Abstract
The objectives of this study are as followed; 1) to assess financial situation of
primary care in terms of; income, expenditure, productivity, costs and production
efficiency 2) to assess management style of CUP 3) to develop information system for
management and monitoring of the development of primary care system.The study employed both quantitative and qualitative approaches. A self-administrative
questionnaire survey on financial status and supports of each CUP and its’ network was
done. In-depth interviews were conducted with the Chief Medical Officers, hospital
directors, and District health officers; in addition, focus group discussions were
conducted separately with representatives from the hospital and health center. Twelve
provinces locating in 12 NHSO regions were purposively selected according to wellestablishment
of health information system. These included Chiang Rai, Phitsanulok,
Uthai Thani, Nakhon Nayok, Samut Songkhram, Samut Prakan, Kalasin, Nong Bua Lam
Phu, Surin, Si Sa ket, Surat Thani, and Songkhla. Al least three CUP were purposively
selected; one provincial hospital CUP, one big district hospital CUP, and one small district
hospital CUP; moreover, additional private hospital or other public hospital CUP was also
included if health centers were included as their network. There were totally 44 CUPs in
the study including 270 health centers under provincial hospital CUPs, 396 health centers
under district hospital CUPs, and 5 health centers under a private hospital CUP.
Results of study show that the financial status of all hospitals and its’ networks
had been improved during 2006 – 2008, net savings of all categories of hospitals and
health centers had been increasing. This indicates that over budgets were sufficient for
the system, but allocation of budget was probably problematic. Financial management
system as a CUP impose the hospital and its’ network, health centers, have to work
closely in terms of supports, communication, and referring. However, how well they
worked together depends on vision and attitude of the hospital director and local
contexts. The itemized payments made by NHSO was criticized as it will deteriorate the
integration and holistic concept of primary care; moreover, it lets health workers putting
emphasis on these activities and entering data in order to get more budgets and may
neglect in providing other services. Average annual total costs of health centers or
primary care units (PCU) in 2008 were 2,571,535.86 Baht for those having doctor,
1,837,809.64 Baht for those having registered nurse, and 1,190,663.21 Baht for those
providing services by health workers. Average annual numbers of productivity were
17,032.24, 10,927.80, and 7,432.85, visit/unit/year for different type of PCU respectively.
The efficiency score calculated by DEA of PCU or health centers was relatively low,
0.538 – 0.593, and there were room for improvement. The result was against with the
complaints of health workers that they had high burdens of work and reports. This was
probably due to burden from reporting was not accounted as productivity of primarycare unit. Moreover, the current available data include only quantity of services
provided, not including quality dimension or non-services activities. Results from the
study illustrates that current available data within the CUP and province was able to use
for management and monitoring of the development of primary care; however, it needs
more efforts in managing the data and require training of staffs.
Policy recommendations are as follows: 1) the provincial health office is crucial
actor in the development of primary care and should not be ignore or bypass; 2) the
payment models for primary care should be designed with caution ensuring that they
will not deteriorate the concept of a holistic and integration of primary care; 3) a good
governance of CUP board should be strengthen and separation of budget for primary
care from secondary care is needed; 4) a national mechanism to monitor efficiency of
budget spending should be established in addition to incentive measures and
mechanisms to improve the efficiency of health service production; 5) strengthening
management information system for planning, monitoring, and development of primary
care.
