Establishing the Resource-Based Relative Value Scale (RBRVS) of Taiwan Dental Services and its Appropriateness Assessment

• Main Authors: Hsiu-Ling Chen, 陳琇玲
• Other Authors: 楊銘欽
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/16174039792743817570

博士 === 國立臺灣大學 === 醫療機構管理研究所 === 94 === Objectives: The objectives of this dissertation is trying to construct a dentistry RBRVS model in Taiwan based on the American Resource-Based Relative Value Scale (RBRVS) method and to examine the appropriateness of our model. Methods: A group of 360 dentists were randomly selected from the national roster of dentists and were asked to participate in the Delphi Technique to estimate dentists’ workload relative value units (RVUs) and procedural time for representing services. We also examined the drugs and materials costs for these services from 4 sample dentistry clinics. We then asked the Technical Consulting Group (TCG) to estimate the dentists’ workload RVUs, procedural time, and drugs and materials costs RVUs for un-surveyed services. By combining the dentistry clinic cost structure investigated with the National Health Insurance (NHI) dental payment schedule and services volume, we adjusted these three kinds of RVUs into a common scale and set up the D-RBRVS for 79 dental services. The appropriateness of our model was evaluated by the following 5 methods: 1) evaluating by the TCG experts, 2) exploring the association between D-RBRVS and the dental ABC cost in a medical center, 3) examining the coverage of the 79 services of our studies to the whole dental services, 4) analyzing the correlation and explanation power of D-RBRVS to the NHI dentistry payment schedule, 5) studying the adjustment of the payment standards in our D-RBRVS base. Results: Three RVUs for dentist''s workload, procedural time, and drugs and materials costs for 79 services and the cost structure of the dentistry clinic were constructed. By using the model of this study, the RBRVS for 79 dental services were established according to these results. In terms of the appropriateness of this model, the views of the TCG and the ABC cost in a medical center were significantly associated with our D-RBRVS. The high coverage, relativity, and explanation power of 79 services to the NHI payment schedule also show the appropriateness of the model. Finally, the converting of the D-RBRVS into a payment schedule supports that the Taiwan dentistry RBRVS model is appropriate. Conclusions: 1) By using of TCG, Delphi method, and extrapolation techniques to study the RBRVS of dental service, we have set up a local dentist’s workload RVUs, the procedural time, and the drugs and materials costs RVUs for 79 dental services. It is better to establish the list of drugs and materials used for each service by a TCG and to investigate the specific costs required through the cooperation of dentistry clinics. It is nearly 50% for dentist’s fee, 15% for drug and material cost, and 35% for other practice cost of the dentistry clinic cost structure in Taiwan. The research model is appropriate to study the resource consumes RVUs of the dentistry services. 2) The current NHI dental fee schedule fairly well matched with the D-RBRVS of our study. 3) The D-RBRVS can be converted into a payment scheme to provide an amendment reference of NHI payment standards.