Factors affecting fund performance management of the local health security fund committee, Sisaket province

Butsakorn Sripho; Aree Butsorn; Anan Chaikhunwatthana

doi:10.12688/f1000research.153423.1

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Research Article

Factors affecting fund performance management of the local health security fund committee, Sisaket province

[version 1; peer review: 1 approved with reservations]

Butsakorn Sripho¹, Aree Butsorn ², Anan Chaikhunwatthana²

PUBLISHED 14 Feb 2025

Author details Author details

¹ Sisaket Provincial Public Health Office, Sisaket Province, Thailand
² Ubon Ratchathani University, Mueang Si Khai, Ubon Ratchathani, Thailand

Butsakorn Sripho
Roles: Conceptualization, Investigation, Writing – Original Draft Preparation

Aree Butsorn
Roles: Data Curation, Methodology, Project Administration, Validation

Anan Chaikhunwatthana
Roles: Formal Analysis, Resources, Software, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the QUVAE Research and Publications gateway.

Abstract

Background

This research aims to study the factors affecting the fund performance management (FPM) of the Local Health Security Fund Committee of the Sisaket Local Health Insurance Fund Committee.

Methods

Data from 324 participants were collected using Descriptive and Inferential Statistics created between October 3, 2022, and February 15, 2023, to determine the factors for predicting the FPM of the Local Health Security Fund Committee of the Sisaket Local Health Insurance Fund Committee.

Results

Using a stepwise multi-regressive analysis, the results showed three variables: organizational support, supporting factors, and being a board member and secretary. They were able to explain the variations in factors affecting the FPM of the Sisaket Local Health Security Fund Committee by 49.87% (R²=0.498, R² _adj=0.493, SE_est=2.50355, F= 105.637, p<0.001) respectively.

Conclusion

Disbursing the budget to solve problems in the area effectively will be the best benefit of the local participants in the area.

Keywords

Factors, fund performance management, health security, Local Health Security Fund Committee

Corresponding author: Aree Butsorn

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Sripho B et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Sripho B, Butsorn A and Chaikhunwatthana A. Factors affecting fund performance management of the local health security fund committee, Sisaket province [version 1; peer review: 1 approved with reservations]. F1000Research 2025, 14:207 (https://doi.org/10.12688/f1000research.153423.1) First published: 14 Feb 2025, 14:207 (https://doi.org/10.12688/f1000research.153423.1) Latest published: 14 Feb 2025, 14:207 (https://doi.org/10.12688/f1000research.153423.1)

Introduction

Thailand has established a Health Security Fund at the local level to create national health security for local people by promoting participation according to availability, suitability, and needs. Section 47 of the National Health Security Act 2000 (B.E. 2545) requires the National Health Security Committee (Main Committee) to support, coordinate, and establish criteria for Local Administrative Organizations to operate and manage the local health security system.¹ It has been in operation since the announcement by the National Health Security Committee. This is to support subdistrict administrative organizations or municipalities in operating and managing the health security system at the local or area level.

In 2006, the National Health Security Office (NHSO), in collaboration with sub-district administrative organizations and pilot municipalities, established 888 mutual funds, focusing on emergency medicine, health promotion, disease prevention, and rehabilitation necessary for health and livelihood, as well as promoting mother and child groups, the elderly, at-risk professionals, people with disabilities, disadvantaged groups, and chronic hospital patients. Therefore, community welfare and public health services can be accessed all over the areas.² In addition, the NHSO has focused on monitoring and evaluating the funds, thus developing a system for reporting each fund’s performance and financial aspects through the NHSO website. This mechanism makes it possible to monitor operations covering all funds, as well as monitoring and evaluation by external agencies, such as provincial public health offices and district health departments, in collaboration with local administrative organizations. Currently, 7,776 local government organizations (100%) apply for local health security funds. In past operations, there have been many problems, such as public participation in the funding of local people and board management, the effectiveness of fund management that affects delayed budget management, unbalanced capital expenditures, and budget disbursements. To solve these problems, more than 3 billion baht will be required in the remaining areas in 2020.³

The NHSO Area No. 10th in Ubon Ratchathani Province covers five provinces: Ubon Ratchathani, Sisaket, Yasothon, Amnat Charoen, and Mukdahan, with 658 local health security funds representing 100 percent, and 11,844 committees. In the past, only 47 % of the fund’s disbursements met the target. There were obstacles to the implementation of the local health security fund; namely, people were less interested in participating in health promotion activities based on the benefits package, the budget of the fund applied did not meet the objectives, the budget disbursement did not meet the target, and the budget of the fund that has been allocated is insufficient. This finding is in line with Varayuth Deeleuthleo’s study that examined factors affecting the operation of health security funds in the Sirindhorn district, Ubon Ratchathani Province. It was found that the obstacles to the health security fund at the local level include people being less interested in participating in health promotion activities according to the benefits package, the budget of the applied fund not meeting its objectives, and the budget of the sufficient fund that has been allocated late.⁴

According to the research data, the Local Health Security Fund in Sisaket province, disbursements of the health insurance fund did not reach the specified threshold in 61 out of 216 locations, representing 28.24, contributing to the efficiency of fund disbursements and access to the public sector. It is an urgent issue that needs to be addressed to further study the factors affecting the management of fund performance by the Local Health Security Fund Committee.

