{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:38:58Z","timestamp":1786451938270,"version":"build-2736575974"},"reference-count":48,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,14]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the evolution of public dental expenditures, reimbursement standards and policy shifts between Taiwan\u2019s National Health Insurance (NHI) Global Budget system and Organisation for Economic Co-operation and Development (OECD) countries from 2010 to 2025, and to evaluate the sustainability implications as Taiwan transitions into a super-aged society.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Longitudinal comparative policy analysis using interrupted time-series (ITS) and panel data regression with fixed effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>National-level dental healthcare systems across Taiwan and 38 OECD member countries. Data sources included the OECD Health Statistics database (2010\u20132025)\u2009and Taiwan Ministry of Health and Welfare (MOHW) NHI Administration annual reports and reimbursement fee schedules (2010\u20132025). Financial data were adjusted using healthcare-specific Purchasing Power Parity (PPP) and Consumer Price Index (CPI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcomes: dental expenditure as percentage of Gross Domestic Product (GDP), per capita dental spending (PPP-adjusted), and real reimbursement value for standardised procedures (full-mouth scaling, composite filling, molar root canal treatment, simple extraction). Secondary outcomes: proportion of preventive vs restorative expenditure, point-value volatility in Taiwan\u2019s global budget system and policy intervention effects on expenditure trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2010 and 2025, Taiwan maintained dental expenditure at 0.52%\u20130.68% of GDP, significantly below the OECD average of 0.89%\u20131.08% of GDP (approximately 5%\u20137% of total health expenditure). Per capita dental spending in Taiwan grew from PPP$145 (2010) to PPP$198 (2025), compared with OECD average growth from PPP$289 to PPP$412. PPP-adjusted reimbursement analysis revealed that Taiwan\u2019s compensation for complex procedures (molar endodontics) represented only 35%\u201337% of levels in Japan and Germany. ITS analysis detected a statistically significant immediate decline in dental claims volume following COVID-19 onset (Q2 2020; p&lt;0.001). The 2025 super-aged society transition is assessed descriptively only (geriatric budget share: 8.2% in 2024 to 11.5% in 2025); formal ITS slope inference requires at least three post-intervention years of data. Panel regression demonstrated that global budget constraints created inverse relationships between service volume and unit reimbursement value (elasticity coefficient: \u22120.76, 95%\u2009CI \u22120.91 to \u22120.61, p&lt;0.001). The preventive care proportion in Taiwan increased from 18.3% (2010) to 26.7% (2025), but remained constrained by budget ceiling rigidity, exhibiting lower growth rates than comparator OECD nations (slope difference: \u22121.2\u2009percentage points\/year, p=0.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Taiwan\u2019s Global Budget system appears to achieve strong cost-containment and high accessibility, though this may rely partly on implicit labour-cost subsidies from dental professionals. As demographic ageing accelerates, the current volume-based payment model may face growing sustainability pressures. Exploring value-based reimbursement, guaranteed point-value floors for complex treatments and expanded geriatric dental benefits could help support equity and quality of care in the post-2025 era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119013","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:05:31Z","timestamp":1786449931000},"page":"e119013","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Decades of dental care evolution: a cross-national comparative study on public dental expenditures and policy shifts in Taiwan and OECD Countries (2010\u20132025)"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0574-4220","authenticated-orcid":false,"given":"Kuan-Yu","family":"Chu","sequence":"first","affiliation":[{"name":"Department of Stomatology, Taipei City Hospital Renai Branch, Taipei City, Taiwan"},{"name":"School of Dentistry and Graduate Institute of Dental Science, College of Oral Medicine, National Defense Medical University, Taipei, Taiwan"},{"name":"Department of Health and Welfare, University of Taipei, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081105051480000_16.8.e119013.1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)31146-8"},{"key":"2026081105051480000_16.8.e119013.2","doi-asserted-by":"publisher","DOI":"10.1177\/0022034515602879"},{"key":"2026081105051480000_16.8.e119013.3","unstructured":"OECD . 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