Abstract
Emergency medical service (EMS) plays a critical role in reducing mortality and mitigating the consequences of emergency health conditions. Despite their importance, EMS systems often encounter
accessibility challenges. In Thailand, a decentralization policy has been introduced, including transferring
the function of provincial EMS dispatch center from provincial hospital of Ministry of Public Health (MoPH)
to the provincial administration organization (PAO). This policy aims to enhance responsiveness and accountability to local government. This study investigated the patients’ perspective on quality of EMS
from exploring the experiences, satisfaction and level of confidence in EMS between decentralized and
status-quo provinces. Our findings indicated a statistically significant reduction in EMS utilization rates in
the transferred dispatch provinces (transferred: 32.7%; non-transferred: 47.5%; p = 0.01). Furthermore,
public confidence in future EMS uses was notably lower in the transferred provinces (transferred: 72.5%;
non-transferred: 83.1%; p = 0.01). Despite these differences, no significant variation was observed in the
satisfaction on operational performances of dispatch centers, ambulance services, and hospital emergency departments across the two groups. These findings highlighted persistent challenges in EMS provision under PAO governance, likely due to the differences of service delivery design and governance
mechanisms between units under MoPH and under local administration. The results underscored the
need for strengthened collaboration between the National Institute of Emergency Medicine (NIEM) and
local governance bodies to address these challenges realizing the full potential of decentralization. Such
efforts would optimize EMS delivery in accordance with local health priorities ensuring equal access to
high-quality emergency care across Thailand.
