Abstract
The incident that the National Health Security Office (NHSO) terminated primary care contracts with the private clinics, so called “Ob-Oon” community clinics, around the end of the fiscal year B.E.2563 as a result of suspected frauds raises a key question if there is any system solutions to correct and prevent a similar incident in the future. This report, therefore, aims to analyze how Ob-Oon community clinics are managed under the NHSO system and propose options for future management. Mixed qualitative research methods over the period of two months were applied, including literature and document reviews and a modified focus-group discussion organization by the Health Systems Research Institute. It is found that participation of the private sector in providing healthcare under the universal coverage scheme (UCS) has been there and developing almost since the beginning of the scheme. Having Ob-Oon community clinics contributed to increasing healthcare access in the Bangkok area. However, other areas of performance, including quality of care and satisfaction, were not as impressive. In addition, there lacked continuous systematic monitoring and evaluation of the private-sector participation, resulting in shorting of information needed for thorough investigation of advantages and disadvantages of the roles of the clinics as key primary care providers in the Bangkok area. There are three possible system management solutions proposed by the study: Solution # 1: Cancel all private sector participation in the UCS as Ob-Oon community clinics; Solution #2: Allow private Ob-Oon community clinics to become full-scale main primary-care providers; Solution #3: Only permit private Ob-Oon community clinics to be network primary-care providers, given the “free-provider choice” policy In considering preferred solutions, the following set of criteria were used: (1) Support for achievement of the balancing and competing goals of universal health coverage, including accessibility of primary care, cost containment and resource efficiency, quality improvement of healthcare and services, and choice; (2) Execution possibility, based on availability of primary care providers, financial and service network management, Information technology, governance and civic participation, and support for future learning and service innovation. Based on the criteria, the most preferred solution is the combination of Solution #2 and Solution #3 as shown in detail in Table 6.4. Nevertheless, there are certain actions that need to be done regardless of which of the solutions for primary care in the Bangkok area is selected. These include the use of the information technology system to enhance capabilities in service arrangement and management, Utilization review by NHSO, Regional 13 Bangkok office, development of the indicator system for key primary care performance along with health management for information system that allow feedbacks to providers and area managers for performance review and improvement, area-based knowledge management to support the development of primary-care service network, review and design for area-based collaborative management platform for planning and improvement of health services and patient referral to ensure quality primary care for all regardless of their registered providers, review and improvement of provider costing and payments based on service requirements and service targets including value-base healthcare programs, urgent review and planning to enhance capabilities of referral centers in Bangkok, and effective implementation of monitoring and evaluation of progress and accomplishment of all operational plan.
