Abstract
This was the developing policy proposals to improve the efficiency of the Local Health
Insurance Funds after transferring the mission of the sub-district health promoting hospital to
the Provincial Administrative Organization that was research and development. The target
group included those involved in fund management, fund service providers, and fund
recipients. Between May of 2023 to May of 2024, both quantitative and qualitative data were
gathered. The results were summarized as follows.
Firstly, it was discovered that the local health insurance fund's readiness was at
a moderate level of 4.95 (full score of 7 points), both before and after the sub-district health
promotion hospital's mission was transferred. Additionally, the structure of the fund was
determined to be devoid of the district and province level monitoring and evaluation systems.
Secondly, the situation and effects of the Sub-district Health Fund following the task transfer
revealed a significant decline in the budgetary allotment (p value <.001). Also, the sub-district
health promotion hospital's budget allocation percentage showed a statistically significant
decreased from the average amount (p value <.001). However, it was found that the efficiency
of the fund's budget expenditure increased with significance (p value <.001), with the
proportion of the remaining budget decreasing statistically significant (p value <.001).
Nevertheless, it was unclear how the fund's efforts to prevent diseases and promote health
had effectively performed in practice.
Thirdly, following the transfer of the sub-district health promotion hospital mission,
the situation and impact of the Long-Term Care System Fund found that the budget of the
fund declined statistically (p value <.001), and the care plan produced after the transfer also
showed a statistically significant decrease (p value <.001). While the efficiency of the budget
expenditure had increased statistically significant (p value <.001), with a statistically significant
decrease in the proportion of the budget (p value <.001). Furthermore, it was showed that
the primary problems with the long-term care system fund were the quantity of care managers
and caregivers, along with fictitious budget disbursement limitations and the absence of
multidisciplinary team visits. Lastly, the main problems with the Rehabilitation Fund's coverage
and accessibility were investigated, revealing that two out of five provinces were unable to
offer services. However, the sub-district health promotion hospital's mission transfer presented
an opportunity to further expand the network of the fund.
As a results, the integrated model of the local health insurance fund and the provincial
health model were the two models created of this study. These models led to the formulation
of policy recommendations to enhance the effectiveness of the health insurance fund locally
following the transfer of the sub-district health promoting hospital's mission. These
recommendations included reorganizing the fund committee and regulations, creating a
system for monitoring and evaluation, developing an information database system for the
fund, and building the potential of those in charge of funds and care managers.
