Abstract
BackgroundThe 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.MethodsThis 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.ResultsReimbursement 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.ConclusionsThe 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.
Highlights
The Taiwan government adopted National Health Insurance (NHI) in 1995, providing universal health care to all citizens
Number of high reimbursement procedures such as root canals, ionomer restoration, and tooth extractions increased while the number of low reimbursement amalgam restorations decreased
Results of the present study show that the number of dentists increased by 23.3% between 1996 and 2001 post-NHI and that more dentists did provide more services to more patients
Summary
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. The government has faced increasing challenges to control NHI expenditures. The government of Taiwan adopted National Health Insurance (NHI) on March 1, 1995 in order to provide universal health care to all its citizens. This comprehensive single-payer, fee-for-service health benefit coverage is financed by mandatory premium contributions made by employers and employees, and NHI-related tax revenues from the government. According to the Directorate General of Budget Accounting and Statistics, 2004, nominal per capita health expenditures increased seven-fold between 1980 and 2000, from NT$ 2,805 (New Taiwanese dollars) to NT$ 23,419, which, adjusted for general inflation amounted to a 69% increase
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