Journal of Health Systems Research

Patient’s Perspectives on Quality of Emergency Medical Service and Related Factors in the Context of Decentralization

Peerasit Sitthirat — 2024-12-29

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.

Factors Associated with the Efficiency of Health Product Consumer Protection by the Primary Care Unit of Provincial Administrative Organization

Pennapa Sriring — 2024-12-29

The role of health product consumer protection has also been transferred to the primary care unit (PCU) of the provincial administrative organization (PAO). This research aimed to evaluate health product consumer protection role of the transferred PCUs, including network supports, health literacy, practices, attitudes, satisfaction, readiness, and to identify factors associated with their role efficiency. A self-administered questionnaire was used to gather information from 404 officials responsible for consumer protection in the PCUs. Most of the respondents were female, aged 38.1 years (SD = 9.98), 83.7% had bachelor’s degree education, 54.5% were in technical public health job titles. The PAO support was at a moderate level. Out of a full score of 10, the mean knowledge score was 5.9 (SD = 1.73); the health literacy score was 3.79 (SD = 0.85) out of 6; the readiness score was 13.8 (SD = 6.08) out of 20. From the full score of 5, their consumer protection activities were low with a mean score of 2.68 (SD = 1.15) out of 5; but with positive attitude (mean = 4.12, SD = 0.56); with satisfaction 3.72 (SD = 0.75); and the efficiency 3.71 (SD = 0.82). The factors associated with efficiency of health products consumer protection were readiness (OR_adj= 6.84), satisfaction (OR_adj = 3.46), networking and supports (OR_adj = 3.11), and health literacy (OR_adj = 2.63).

Fringe Benefit, Welfare and Career Path of Health Workforce of Sub-District Health Promoting Hospital under Provincial Administrative Organization

Atiya Sarakshetrin — 2024-12-29

Background and Rationale: Providing fringe benefits, welfare, and promoting career advancement to health workforce of a sub-district health promoting hospital (SHPH) under the provincial administrative organization (PAO) are crucial. The purpose of this research was: 1) to examine the fringe benefits, welfare, and career advancement opportunities for SHPH personnel; 2) to investigate the problems, obstacles, and proposals regarding fringe benefits, welfare, and career advancement for SHPH personnel; and 3) to develop policy recommendations related to fringe benefits, welfare, and career advancement for SHPH personnel under PAO.

Methodology: This research employed a mixed-methods approach, incorporating quantitative and qualitative research methodologies conducted from April to August 2023. The qualitative samples selected purposively consist of policy-level executives including experts and executives of the Ministry of Public Health (n=15); local government organization executives, provincial health executives and regional health executives (including health region inspectors, provincial chief medical officers, PAO presidents, public health division directors, and representatives from local administrative organizations: n=80); operational health workforce of the transferred SHPHs (n=120); and experts joining final policy meeting (n=20). Qualitative data were collected through in-depth interviews and focus group discussions. For the quantitative study, the samples consist of 430 personnel from transferred SHPHs. The participants were selected using purposive and stratified random samplings based on staff proportions. Quantitative data were collected using an online questionnaire. Data were analyzed using descriptive statistics for quantitative method and content analysis for qualitative method.

Results: 1. Overall fringe benefits, welfare, and career advancement were at moderate level. The qualitative findings showed that these aspects generally followed the healthcare decentralization guidelines of the SHPH (and the 60^th Anniversary of Her Majesty Queen Sirikit Health Center). 2. Problems included delays in compensation payments, unfair salary promotion evaluations, differences in welfare benefits, and limited growth opportunities in certain job positions. 3. Key policy recommendations included: the Department of Local Administration overseeing decentralization should organize knowledge-sharing activities and review hindering regulations to ensure health workforce receiving appropriate benefits. PAOs should develop and widely disseminate manuals, procedures, regulations, and practical guidelines.

Discussion and conclusion: To boost staff morale and motivation, relevant agencies should simplify and improve compensation payment rules for quicker processing, set clear and fair criteria for salary increases, create clear career paths for all job titles, establish higher-level positions, especially for professional nurses; and speed up academic performance reviews within 6 months.