Methods

A Cross-sectional Analytical Study was conducted to study the Factors Affecting the FPM of the Sisaket Local Health Security Fund Committee (Sripho Butsakorn et al., 2024). It comprises 1) personal factors (gender, age, marital status, education level, income, and position on the board); 2) operational experience of the Local Health Fund Committee (motivating factors in job success, recognition, responsibilities, job descriptions, and job progress); 3) supporting factors (remuneration, policy and regulation, relationships with supervisors and colleagues, work environment, and work security); and 4) organizational support factors (human resources, budget, materials, and time) that affect the management of fund outcomes of the Local Health Security Fund Committee.

Population and participants

The participants were from the Local Health Security Fund Committee in Sisaket Province, where the researchers determined the sample size using the Accuracy Parameter Estimated AIPE method, which Kelly & Maxwell presented with the following formula.⁵

N_{M} = (\frac{Z_{(1 - α) / 2}}{w}) (\frac{1 - R^{2}}{1 - R_{XXj}^{2}}) (\frac{χ_{(1 - γ; N - 1)}^{2}}{N - p - 1}) + p + 1

N_M = Number of samples

N = 50% chance of obtaining a 95% CI of R² less than 0.1

P = Number of predictive variables in the full model (assigned to three predictors)

α = Decision point level for the confidence interval test (0.05)

w = Half of the confidence range of the main predictive variable.

R² = Squared of the regression analysis coefficient for the full model, obtained from a study by Nichanan Ngamnoi and the team,⁶ studying factors FPM of the Sisaket Local Health Security Fund Committee in Nonthaburi. 70.80% (R² = 0.708)

R²_x-xj = Squared of the regression coefficient of the primary variable with the other early variables (R²=0.441).⁶

$X^{2 (1 - γ; N - 1)}$ = Quartile of chi-distribution (0.08)

The sample size was calculated using the AIPE function of STATA version. The sample size for the factors affecting the performance of the Local Health Security Fund Committee in Sisaket Province was 110. The researcher demonstrated that when the design effect was 3, the sample size was 330 people using Cluster Random Sampling. It was divided into six zones by randomly selecting one district per zone. The six districts can be divided into six zones: Zone 1) Muang District, Zone 2) Nonkhun District, Zone 3) Kantharalak District, Zone 4) Prang Ku District, Zone 5) Utumpornpisai District, and Zone 6) Yangchun Noi District. Then, zones were separated into A+ or A, B, and C levels, randomly selecting three funds per district, a total of 18 funds for 18 people each, for a sample of 324 people.

Study tools

Questionnaires on the Factors Affecting FPM of the Local Health Security Fund Committee of the Sisaket Local Health Insurance Fund Committee were researched and created by studying the documents and related research and were divided into five parts as follows:

Part 1: Seven questionnaires on personal attribute factors including gender, age, marital status, education level, income, position, and experience of the Local Health Security Fund Committee.

Part 2:15 questionnaires on motivational factors, with questions evaluated according to a Likert scale. There were three options: agree, uncertain, or disagree, with 45 points.

Part 3: Fifteen questionnaires on supporting factors, with the question being evaluated according to the Likert scale. There were three options: agree, uncertain, or disagree, with 54 points.

Part 4:15 questionnaires on organizational support factors, with questions evaluated according to a Likert scale. There were three options: agree, uncertain, or disagree, with 45 points.

Part 5: Fifteen questionnaires on the management of fund performance by the Local Health Security Fund Committee of the Sisaket Local Health Insurance Fund Committee were evaluated according to the Likert scale. There were three options: always practice, sometimes practice, and not practice, with 45 points.

Tool monitoring

The tool is monitored to determine content validity by using a finished device for three experts to check the accuracy of content and language. Subsequently, it was revised according to the recommendations before being tested for confidence and consistency between the purpose and scope. By finding the Index of Item Objective Congruence (IOC), it was found that the IOC score was between 0.67-1.00, and reliability was obtained by taking the revised questionnaire and testing it with a sample in 30 sets of Ubon Ratchathani province. Subsequently, it was analyzed for confidence using a ready-made computer program using Cronbach’s Alpha Coefficient. Confidence in the motivational factor was 0.840, the supporting factor was 0.820, and the organizational support factor was 0.760.

Data analysis

Descriptive data were analyzed using frequency distributions, percentages, averages, standard deviations, median, 25^th percentile, and 75^th percentiles to determine factors affecting the management of fund performance of the Sisaket Local Health Security Fund Committee. Pearson’s correlation and stepwise multiple linear regression were used to define a significance level of 0.05.

