Abstract
Background: Transferring the mission regarding primary care services at Chaloem Phrakiat Health Center (CPHC) and the Tambon health promoting hospital (THPH) to the local government organization (LGO), resulting in fairness, equity and equality. The mechanism for allocating resources and budgets with primary care is one of the keys to transforming the health care system for reducing inequitable accessibility to health care services. Objectives: 1) to study the situation of health insurance fund management and expenditure allocation for public health services from the health insurance fund of the contracting unit for primary care (CUP) to CPHC and THPH 2) To compare the proportion of expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH 3) to develop the policy recommendation on health insurance fund management and expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH. Methods: This study was a mixed method research under provider perspective that considers a top-down approach that includes tangible costs and intangible costs of the CUP to CPHC and THPH in the fiscal year of 2022. The four study sites were included in this study based on purposive sampling of the CUP with two of CPHC or THPH those has been transferred to the LGO during 2008 and 2012 and two of those do not transfer. The process of this study consisted of 3 steps; step 1, we conducted in-depth interview of 16 key informants and content analysis was employed, step 2, we compared the proportion of expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH and step 3 we developed the policy recommendation on health insurance fund management and expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH. Results: 1) The allocation models depend on the agreement of the District Coordinating Committee. There are various of allocation models regarding to the context of the CUP. The National Health Security Fund budget has a form of money allocation. The expenses of pharmaceutical, non-pharmaceutical supplies and equipment were included in the Outpatient (OP) budget and the payment was a Fixed cost. Most of the CUP allocated the OP budget regardless to the number of health care service output provided by the CPHC and THPH. While the P&P budgets were allocated based on the number of health care service output provided by the CPHC and THPH. However, there are some studied sites those allocate the P&P budget regardless to the number of health care service output provided by the CPHC and THPH. For other health insurance funds, the allocation models depend on the context of each health insurance funds. 2) The proportion of expenditure allocation (in cash: in kind) for public health services from the health insurance fund of the CUP to the CPHC and THPH and the transferred CPHC and THPH were 73.05:26.95 and 54.78:45.22, respectively. The ratio of expenditure allocated (in cash: in kind) to the CPHC and THPH was 2.23 times compared to the transferred CPHC and THPH. The highest expenditures were for providing OP and P&P (UC) services. The OP and P&P (UC) expenses of the CPHC and THPH and the transferred CPHC and THPH were 1,5085,019.85 Baht (95.35%) and 6,670,911.35 Baht (93.03%), respectively. The proportion of per capita budget for providing OP and P&P (UC) those allocated to the CPHC and THPH were higher than to the transferred CPHC and THPH. The global budgets cover the cost for providing public health services of the CPHC and THPH and the transferred CPHC and THPH were come from the same source which were ranged between 50.32% and 52.52%. Labor costs were the highest cost covered by the global budgets (51.57%-65.27%). Material costs were the highest cost covered by the maintenance budgets (67.99%-70.10%) followed by the expenses from the CUP (22.27%-29.49%). The cost of treatment activities provided by the physicians were ranged from 0 Baht (no activity) to 319.34 Baht. Finally, the cost of treatment activities provided by other health care personnel were ranged from 27.27 Baht to 1,454.48 Baht. 3) Management and budget allocation model for public health service should be sufficiently allocated to any kind of services in health center and health promotion hospital which should include those did not transferred and transferred hospital to subdistrict and provincial administrative organization. This is for the fairness of the allocation option 1, in case that the original Contracted unit of Primary care (CUP) (no paid) in the context of editing Ministry of Public Health’s maintenance allowance. Option 2, in the case that original CUP (no paid) with directly allocated to health promotion hospital in the context that no editing of Ministry of Public Health’s maintenance allowance. Option 3, in the case that new CUP (With paid) with the directly allocate to health promotion hospital.
