Abstract
Banpaew Hospital, located in Samut Sakorn province, was the First Autonomous Public Hospital on October 1, 2543. The hospital charged 40 baht each for outpatient visit and 100 baht for inpatient services. A study should then be conducted to identify population in health impact in Ampur Banpaew. The purpose of this study was to figure out the changes in health status, attitudes, awareness, healthcare behavior, social and environmental factors, and any other changes regarding to the use of Autonomous Public Hospital services. The study will be compared the changes before and after became an autonomous public hospital using Quasi experimental Stratified Multistage Sampling method was used to sampling the area, Banpaew consists of 12 tambons divided into two stratus: municipal area and non-municipal area. Within each area, a random of village (moo-baan) was selected and, within each village, 40 households were randomly picked for the total of 1,000 households, with an average number of 4-6 members per each household. The total of 4,485 head of household both male and female participated in the study. The data was collected through interviews and observation of household status, environments, and its members. The research in conducted twice. The initial survey was performed after one year of Autonomous hospital during March to April 2001. The second survey in the same area was done form August to September 2002. But in October 2001, the government has launched policy of 30 baht for every disease was in effect in Samut Sakorn province. The results from both survey periods are at satisfactory level in all aspects. Due to the changes in public health system that occurred during the second study period, which charges 30 baht for both outpatient and inpatient services, the medical supplies and medicines (that cannot be claimed) expenses averaged significantly lower than the first study period. Those who attended the hospital services as inpatients and outpatients were more satisfied with the quality, effectiveness, and its staffs than the first study period (p<.05). As for the aspect of health insurance cards for household members, during the second study period, 95 percent went to either public hospitals of health centers when they become sick, due to the 30 baht for all disease policy, in comparison to only 49 percent during the first study period. The overall population health status was in a good to excellent level. The findings from both study periods found that those patients were mostly seniors of 60 years and older with diabetes, high blood pressure, and joint diseases. The study also found that there were more of them in the second study period than the first one (P<0.5) because there are more public health personnel to go visiting with households and giving advice and suggestions to the community, in addition to the public increased interests of better health awareness. However, this is only the beginning phase of the study covering the period of two years. After the status change of Banpaew Hospital along with the 30 baht for every disease policy, which was first introduced in October 2001, a longer-term study of 4-5 years should be conducted in order to yield more accurate estimates and results.