Ethical consent

This study was approved by the Human Research Ethics Committee of Ubon Ratchathani University on October 3, 2022, with approval number 139/2565. All participants were informed about the study’s purpose and their right to withdraw at any time without consequences. Written informed consent was obtained from all participants before data collection. The study guaranteed confidentiality and anonymity of all responses, following ethical standards set by the Human Research Ethics Committee.

Research results

General information

It was found that 50.3% of the respondents were male, with an average age of 47.91 years (SD = 8.611 years), 81.2% were married, and 33% had graduated from high school. The monthly family income was determined as a median of 18,000 baht (P₂₅ = 10,000 baht: P₇₅ = 29,777 baht). In addition, 59.9% of the respondents have an average operating experience of 1.40 years (SD = 0.491 years), respectively.

Factors affecting the management of the performance of the Sisaket Local Health Security Fund Committee

There were six variables related to the direction of the performance of the Sisaket Local Health Insurance Fund Committee: High School (M.6) or Vocational Certificate (Diploma) (R=0.139, P-value=0.012), average monthly income (r=-0.115, p-value=0.038), chairman of the committee (r=-0.111, p =0.045), motivational factors (r=0.476, p <0.001), supporting factors (r=0.520, p-value<0.001), and organizational support (r=-0.652, p-value<0.001). The details are presented in Table 1.

Table 1. Correlation analysis of factors influencing Local Health Security Fund Committee performance, with 324 variables.

Factors	Average and Standard Deviation	Relationship level (r)	p-value
Male	0.51(0.52)	0.041	0.461
Age	47.91(8.61)	0.007	0.894
Single	0.13(33)	-0.051	0.362
Married	0.81(0.39)	-0.045	0.422
Primary school	3.98(1.42)	0.040	0.469
Secondary school	3.98(1.42)	-0.014	0.798
High School or Vocational Certificate	3.98(1.42)	0.319	0.012*
Diploma	3.98(1.42)	0.077	0.169
or Bachelor’s degree	3.98(1.42)	-0.103	0.063
Average monthly income	21,363.16(14,647.69)	-0.115	0.038*
Chairman	3.07(0.837)	-0.111	0.045*
Deputy Chairman	3.07(0.837)	0.001	0.994
Committee	3.07(0.837)	0.080	0.153
Committee & Secretary	3.07(0.837)	-0.081	0.147
Operational Experience	4.50(3.44)	-0.066	0.233
Motivational factor	42.05(3.42)	0.476	<0.001**
Supporting factor	42.38(3.66)	0.520	<0.001**
Organizational support factor	42.29(3.26)	0.652	<0.001**

** Correlation is significant at the 0.01 level (2-tailed).

* Correlation is significant at the 0.05 level (2-tailed).

Factors affecting the FPM of the Sisaket Local Health Security Fund Committee

A study of the Factors Affecting FPM of the Local Health Security Fund Committee of the Sisaket Local Health Insurance Fund Committee was conducted by applying factors with a significance level of below 0.25 to the analysis of individual data to obtain a total of 11 variables, such as High School or Vocational Certificate, high school or vocational certificate, bachelor’s degree, family monthly income, Chairman, Deputy Chairman, Committee, Committee and Secretary, Operational experience, Motivating Factors, Supporting Factors, and Organizational Support. The organizational support factor was the first forecast variable with a statistically significant correlation of 0.05, which can explain the variation in the management prediction factor in the performance of the Sisaket Local Health Security Fund Committee by 42.6% (R²=0.426). When an additional forecast variable, the supporting element, was added, the forecasting coefficient increased significantly at 0.05, which can explain the variation in the management prediction factor in the performance of the Sisaket Local Health Security Fund Committee by 47.8% (R²=0.478). Moreover, when one more forecast variable, the committee and secretary, is added, the coefficient of forecasting increases statistically significantly at 0.05, which can explain the variation in the management prediction factor in the performance of the Sisaket Local Health Security Fund Committee by 49.8% (R²=0.498). In summary, it was found that there are three significant forecast variables for the management of the Sisaket Local Health Security Fund Committee’s performance: organizational support, supporting factors, and being a committee and secretary. Variations in the predictive characteristics of the performance of the Sisaket Local Health Security Fund Committee can be explained by 49.87% (R²=0.498, R²_adj=0.493, SE_est=2.50355, F= 105637, p<0.001). The details are presented in Table 2.

Table 2. Regression coefficients analyze the power of predicting factors to predict the performance of the Sisaket Local Health Security Fund Committee.

(n = 324 people).

