健保支付標準與醫師執業耗用資源 對牙科服務量之影響

Translated title of the contribution: The effects of BNHI payment rates and resource-input on the changes of dental service volume

陳琇玲, 溫信財, 楊志良, 黃文駿, 黃意婷, 徐慧娟

Research output: Contribution to journalArticle

Abstract

Objectives: There is considerable evidence indicating that physicians' behavior may be affected by economic incentives in the payment system. We investigated the relationship between price-adjusted and volume-increased under the consideration of resource-consumed in the dental practice. Methods: We evaluated 79 major dental procedures that were performed more than 1,000 times in the second half of both 1998 and 1999. The reimbursement for 13 of these procedures (designated price-adjusted procedures, PAP) was adjusted upward in 1999, while it remained the same for 44 procedures (designated price-unadjusted procedures, UAP). Using resource-input data from other research, we analyzed differences in service volume and total payment between PAP and UAP and the effects these had on dentists' behavior. Results: (1) Pearson's coefficients showed no significant correlation was found between price-adjusted and volume-increased, between price-adjusted and total payment-increased, and between the ratio of price-adjusted to the cost of physician work and the volume-increased. However, there was a significant correlation between the volume-increased rate and the price-adjusted rate, between the volume-increased rate and the physicians' real-income-adjusted rate, between the volume-increased rate and the ratio of price-adjusted to the cost of physician work, and between the price-adjusted rate and the total payment-increased rate (plt;0.05). (2) After excluding four procedures (2 each from PAP and UAP) which can be replaced by each other and whose change in volume was significantly affected by patient demand, we found the volume of 10 PAP (91%) increased in 1999, compared with 18 UAP (43%). All of the PAP had a higher payment-increased rate than the average, but only 11 UAP (26%) did. The total volume of PAP increased by 5% and of UAP by 1%. The corresponding increases in total payment were 5% and 2% due to the factor of "quantity". Conclusions: (1) Price-adjusted and volume-increased were not significantly correlated, but the price-adjusted rate and volume-increased rate were significantly correlated. (2) Excluding procedures replaceable by each other and influenced by patient demand, dentists increased the volume of PAP more than UAP, presumably to increase their revenue.

Translated title of the contributionThe effects of BNHI payment rates and resource-input on the changes of dental service volume
Original languageTraditional Chinese
Pages (from-to)17-26
Number of pages10
Journal台灣公共衛生雜誌
Volume21
Issue number1
Publication statusPublished - 2002

Keywords

  • Dentist
  • Payment scheme
  • Physician behavior
  • Resource-input
  • Service volume

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Fingerprint Dive into the research topics of 'The effects of BNHI payment rates and resource-input on the changes of dental service volume'. Together they form a unique fingerprint.

  • Cite this