Impacts of Dental Global Budgeting Under National Health Insurance on the Distribution of Health Resources

[[abstract]]目標：許多研究均證實總額預算支付制度能有效控制醫療花費的成長，但是否能促進資源的平均分配則未有定論。本研究以牙醫師人力、民眾就醫診次及醫療費用等三項牙醫醫療資源指標分部的變動，評估全民健保實施牙醫總額預算制度是否促進牙醫醫療資源的均勻分布。方法：以衛生統計、台閩地區人口統計及健保資料庫申報總檔等資料，運用Lorenz曲線及其Gini係數作為衡量醫療資源資源分布不均勻程度的指標，採用時間數列之介入分析模式，評估開辦總額預算制度前後Gini指標的變動，並與中醫進行對照比較。結果：牙醫總額預算實施後，三項醫療資源分布不均指標顯著下降，依據研究分析結果，本研究認為總額預算制度可能具有促進醫療資源均勻分布之效果。結論：總額預算制度除了可控制醫療費用總量的上漲外，因支付制度之影響使得內部結構進行調整，似乎亦具促進醫療資源均勻分布效果，若在醫療品質得以確保的情況下，應可逐步推展。 Objectives: Many studies have indicated that global budgeting can control medical expenses to some extent; nevertheless, whether global budgeting can improve health resources distribution is still unclear. This study attempts to evaluate whether NHI’s implementation of dental global budgeting has improved the equality of health resources distribution. Method: The Lorenz curve and Gini coefficient were used to analyze the degree of inequality of health resources distribution. The intervention analysis, based on time series data was employed to identify the potential impact resulted from the policy of global budgeting. Results: After the implementation of dental global budgeting, the inequality of three health resources distribution measured by Gini coefficients has dropped dramatically. The result reveals that global budgeting could have improved the equality and accessibility of health resources distribution. Conclusions: Previous studies have pointed out that the implementation of global budgeting could control the increase in medical expenses. This study examined the new payment system from another angle, and found that it could cause the structural change of dental industry and led to some adjustments of dental practice, which have potentials to enhance equalizing the health resources distribution. As a result, when the quality of dental care is assured, the global budgeting reimbursement system could be adopted to enhance the equalization of health care resources distribution