Developing assessment criteria for operation control of local security health fund in the upper central area, Thailand

Introduction

World Health Organization (WHO) attention to the policy of creating universal health insurance (Universal Coverage Scheme)¹ and need for collaborative working was highlighted in the 1986 Ottawa Charter for Health Promotion. The health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organizations, by local authorities, by industry and by the media. The recognition of the role those social determinants play in the health of the population makes it clear that health cannot be the responsibility of just one agency and, over the last three decades, collaboration has been an increasing focus of health promotion internationally.² In 1997 the Jakarta Declaration identified partnerships for health and social development between different sectors as one of its five key priorities. It stressed the need to strengthen existing partnerships and urged the development of new partnerships³ (Jakarta 1997). These priorities were further highlighted in 2005 when the Bangkok Charter stated that “partnerships, alliances, networks and collaborations provide exciting and rewarding ways of bringing people and organizations together around common goals and joint actions to improve the health of populations”⁴ (WHO 2005).

Thailand’s policy on universal health coverage (UHC) has made good progress since its inception in 2002 by National Health Security Office Thailand (NHSO). Every Thai citizen is now entitled to essential health services at all life stages.⁵ The NHSO has a duty to support Coordinate and prescribe rules for local authorities to operate and administer the health insurance system at the local level as readily or appropriately to create health insurance for the population in each region. Well-coordinated district health systems enable individuals to seek care or referral at health units close to home.⁶

The NHSO is working with local governments to establish the Local Health Security Fund (LHF), with the key goal of increasing access to health promotion and disease prevention services in the community. There is a process by community participation in solving health problems that has been ongoing since 2006 to the present. Over the past 10 years, the local health insurance fund has been established and developed continuously. Therefore, the assessment and monitoring tools are very important for the Fund's development in order to know the factors affecting the coverage of health services such as education level, health, socioeconomic status.⁷ LHF Performance Assessment Emphasis is placed on work processes requiring the creation and development of LHF management evaluation criteria, which must be developed and improved to suit the current situation. In particular, the indicators can indicate that the fund management committee is effective and can reflect the level of strength and sustainability of the LHF.⁸

However, the original LHF efficacy model did not cover all aspects of fund management and people still had insufficient access to local government services.⁹ Therefore, the development of an LHF operated and managed by the local government that can drive the health care of local people more efficiently and sustainably requires the development of an efficient and effective assessment tool to provide an overview of its operations.

In this research, it has been developed and designed to be used as a guideline to assess the quality of LHF management to be effective in the future.

Methods

Results

Discussion

Analysis of factors related to effective LHF management found that seven items were derived from the accompanying analysis. It was found that some factors were not variables for the implementation of local health insurance funds. The variables that the researcher chose to exclude variables from the statistic were values less than 0.5 out of the 1 variable (LV1). By collecting data from a sample group covering each size of LHF representatives in Thailand, both urban and rural communities, each category of the assessment had different assessment questions as follows.

In item 1 (LV1) Basic management was component OV2-6. which contains questions about fund management by carrying out activities in the development of the LHF in order to achieve its goals. A Case Study on Tacoma–Pierce County, Washington, in Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage, found action by local governments in health care to obtain funding. Government sectors need to have good financial management or planning.¹² A study of key factors for inefficient district health management practices in Ghana found inadequate planning in health management.¹³

In LV2 Service deliver for health care has been component OV7-11 is a measure of individual health care services. It is a measure of the effectiveness of LHF health services. Several studies have been conducted on the effectiveness of collaboration between government and local governments in evaluating public health promotion actions. Randomized controlled trials occurred in the Jerusalem region, Israel,¹⁴ to investigate the effectiveness of local government health services, measure illness-related absenteeism, handwashing behaviors before lunch and after using the bathroom. In 2008, a study in Copenhagen and Aarhus, Denmark¹⁵ measured Symptoms on the Scale for Assessment of Psychotic Symptoms and others to measure the effectiveness of local government health services. It was found that the knowledge and attitudes of the people towards the health services of the local government were measured.^16,17

LV3 Leadership and governance has been component OV12-17. It measures the part of organizational leaders in managing policies and managing funds for maximum efficiency. Several studies have found that the management or decision-making of a leader in health administration is extremely important. The study Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage to determine Factors influencing the work efficiency of district health managers 12 found that one important factor was a narrow decision space that constrains the authority of health leaders. A 2007 study in Tanzania¹⁸ found that corporate leaders play a key role in managing the Community Health Fund.

LV4 Strategic planning has been component OV18-24. This section assesses management planning to ensure that the Fund implements health activities in the best interests of the people. A Philippine Local Government Health Administration study found that lack of Strategic planning would result in less inequality and less access to local government health care systems among citizens.^19,20

LV5 Human resource development has been component OV25-30. A study by Bruzzese et al.²¹ in 2006 examined the management of asthma between schools, families, and primary care providers similar to health management with the participation of government or local residents. It was found that the potential development of personnel in the patient care network required training. Developing potential to have knowledge to be able to work effectively.

LV6 Health information system has been component OV31-37. We believe that the provision of health information and information management will lead to the most efficient management of the LHF. A 2011 study by Florence et al.²² found that an information sharing partnership between health services, police, and local government in Cardiff, Wales, altered policing and other strategies to prevent violence based on information collected from patients treated in emergency departments after injury sustained in violence.

LV7 Monitoring and evaluation has been component OV38-42. It is an important process to monitor the progress and results of LHF activities to ensure continuity and maximum efficiency. Kamuzara and Gilson (2007)¹⁸ study found that the influencing factors in the implementation of local health funds in Tanzania suggests that a lack of good management plans prevents the inability to assess or monitor the progress of implementation. This will affect future follow-up supervision.

Conclusions

In summary, the ACOLF is a 41-item survey rated on a sliding scale from 0-9, with 5 Basic management, 5 Service deliver for health care, 6 Leadership and governance, 7 Strategic planning, 6 Human resource development, 7 Health information system and 5 Monitoring and evaluation. The ACOLF subscales demonstrated convergent validity, internal consistency and reliability. The ACOLF is a concise, valid, and reliable instrument for evaluating local organization management differences in Basic management, Service delivers for health care, Leadership and governance, Strategic planning, Human resource development, Health information system and Monitoring and evaluation. This measure provides a new tool for ranking operation control of local security health fund in Thailand.

Author roles

Boonmee P.: Conceptualization, Data Curation, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation; Kessomboon P.: Conceptualization, Methodology, Supervision, Writing – Review & Editing; Thongjit S.: Data Curation, Formal Analysis, Methodology, Visualization, Writing – Review & Editing.

Grant information

This study was granted by Faculty of Medicine, Khon Kaen University, Thailand; IN 63202.

Data availability