Analytical models	Variation	Coefficient		R²	R²_adj	Sr²	R² change
Analytical models	Variation	B	β	R²	R²_adj	Sr²	R² change
Significant models	Organizational Support	0.470	0.436	0.426	0.424	2.6680	0.426
	Supporting Factor	0.323	0.336	0.478	0.475	2.5468	0.053
	Committee and Secretary	0.588	0.140	0.498	0.493	2.5035	0.019
Constant = 7.609, R² = 0.498, R²_adj = 0.493, SE_est = 2.50355, F = 105.637, p<0.001

Discussion

There are three variables for the management of the performance of the Sisaket Local Health Security Fund Committee: organizational support, supporting factors, and being committee and secretary.

Support is one of the factors affecting the FPM of the Sisaket Local Health Security Fund Committee. The Local Health Security Fund was voluntary and was applied to the National Health Security Office. According to the population in the area, 45 Thai Baht per person is funded by the National Health Security Office. The local administrative organization supports funds according to the budget size received. It will then be managed under the fund committee’s operation, in which the fund’s chairman will head as the president of the local administrative organization and the fund secretary is the permanent secretary of the local administrative organization or the Deputy Chief of the District. The committee came from several sections, such as the Head of the Financial Section of the local administrative organization, the Director of the District Hospital, Village Health Volunteers, District Health Consultants, and the Director of Community and Local Hospitals. The management team is directly local, and the management of the local administrative organization is the same person as the fund’s chairman. The Deputy Chief of the District of the Local Administrative Organization is the fund secretary. Therefore, if a local administrative organization and the president are both the chairmen of the local health security fund that they support, the operation of the local health security fund, including personnel, budget, supplies, and good management, will also affect the operation of the fund committee. Another issue is the local government’s willingness to support and promote public health services through other service units or facilities, including alternative facilities in the area. This work focuses on health promotion, disease prevention, rehabilitation, and primary medical care, which are necessary for health and livelihoods, in line with the needs of public health promotion and disease prevention in the area caused by the needs of local people. Therefore, if the head of the governing body supports the operation of the local health insurance fund committee, it should positively affect the overall performance of the fund committee. This is congruent with the research of Srika,^5–7 who studied the factors affecting the FPM of local health security funds in Maha Sarakham district, Maha Sarakham Province. The population used in this study were local health security fund committees in Maha Sarakham District, Maha Sarakham Province, with 121 people from 15 funds. Questionnaires were used as research tools to collect the data. At the same time, the statistics used to analyze the data are percentages, averages, standard deviations, and statistics used to test hypotheses and correlation coefficients. The study found that the committee’s education and income levels affected the performance of the local health security fund, fund readiness, human resources, budgets, and supplies.

Technology affects the operational efficiency of the local health security fund in Maha Sarakham District. Factors related to management, planning, organization, workforce, administration, coordination, reporting, and budgeting affect the operational efficiency of the local health security fund. (R = 0.846, P-value<0.001) Rattanakorn Inmuong⁸ studied factors that correlate with the performance of local health security fund committees in Chum Phae District, Khon Kaen Province. The results of the study showed that the overall support for the organization was very high, average of 3.54 (SD = 0.57), the overall Local Health Security Performance was an average of 3.73 (SD = 0.68), the position in the local health security committee had a statistically significant positive correlation with the performance of the local health security fund committee (10.231, p-value <0.05), and overall organizational support had a statistically significant positive correlation with the performance of local health security fund committees (r = 0.719, p <0.001). When considering individual aspects, it was found that personnel, management, budget, and materials had a statistically significant moderate and positive correlation (r= 0.653, r= 0.637, r= 0.631, r=0.626, p < 0.001) with the performance of the local health security fund committee in Chum Phae District, Khon Kaen Province. The most common obstacle is the support of material organizations. Riley⁹ studied the factors influencing participation in the Health Security Fund Committee operation in the Chaiyaphum District, Chaiyaphum Province. The study found that the variables that contribute to health security fund participation are management, time management, and human resources. The three factors can jointly predict participation in the health security fund operation of the Health Security Fund Committee in Muang District, Chaiyaphum province (73.5%), with the majority of obstacles encountered (44.44%) as support from management organizations.

