| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 91 === The purpose of this study is to evaluate if the implementation of the Dental Global Budget System, which had been put into practice since July 1998, increased the possibility of shifting children and delaying treatment, which will lead to decrease children’s access and equity of dental care utilization. The data of this study are from two sources: the National Health Insurance research database and Demographic fact books published by Ministry of the Interior from 1996 to 2001. By using trend graphs and Random Coefficient Models, this study analyzes the changes of dental care utilization rate, average dental visits per person, ratio of visits clinics shared, and average expenditure per visit of hospitals and clinics.
There are two main results in this study. The first result is about the possibility of shifting children. The ratio of clinical visits for preschool-aged children decreased noticeably after implementing the Dental Global Budget System, and the younger the children are, the more degree of the decreasing ratio is. It indicates that younger children had greater possibility of being shifted by clinical dentists. Otherwise, each branch of National Health Insurance Bureau had the same trend, but there was slightly difference between them. However, the dental care utilization rate and average dental visits per person still grew after implementing the Dental Global Budget System, the phenomenon of shifting younger children may indicate that in the much dental service providing for children after implementing the Dental Global Budget System, the ratio of quantity clinics shared had the decreasing trend, and then shows the reducing inclination of clinical dentists to treat younger children.
The second result is about the possibility of delaying treatment for children. Because of the adjustment of payment level, it can be demonstrated based on the greater growth of average expenditure per visit in hospitals than in clinics after implementing the Dental Global Budget System, that children whose age between 0 and 3 seemed to have the possibility to receive delayed treatment. There were the same trends in Taipei, Northern, Southern and Kao-Ping branches, but Central and Eastern branches had different trend. Clinics in Central branch had greater growth of average expenditure per visit than hospitals after implementing the Dental Global Budget System. The phenomenon above might be caused by vicious competition, which is due to lack of trust between dentists. In addition, the implementation of the Dental Global Budget System just provided dentists the incentive to go to the region where there was not sufficient medical resource for practicing. Therefore delayed treatment was not common in Eastern branch.
In conclusion, the implementation of the Dental Global Budget System could have negative impacts such as reduction of children’s access to dental care, which was caused by inappropriate planning and implementation of the system. For instance, the distribution of global budget did not protect vulnerable population (such as children) and did not consider the suitable disposition of budget between hospitals and clinics; the somewhat unreasonable level of payment and unit of payment could not control and manage dentists’ behavior effectively; the numerous and complicated internal regulations of each region might result in the difference of the quality and quantity of dental care. Hence, it is necessary that authorities have to take vulnerable population’s rights and the ratio of budget between hospitals and clinics into consideration when designing the Global Budget System. The other suggestions are to introduce capitation for unit of payment, which can decrease the possibility of reducing necessary service, and to establish common norm for internal regulations. Therefore, the benefits of implementation the Global Budget System can be maximized when public’s access and equity of health care are under protection.
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