考文献：1. Cheng TM: Taiwan鈥檚 national health insurance. In / Republic of China 2000 Health Statistical Trends. Department of Health, Taiwan; 2002.
  2. Chang HJ: Taiwan鈥檚 national health insurance: overview and perspectives. In / Republic of China Health 2000 Health Statistical Trends. Department of Health, Taiwan; 2002.
  3. Kamke K: The German health care system and health care reform. / Health Policy 1998, 43:171鈥?94. CrossRef
  4. Hsueh YA, Lee SD, Huang YA: Effects of global budgeting on the distribution of dentists and use of dental care in Taiwan. / Health Serv Res 2004, 39:2135鈥?153. CrossRef
  5. Goozner M: Global budgeting: a viable alternative to fee-for-service health care? / The Fiscal Times 2010. http://www.thefiscaltimes.com/Columns/2010/02/18/Global-Budgeting-A-Viable-Alternative-to Fee-for-Service-Health-Care.aspz Accessed 15 Jul 2011
  6. Lu JFR, Hsaio WC: Does universal health insurance make health care unaffordable? Lessons from Taiwan. / Health Aff 2003, 22:77鈥?8. CrossRef
  7. Chang L, Hung JH: The effects of the global budget system on cost containment and the quality of care: experience in Taiwan. / Health Serv Manage Res 2008, 21:106鈥?16.
  8. Hsiao FY, Yang CL, Huang YT, Huang WF: Using Taiwan鈥檚 national health insurance research databases for pharmacoepidemiology research. / J Food Drug Anal 2007, 15:99鈥?08.
  9. Brown AD, Mellor AC, Main JR: A survey of patient perceptions of dental charge. / Prim Dent Care 1999, 6:151鈥?55.
  10. Oscarson N, K盲llestal C, Karlsson G: Methods of evaluating dental care costs in the Swedish public dental health care sector. / Comm Dent Oral Epidemiol 1998, 26:160鈥?65. CrossRef
  11. Brown LJ, Lazar V: Trends analysis of dental expenditures by selected dentist and practice characteristics, 1985鈥?995. / J Am Dent Assoc 1998, 129:1615鈥?621.
  12. Harris NO, Garcia-Godoy F: / Primary Preventive Dentistry. 6th edition. Pearson Prentice Hall, Upper Saddle River, NJ; 2004.
  13. Atchison KA, Mayer-Oakes SA, Schweitzer SO, Lubben JE, DeJong FJ, Matthias RE: The relationship between dental utilization and preventive participation amon a well-elderly sample. / J Pub Health Dent 1993, 53:88鈥?5. CrossRef
  14. Burt BA, Eklund SA: / Dentistry, Dental Practice, and the Community. 5th edition. WB Saunders, Philadelphia; 1999.
  15. Friedman JW, Atchison KA: The standard of care: an ethical responsibiity of public health dentistry. / J Pub Health Dent 1993, 53:165鈥?69. CrossRef
  16. Tsai WC, Kung PT, Chang WC: Influences of market competition on dental care utilization under the global budget payment system. / Community Dent Oral Epidemiol 2007, 35:459鈥?64. CrossRef
  17. Porter J, Coyte PC, Barnsely , Crawford R: The effects of fee bundling on dental utilization. / Health Serv Res 1999, 34:901鈥?21.
  18. Chen FJ, Laditka JN, Laditka SB, Xirasanar : Providers鈥?responses to global budgeting in Taiwan: what were the initial effects? / Health Serv Manage Res 2007, 20:113鈥?20. CrossRef
  19. Brennan DS, Spencer AJ: The role of dentist, practice and patient factors in the provision of dental services. / Community Dent Oral Epidemiol 2005, 33:181鈥?95. CrossRef
  20. P茅rez-N煤帽ez R, Vargas-Palacios A, Ochoa-Moreno I, Medina-Solis CE: Household expenditure in dental health care: national estimations in Mexico for 2000, 2002, and 2004. / J Pub Health Dent 2007, 67:234鈥?42. CrossRef
  21. Allison RA, Manski RJ: The supply of dentists and access to care in rural Kansas. / J Rural Health 2004, 23:198鈥?06. CrossRef
  22. Lee MC, Jones AM: How did dentists respond to the introduction of global budgets in Taiwan? An evaluation using individual panel data. / Int J Health Care 2004, 4:307鈥?26.
  23. Nguyen L, Hakkinen U: Choices and utilization in dental care: public vs. private dental sectors, and the impact of a two-channel financed health care system. / Eur J Health Econ 2006, 7:99鈥?06. CrossRef
  24. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/12/339/prepub
  
• 作者单位：Chienhung Lin (1)
  Hailun Chao (1)
  
  1. Department of Health Care Administration, Chung-Hwa University of Medical Technology, Tainan, Taiwan
  

文摘

Background 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. Methods 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. Results 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. Conclusions 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.