Support is one of the factors affecting the FPM of the Sisaket Local Health Security Fund Committee. According to Frederick Herzberg’s two-factor theory of motivation,¹⁰ the maintenance factor, also called the hygiene factor, is a prerequisite that can cause dissatisfaction with their work. These factors are not incentives for more workers but are related to the work environment. These include salary and compensation, interpersonal relations, status, policy and administration, working conditions, job security, and supervision techniques. According to Herzberg’s concept, one vital thing to remember is that although the elements that cause satisfaction and dissatisfaction come from different aspects, they cannot be categorically separated and have some related or overlapping parts. On the other hand, it can be said that these supporting factors are related to the working environment, including compensation, policy and regulations, relationships with supervisors and colleagues, and job security. Organizational support includes personnel, budget, supplies, and time spent on managing the fund performance of the Sisaket Local Health Security Fund Committee.¹¹ One study focused on factors affecting the efficiency of budget disbursements for the Department of Land’s fiscal year 2013. This includes 140 personnel from the Planning Division, Treasury Division, and Supplies Division (only the Procurement and Planning and Construction Supervision Department) of the Land Department. The study found that the level of budget disbursement efficiency of the Land Department for the fiscal year 2013 was low. The Work Progress Regulations related to performance were statistically significant at level 05. For different levels of education, it does not affect the efficiency of budget disbursements for the 2013 Land Department Thasany Phanphom.¹² This study correlates with the District Health Fund Committee operation in Muang District, Sisaket Province. The population and sample are the Heads of District Administration organizations. A total of 32 people and 46 people from the District Health Fund Committee were selected using a simple random method; 96 people were sampled. The study found a high level of awareness of the role of the District Health Fund Committee (43.8 percent) in the operation of the District Health Fund Committee. The performance was moderate, at 42.7 percent. When analyzing factors that correlate with the process of the District Health Fund, it was found that age, duration of work, position in the community, population in charge, recognition of the benefits of the District Health Fund, recognition of the role of the committee, and access to information have a statistically significant correlation with the operations of the District Health Fund Committee. The knowledge factor of the District Health Fund had no statistically significant correlation with the committee’s functions. The recommendation of this study is that administrators or those involved in the management of the District Health Fund should provide training courses on how to provide health promotion, disease prevention, and rehabilitation services according to the set of benefits to community leaders, develop the capacity of the District Health Fund Committee in budget management, and encourage people to participate in the proposal of the project plan for support from the District Health Fund.⁶ A study on factors affecting the operation of local health security funds in Nonthaburi Province, with the population and sample, is the Nonthaburi Health Security Fund Management Committee and a total of 43 funds. The results showed that 59.90% of the sample had a good level of understanding of the objectives and regulations of the health security fund. Average 2.61 (SD = 0.42); There is a significant level of awareness of the benefits of the fund, as it is 2.61 (SD = 0.42), and the role of the committee is perceived to a large extent, as an average of 2.52 (SD = 0.44). 2) The organization’s structure is at a high level, with an average of 4.33 (SD = 0.55) 3), and corporate communication is at a high level, with an average of 4.20 (SD = 0.56). 5) Innovation based on the committee’s perception was high, with an average of 3.91 (SD = 0.77). 4) The committee’s recognition of the role, organizational structure, and corporate communications predicted the performance of the Nonthaburi Local Health Security Fund by 70.80% (R² = 0.708), with a statistical significance of 0.05. The local health security fund committee was aware of its role, organizational structure, and good communication to effectively operate gender as a common factor in predicting sexual health behaviors by 44.10% (R² = .441, p<.01), with media as the best predictor (β = .374, p<.01).