Factors Influencing Decision to Participate and Tendency to Adhere to the One ID Card to Every Private Dental Clinic of the 30-Baht Universal Coverage Project: A Case Study in Nakhon Ratchasima Province

Nagorn Wisetsena — 2024-12-29

The one ID card to every health facility of the 30-baht universal coverage project aims to increase access to dental care services for Thai people based on primary care concept with services close to their home including private dental clinics that registered as service units to the project. The objectives of this cross-sectional study were to examine the relationship between factors influencing private dental clinics’ decision to participate, and the tendency to remain in the project. A questionnaire was developed specifically as the research tool of this study. The questionnaire covered questions on the benefits to the public sector, to the government sector, to entrepreneurs, and obstacles. The data were collected between 3–13 June 2024 directed to all 63 dental clinics registered as service units in the National Health Security system of Nakhon Ratchasima province. The rate of responses was equal to 57%. The results revealed as follows. All aspects of the factors influencing decision making to participate in the project of private dental clinics were not related to the tendency to remain in the one ID 30-Baht universal coverage project (p > 0.05). Rates of payment per visit to private dental clinics were significantly related to tendency to remain in the project (p = 0.003). Dental clinics viewing proper compensation rates tended to remain in the project. Such tendency was 10.7 times higher than clinics viewing that the compensation rate was too low (odds ratio = 10.7).

Evaluating the Cost Efficiency of Refilling Medicines at the Chiangrai Prachanukroh Hospital Pharmacy Network

Samanya Sakkawong — 2024-12-29

Background and Rationale: Chiangrai Prachanukroh Hospital implemented a project aimed at reducing congestion and waiting times for patients with chronic non-communicable diseases by enabling them to obtain medications from local pharmacies. This initiative service model 1 allows participating hospital procuring and dispensing medications for individual patients and delivering them to patients at partnered pharmacies (network). The objective of this study was to evaluate of efficiency of service model 1 from the hospital's perspective.

Methodology: A descriptive study was conducted using data collected from the hospital’s information system spanning the fiscal years 2020 to 2023. The cost efficiency focused on total management and delivery costs per prescription, complemented with the reliability cost incurred from medication returns and errors. The system's capacity to manage medication distribution for variety of diseases was another complementary indicator.

Results: From 2020 to 2023, there were 36,415 prescriptions dispensed through partnered pharmacies, equivalent to 8.7% of all prescriptions (4.5% of during office hours and 43.3% of after-hours). Most services served the patients of the universal coverage scheme. Cost analysis revealed a reduction in dispensing costs from 105.50 THB in 2020 to 41.23 THB in 2023, attributed to saving in overtime wages, despite a cost rise from the medication return rate of 2.5% in the most recent year. The service model demonstrated improved cost efficiency, but not covered the reimbursement of 49 THB per prescription set by the National Health Security Office. The distribution capacity covered conditions such as glaucoma, hypertension, hyperlipidemia, diabetes, and chronic kidney disease.

Conclusion: Future policy considerations should address adequate reimbursement rates to cover costs and promote integrated services to optimize resource utilization and health outcomes. These adjustments will help ensure the financial sustainability of the initiative and enhance the quality of healthcare delivery.

Cost Utility Analysis of Population-Based Type 2 Diabetes Mellitus Screening in Thailand

Sukhontha Kongsin — 2024-12-29

Background and rationale: The economic evaluation of screening for type 2 diabetes mellitus (T2DM) in the general population is limited. This study aimed to evaluate the cost-utility of T2DM screening strategies using the DM risk score (DMRS) and fasting plasma glucose (FPG)/fasting capillary blood glucose (FCBG) compared to no screening in Thailand.

Methodology: Decision tree and Markov models were constructed to compare costs and quality-adjusted life years (QALYs) gained of T2DM screening using DMRS & FPG/FCBG versus no screening. Cost-utility data were from secondary and primary medical records of Thai population aged 35-59 years in three tertiary and two university hospitals. Incremental cost-effectiveness ratio (ICER) was calculated from both societal and provider perspectives.

