Abstract
Background: Decentralization plan and Action plan of local government organization (LGO) indicate that the Office of the Permanent Secretary Ministry of Public Health (MoPH) transfers the mission regarding primary care services at Chaloem Phrakiat Health Center (CPHC) and health promotion hospital (HPH), in which the transfer should be transparent in terms of fiscal management, equity, and equality. Objectives: 1) to explore the present situation and pattern of the financial management between CPHC and HPH and public insurances, and possible patterns in the future; 2) to propose practical guidelines concerning the financial management for CPHC and HPH after transferring to the LGO, together with comparing subsequential impacts respecting to different public insurances; and 3) to develop recommendations for public insurances regarding budget allocation to CPHC and HPH after transferring to the LGO. Methods: A qualitative research to explore the pattern of financial management was conducted from the provider and healthcare payer perspectives, including both government subsidy budgets, non-government subsidy budgets, and budgets from other sources. The process consisted of 3 steps: 1) we explored the present situation and pattern of the financial management between CPHC and HPH and public insurances, and possible patterns in the future, by interviewing 48 stakeholders. Content analysis was performed afterward; 2) we proposed practical guidelines concerning the financial management for CPHC and HPH after transferring to the LGO, together with comparing subsequential impacts respecting to different public insurances, by analyzing research documents in respect to concepts and theories relating to budget allocation after decentralization; and 3) we developed recommendations for public insurances regarding budget allocation to CPHC and HPH after transferring to the LGO, using the content analysis technique. Results: 1) Health service provisions of CPHC and HPH were financed by many insurances, with the biggest contribution from the National Health Security office (NHSO). Budgets from each insurance were managed following to the regulation of the respective source. For example, the condition to allow/ not allow to use budgets for the purposes of particular activities, pharmaceuticals/non-pharmaceuticals, employment, and personnel work support in CPHC and HPH. This depends on the financial status of the service providers or contracting hospitals. 2) Suggestions for budget allocation should be divided into 2 phases. For the early phase, CPHC and HPH should deal with the current contracting hospitals to transfer budgets due to the flexibility of management and the economy of scale. Experiences from CPHC and HPH, which were already transferred to LGO several years ago, shows the consistent connection with the previous contracting hospitals; this is to minimize the effect of decentralization action to the patients during the first phase. For the late phase, there should consider finding the contracting providers under LGO to improve management flexibility in the long run. Nonetheless the selection of contracting providers should not affect access to healthcare of the patients in the area. 3) Recommendations for managing per-capita-payment for health services during the transition, MoPH should provide support to the transferring units to LGO pertaining to the regulations of how to use subvention. Supports for pharmaceuticals/non-pharmaceuticals should consider the purpose to provide services to the patients. Regarding the employment, LGO may be considered as the funder role.
