มุมมองผู้ป่วยเกี่ยวกับคุณภาพบริการการแพทย์ฉุกเฉินและปัจจัยที่เกี่ยวข้องในบริบทการกระจายอำนาจสู่องค์กรปกครองส่วนท้องถิ่น

Peerasit Sitthirat; Piwat Suppawittaya; Phupinyo Limchantra; Phanuwich Kaewkamjornchai; Pongsakorn Atiksawedparit; Paibul Suriyawongpaisal; Samrit Srithamrongsawat

Authors

Peerasit Sitthirat Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Piwat Suppawittaya Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Phupinyo Limchantra Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Phanuwich Kaewkamjornchai Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Pongsakorn Atiksawedparit Pongsakorn Atiksawedparit
Paibul Suriyawongpaisal Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Samrit Srithamrongsawat Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University

Keywords:

emergency medical service, decentralization, local administrative organization

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.

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