title: 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.
abstract: 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.
authors.affiliation: Department of Health Care Administration, Chung-Hwa University of Medical Technology, Tainan, Taiwan.
authors.forename: Chienhung
authors.initials: C
authors.lastname: Lin
authors.forename: Hailun
authors.initials: H
authors.lastname: Chao
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D002017:Budgets; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D012051:Reimbursement Mechanisms; D013624:Taiwan