Decades of dental care evolution: a cross-national comparative study on public dental expenditures and policy shifts in Taiwan and OECD Countries (2010-2025).

objectiveTo compare the evolution of public dental expenditures, reimbursement standards and policy shifts between Taiwan's 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.

designLongitudinal comparative policy analysis using interrupted time-series (ITS) and panel data regression with fixed effects.

settingNational-level dental healthcare systems across Taiwan and 38 OECD member countries. Data sources included the OECD Health Statistics database (2010-2025) and Taiwan Ministry of Health and Welfare (MOHW) NHI Administration annual reports and reimbursement fee schedules (2010-2025). Financial data were adjusted using healthcare-specific Purchasing Power Parity (PPP) and Consumer Price Index (CPI). PRIMARY AND SECONDARY OUTCOME MEASURES: 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's global budget system and policy intervention effects on expenditure trends.

resultsBetween 2010 and 2025, Taiwan maintained dental expenditure at 0.52%-0.68% of GDP, significantly below the OECD average of 0.89%-1.08% of GDP (approximately 5%-7% 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's compensation for complex procedures (molar endodontics) represented only 35%-37% 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<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: -0.76, 95% CI -0.91 to -0.61, p<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: -1.2 percentage points/year, p=0.003).

conclusionsTaiwan's 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.