Abstract
The satisfaction of clients with services provided by Tambon Health Promoting
Hospitals (THPs) transferred to the Provincial Administrative Organizations (PAOs) research
project aimed to follow up and evaluate the outcomes after the transfer of these hospitals.
The objectives of the research were to compare service performance, service expectations,
disconfirmation, service satisfaction, health outcomes based on indicators of the THPs
transferred to PAOs and the ones under the Ministry of Public Health (MoPH). The study also
investigated the relationships between service performance, expectations, disconfirmation,
health outcomes, and service satisfaction, according to the type of THPs under the PAOs and
the MoPH in a sample group of 10,435 people across 16 provinces.
The data analysis revealed that the majority of the sample had high service
expectations (n = 3,185, 30.52%) and perceived service performance as good (n = 4,168,
39.94%). Approximately one-third of participants reported positive disconfirmation (n = 3,166,
30.34%). Half of the participants rated service satisfaction at a high level (n = 5,603, 53.69%).
There was a statistically significant difference in service expectations between the two types
of hospitals (U = 9,045,733.5, Z = -8.373, p < .001), with expectations being lower for THPs
transferred to PAOs (M = 5,081.00) compared to those under the MoPH (M = 5,635.96).
In terms of service performance, the two groups also showed a statistically significant
difference, with performance being lower in THPs transferred to PAOs (M = 5,090.73) compared
to those under the MoPH (M = 5,606.29, U = 9,122,151.5, Z = -7.904, p < .001). When
comparing disconfirmation and service satisfaction, no significant differences were found
between THPs transferred to PAOs and those under the MoPH. When considering the transfer
percentage groups of THPs that were transferred to the jurisdiction of PAOs, significant
differences in expectations, perceived performance, disconfirmation, and service satisfaction
were observed among the areas with 100% transfer areas with 50–99% transfer and areas with
less than 50% transfer (p < .001). Regarding health outcomes, the comparison between THPs
transferred to PAOs and those under the MoPH revealed that only two indicators showed
significant differences including the percentage of pregnant women receiving iodine-containing
tablets and the percentage of infants with a low birth weight (less than 2,500 grams). In the
MoPH group, positive correlations were found between health outcomes and service
indicators, specifically in hypertension screening in the population aged 35 and above and the
low-birth-weight infant indicator. In contrast, negative correlations were observed in the PAO
group, including the vaccination rate in children under 2 years of age, outpatient traditional
medicine services, breast cancer screening, nine- aspect elderly screening, and influenza
vaccination in pregnant women. The refore, to improve the effectiveness of the THPs
transferred to PAOs in meeting public health needs, these changes may impact on the quality
of healthcare services and service satisfaction in some areas. A comprehensive quality
management approach is suggested to enhance the health service system in THPs transferred
to PAOs, ensuring effective and sustainable operations.