Results: From both societal and provider perspectives, T2DM screening using DMRS and FPG/FCBG compared to no screening had an ICER of 157,570 baht per quality-adjusted life year gained, with the ICER being less than 160,000 baht per quality-adjusted life year gained.

Conclusion: The T2DM screening strategies using DMRS and FPG/FCBG were considered cost-effective in Thailand, as the ICER per QALY gained was lower than the willingness-to-pay threshold.

Situation and Development of Genetic Counseling for Breast Cancer at Ubonratchathani Cancer Hospital

Chaliya Wamaloon — 2024-12-29

This research and development aimed to describe the situation, develop and evaluate a cancer genetic counseling model at Ubonratchathani Cancer Hospital, Thailand. This study was conducted between February 2022 to December 2023. The research comprised two phases. Phase 1 studied the situation. The sample consisted of 2 physicians, 7 registered nurses, 2 medical technologists and 17 cancer patients by using questionnaires and semi-structured interviews. Phase 2 was developing a model, conducting an implementation and evaluating the cancer genetic counseling model. The sample consisted of 5 physicians and 31 registered nurses. In addition, 88 counseling service recipients selected by a simple random quota sampling method who met the inclusion criteria also evaluated the counseling model. Divided into an experimental group of 44 people who were at high risk for hereditary breast and ovarian cancer syndrome (HBOC) received an individual cancer genetic counseling program in Ubonratchathani Cancer Hospital. Comparison or control group was 44 people who received treatment as usual. Data were collected using knowledge, attitude, skills assessment form, satisfaction assessment form, Thai hospital anxiety and depression scale (Thai-HAD), and the cancer worry scale. The gathered data were analyzed using descriptive statistics, content analysis, thematic analysis, and t-test statistics.

The study revealed that existing cancer genetic counseling service was unclear. Medical personnel had insufficient knowledge and competence about the cancer genetic counseling. In terms of model development results, three main operational components were the structure, staff and system. The nurses’ knowledge, attitude, and skills after the training for setting up the counseling service increased significantly (p-value<.05). Satisfaction with the overall service was at the highest level. The knowledge and attitude of the service recipients after the consultation increased and were higher than the control group (p-value<.05). As for the Thai-HAD, the level of cancer worry of clients after the model set up was lower than before and was significantly lower than the control group (p-value<.05). Overall, the satisfaction of receiving the counseling service was at the highest level.

In conclusion, genetic counseling was a communication process that helped patients or families understand the disease, its causes, treatment, and prevention methods, as well as making the most possible and appropriate risk management options. It also helped the patients and family members to accommodate the disease. Therefore, this cancer genetic counseling model should be applied to be the standard of cancer genetic counseling service for the cancer health service unit.

Artificial Intelligence for Monitoring Illegal Dietary Supplement Sales and Advertising on E-commerce Platforms in Thailand: Perceptions of Key Stakeholders

Chawalin Inthong — 2024-12-29

Background: The rapid growth of e-commerce platforms has facilitated the illegal sale and advertising of dietary supplements that poses risks to consumers.

Objectives: This study explored key stakeholders' perspectives on using artificial intelligence (AI) tools to monitor the illegal sale and advertising of dietary supplements on e-commerce platforms in Thailand.

Methods: A qualitative study using semi-structured in-depth interviews was conducted with representatives from eight organizations, including government authorities, non-governmental organizations, consumer advocacy groups, e-commerce platform providers, and academia. Thematic analysis was employed to identify key themes.

Results: Stakeholders identified several factors that could facilitate the successful implementation of AI-powered monitoring systems, such as: the innovative advantages offered by AI technology, alignment with the local context, supportive partnerships, financial support, and a clear need for such a system among stakeholders. Conversely, barriers to adoption included the need to adapt AI to real-world operational contexts, the complexity of the technology, associated costs, relevant policies and laws, and existing infrastructure limitations. E-commerce providers were identified as the primary target users for this technology.

Conclusions: AI for monitoring the sales and advertising of dietary supplements on e-commerce platforms is likely to grasp opportunities and to face challenges that need careful implementation. It is important to develop effective AI models that align with stakeholders’ needs and deliver values to encourage adoption, rather than relying solely on regulatory enforcement.