Being a committee and secretary is one factor affecting the FPM of the Sisaket Local Health Security Fund Committee. The selection and participation of the Fund Committee must follow the announcement of the NHSO. The roles and responsibilities are assigned to the committee, with at least four meetings held annually, and Minutes of Meetings (MoM) are held. The Fund Advisor should attend at least two meetings, and the Fund Secretary should prepare the agenda and record the MOM. Factors in fund management include: 1) a local health security fund committee composed of local government organizations, health workers, and public sector representatives. 2) Regulations of funds 3) Budgets derived from support from the NHSO, local government organizations, donations from people and communities, and income related to the Local Health Security Fund. Based on the basic information of the Local Health Security Fund Committee in the Northeast, most fund committees are local; 46.3 percent of them graduated from primary school, and the majority of informants were 81.9 percent. The proportion of people living in the local community was the highest. When the Local Health Security Fund Committee is selected, the power to allocate funds to solving local people’s problems is assigned. Therefore, the committee intends to perform its duties so that the local community can benefit as much as possible. This is why such a study group affects the Management of the Fund Committee, in line with the study by Sengyamsap showing that factors influencing the participation of community leaders and volunteers in the operation of local funds are participation capacity, opportunities to participate, and level of education.¹³ These variables can explain the statistically significant variance of 59.60% (R² = 0.596, F = 46.63) at 0.01. The study on the management model of local health security funds in Health Service Area No. 7 in Roi Kaen Sarasin Province (Roi Et, Khon Kaen, Maha Sarakham, and Kalasin). The researcher combined the qualitative and quantitative research methods. Qualitative research methods focused on the target samples, including experts involved in fund management and local health insurance in Health Service Area No. 7 in Roi Kaen Sarasin Province. The results showed that 1) the management of the local health security fund found that there are relevant factors, including knowledge and understanding of the operation of the fund; leadership management; awareness of the role and duties of the Fund Management Committee; community health planning; expectations of benefits received concerning the fund; and the preparation of health services based on benefits, budget, and support for local health services, participation of the fund management committee, public and community participation, and public relations of the fund.^14–16 2) Level of success in health security fund management: Overall, the average was 3.44, and the standard deviation was 0.76. In descending order of average, the average fund benefit success was 4.52, the standard deviation was 0.73, the average participatory management was 3.31, the standard deviation was 0.76, and the average participation was 0.76. Participatory innovation averaged 2.48, with a standard deviation of 0.81. 3) Factors influencing the success of local health insurance fund management from the influence analysis were predicted to be 76.50%, which was statistically significant (R² = 0.765, p-value ≤ 0.05). Sorting the overall influence coefficient in descending order shows that the management factor is 0.38, Fund Public Relations Factors is 0.26, Knowledge and Understanding Factors is 0.23, Fund Factors Recognition of the role of the Fund Management Committee is 0.19, leadership factors is 0.18, factors related to the preparation of health service activities based on benefits and factors of participation of the Fund Management Committee is 0.10, and factors of public and community participation is (-0.18), respectively. 4) The local health security fund management model in Health Service Area No. 7 was tested by testing the linear structural equation model from the factors influencing the management of the local health insurance fund. In agreement with the empirical data, x² = 1.44, df = 2, p-value = 0.485, GFI = 1.00, AGFI = 0.97, RMSEA = 0.00, RMR = 0.0025, CN=1775.04.³ This study focused on the factors affecting the operation of the local health security fund in Sirindhorn District, Ubon Ratchathani Province. The population and sample are 300 Village Health Volunteers in Sirindhorn District in the 2009-2010 fiscal year. The study results showed that 1) opinions on the performance of the health security fund in the Sirindhorn district, Ubon Ratchathani province as a whole were moderate. 2) Opinions on the operating factors of the Local Health Security Fund include the fund management and leadership aspects of the committee. In terms of public participation, knowledge, and understanding of the committee, all aspects were moderate. 3) Local health security fund operating factors that affect the operation of the health security fund in order of priority: (1) fund management, (2) public participation, and (3) leadership of the committee. This can jointly forecast the performance of the local health security fund to be 49.50%. 4) Personal factors affecting the level of opinion on the performance of the Sirindhorn Health Security Fund include gender, age, education level, and experience of training or meetings to clarify the operation of the local health security fund. 5) Personal factors affecting the operation of local health security in Sirindhorn District, Ubon Ratchathani Province, include age, occupation, income, duration of volunteering, positions in the community, and experience of training or meetings to clarify the operation of the health security fund. 6) Obstacles to the implementation of the local health security fund: (1) people are interested in participating in health promotion activities according to the small benefits, (2) the budget of the fund does not meet the objectives, and (3) the budget of the fund has been allocated late and insufficient. 7) Recommendations for the operation of the local health security fund include the preparation of publishing funds, the use of community methods in each village to select a committee to prepare a plan to develop the potential of the community, the process of remembering the project plan, and setting up an evaluation committee to review each activity funded by the fund. A recent study was focused on factors that correlate with the management of the local health security fund of NHSO Area No. 1 Chiang Mai.¹⁷ The population and sample groups are the Local Health Security Fund Committee or the NHSO Chiang Mai Area No.1, which included eight northern provinces in 2014. The study found a relationship between local governments, funding factors, and local health security management. It was found that the size of local administrative organizations, the population, the number of villages, the number of contributed budgets, the total budget, the presence of qualified staff in the field of medicine, nurses and public health staff, qualified officers, medicians, nurses, and public health committees had a statistically significant positive correlation with local health security management at a level of 0.05. The type of local administrative organization, qualified staff in medicine, nurses, and civil servants in public health, duration of participation and fund management, environment, and implementation of strategic plans did not correlate with the management of local health security with statistical significance at a level of 0.05.

Conclusion

The study identified three significant factors that affect the fund performance management of the Local Health Security Fund Committee in Sisaket province: organizational support, supporting factors, and being a board member and secretary. These factors were found to have a significant impact on the FPM of the committee, explaining almost 50% of the variations observed. The findings of this research can be used to improve the management of local health security funds in Sisaket province and potentially in other areas of Thailand facing similar challenges. By addressing these factors, the committee can ensure effective and efficient use of the funds, leading to better health outcomes for the local population.

Recommendation

Based on this research, the supporting factor is the Fund Performance Management (FPM) of the Local Health Security Fund Committee of the Sisaket Local Health Insurance Fund Committee. Local administrative organizations, as administrators of the Local Health Security Fund, chaired by the president of the Local Health Security Fund, should support and give importance to the Local Health Security Fund regarding budgets, personnel, supplies, and management. In addition, there should be cooperation from all sectors in fund operation and training on the role of the local health security fund committee. Achieving its objectives and disbursing the budget to solve problems in the area effectively will be the best benefit of the local participants in the area. Future research suggests that the regional health security fund operation model should be studied to develop the fund and succeed as an A+-level health security fund. To be a model and propose other fund management guidelines or further explore the performance of the local health security fund and how budget disbursements to solve various problems affect local participants in the area.

Data availability statement

Figshare: Underlying Data https://doi.org/10.6084/m9.figshare.25422742.v2.¹⁸

The project contains the following underlying data:

• Underlying Data.xlsx.

Extended Data: Questionnaire

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Ethics and consent

This study was approved by the Human Research Ethics Committee of Ubon Ratchathani University on October 3, 2022, with approval number 139/2565. All participants were informed about the study’s purpose and their right to withdraw at any time without consequences. Written informed consent was obtained from all participants before data collection. The study guaranteed confidentiality and anonymity of all responses, following ethical standards set by the Human Research Ethics Committee.

Acknowledgement

The authors would like to acknowledge QUVAE Research and Publications for their invaluable assistance in depositing the raw data into the Figshare repository.

References

1. Innes GK, Lambrou AS, Thumrin P, et al.: Enhancing global health security in Thailand: Strengths and challenges of initiating a One Health approach to avian influenza surveillance. One Health (Amsterdam, Netherlands). 2022; 14: 100397. PubMed Abstract | Publisher Full Text | Free Full Text
2. Gyllstrom E, Gearin K, Frauendienst R, et al.: Local health department factors associated with performance in the successful implementation of community-based strategies: A mixed-methods approach. Am. J. Public Health. 2015; 105(Suppl 2): S311–S317. PubMed Abstract | Publisher Full Text | Free Full Text
3. Kelly TR, Machalaba C, Karesh WB, et al.: Implementing one health approaches to confront emerging and re-emerging zoonotic disease threats: Lessons from PREDICT. One Health Outlook. 2020; 2: 1. PubMed Abstract | Publisher Full Text | Free Full Text
4. Hinjoy S, Wongkumma A, Kongyu S, et al.: An assessment of epidemiology capacity in a one health team at the provincial level in Thailand. Vet. Sci. 2016; 3: 30. PubMed Abstract | Publisher Full Text | Free Full Text
5. Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, et al.: Human disease from influenza A (H5N1), Thailand. Emerg. Infect. Dis. 2004; 11(2): 201–209. PubMed Abstract | Publisher Full Text | Free Full Text
6. Young BE, Chen M: Influenza in temperate and tropical Asia: A review of epidemiology and vaccinology. Hum. Vaccin. Immunother. 2020; 16: 1659–1667. PubMed Abstract | Publisher Full Text | Free Full Text
7. Beitsch LM, Rider NL, Joly BM, et al.: Driving a public health culture of quality: How far down the highway have local health departments traveled? J. Public Health Manag. Pract. 2013; 19(6): 569–574. Publisher Full Text
8. Inmuong U, Charerntanyarak L, Furu P: Community perceptions of health determinants in Khon Kaen Province, Thailand. Southeast Asian J. Trop. Med. Public Health. 2009; 40(2): 380–391. PubMed Abstract
9. Riley WJ, Helen P, Duffy G, et al.: Realizing transformational change through quality improvement in public health. J. Public Health Manag. Pract. 2010; 16(1): 72–78. PubMed Abstract | Publisher Full Text
10. Marshall AI, Witthayapipopsakul W, Chotchoungchatchai S, et al.: Contracting the private health sector in Thailand’s Universal Health Coverage. PLOS Glob. Public Health. 2023; 3(4): e0000799. PubMed Abstract | Publisher Full Text | Free Full Text
11. Mays GP, McHugh MC, Shim K, et al.: Institutional and economic determinants of public health system performance. Am. J. Public Health. 2006; 96(3): 523–531. PubMed Abstract | Publisher Full Text | Free Full Text
12. Tangcharoensathien V, Limwattananon S, Patcharanarumol W, et al.: Achieving universal health coverage goals in Thailand: The vital role of strategic purchasing. Health Policy Plan. 2015; 30(9): 1152–1161. PubMed Abstract | Publisher Full Text | Free Full Text
13. Harinasuta C, Sornamani S, Migasena P, et al.: Socio-economic, health and nutritional status of the villagers in the Nong Wai irrigation area, Khon Kaen, Northeast Thailand. Southeast Asian J. Trop. Med. Public Health. 1976; 7(4): 601–621. PubMed Abstract
14. Kok MC, Dieleman M, Taegtmeyer M, et al.: Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2015; 30(9): 1207–1227. PubMed Abstract | Publisher Full Text | Free Full Text
15. Atkinson JA, Vallely A, Fitzgerald L, et al.: The architecture and effect of participation: A systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination. Malar. J. 2011; 10. PubMed Abstract | Publisher Full Text | Free Full Text
16. Bhattacharyya OK, Estey EA, Zwarenstein M: Methodologies to evaluate the effectiveness of knowledge translation interventions: A primer for researchers and health care managers. J. Clin. Epidemiol. 2011; 64: 32–40. PubMed Abstract | Publisher Full Text
17. Rajatanavin N, Witthayapipopsakul W, Vongmongkol V, et al.: Effective coverage of diabetes and hypertension: An analysis of Thailand’s national insurance database 2016-2019. BMJ Open. 2022; 12(12): e066289. PubMed Abstract | Publisher Full Text | Free Full Text
18. Sripho B, Butsorn A, Chaikhunwatthana A: Underlying Data.xlsx. Dataset. figshare. 2024. Publisher Full Text

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Author details Author details

¹ Sisaket Provincial Public Health Office, Sisaket Province, Thailand
² Ubon Ratchathani University, Mueang Si Khai, Ubon Ratchathani, Thailand

Butsakorn Sripho
Roles: Conceptualization, Investigation, Writing – Original Draft Preparation

Aree Butsorn
Roles: Data Curation, Methodology, Project Administration, Validation

Anan Chaikhunwatthana
Roles: Formal Analysis, Resources, Software, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Sripho B, Butsorn A and Chaikhunwatthana A. Factors affecting fund performance management of the local health security fund committee, Sisaket province [version 1; peer review: 1 approved with reservations]. F1000Research 2025, 14:207 (https://doi.org/10.12688/f1000research.153423.1)

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Reviewer Report 25 Jul 2025

Dina Lusianti, Universitas Muria Kudus, Kudus, Indonesia

Approved with Reservations

https://doi.org/10.5256/f1000research.168323.r398148

This article presents a well-structured and relevant empirical study on the factors influencing fund performance management (FPM) of the Local Health Security Fund Committee in Sisaket Province, Thailand. The authors successfully identify three significant predictors: organizational support, supporting factors, ... Continue reading

This article presents a well-structured and relevant empirical study on the factors influencing fund performance management (FPM) of the Local Health Security Fund Committee in Sisaket Province, Thailand. The authors successfully identify three significant predictors: organizational support, supporting factors, and being a committee member and secretary, which together explain nearly 50% of the variance in performance outcomes. The use of stepwise multiple regression analysis is methodologically sound and appropriately applied to the research objectives.

The study benefits from a representative sample drawn from six districts, utilizing a robust sampling design. The research instruments demonstrate satisfactory content validity and reliability, which supports the credibility of the findings. Nevertheless, the cross-sectional design limits the ability to establish causal relationships, a limitation that should be explicitly acknowledged and addressed in the discussion.

The discussion section is thorough and well-grounded in theory, particularly through the application of Herzberg’s Two-Factor Theory. The authors also contextualize their findings by referencing related studies in similar settings, enhancing the scholarly value of the work. However, the manuscript would be strengthened by a clearer articulation of practical implications—specifically, how local health administrators might translate these findings into policy or capacity-building interventions.

One notable omission is the limited integration of the community’s perspective, particularly the end beneficiaries of the fund. Including such a viewpoint could help bridge the gap between fund management effectiveness and its actual impact on local health outcomes.

In conclusion, this article makes a meaningful contribution to the literature on local health policy and fund management in decentralized healthcare systems. It is particularly relevant for low- and middle-income countries seeking to optimize their local health governance structures. The manuscript is suitable for publication after peer review, with minor revisions suggested to enhance its policy relevance and broaden its stakeholder perspective.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: management; health insurance; marketing

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Dina Lusianti, Universitas Muria Kudus, Kudus, Indonesia

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25 Jul 2025 | for Version 1

Dina Lusianti, Universitas Muria Kudus, Kudus, Indonesia

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Approved With Reservations

This article presents a well-structured and relevant empirical study on the factors influencing fund performance management (FPM) of the Local Health Security Fund Committee in Sisaket Province, Thailand. The authors successfully identify three significant predictors: organizational support, supporting factors, and being a committee member and secretary, which together explain nearly 50% of the variance in performance outcomes. The use of stepwise multiple regression analysis is methodologically sound and appropriately applied to the research objectives.

The study benefits from a representative sample drawn from six districts, utilizing a robust sampling design. The research instruments demonstrate satisfactory content validity and reliability, which supports the credibility of the findings. Nevertheless, the cross-sectional design limits the ability to establish causal relationships, a limitation that should be explicitly acknowledged and addressed in the discussion.

The discussion section is thorough and well-grounded in theory, particularly through the application of Herzberg’s Two-Factor Theory. The authors also contextualize their findings by referencing related studies in similar settings, enhancing the scholarly value of the work. However, the manuscript would be strengthened by a clearer articulation of practical implications—specifically, how local health administrators might translate these findings into policy or capacity-building interventions.

One notable omission is the limited integration of the community’s perspective, particularly the end beneficiaries of the fund. Including such a viewpoint could help bridge the gap between fund management effectiveness and its actual impact on local health outcomes.

In conclusion, this article makes a meaningful contribution to the literature on local health policy and fund management in decentralized healthcare systems. It is particularly relevant for low- and middle-income countries seeking to optimize their local health governance structures. The manuscript is suitable for publication after peer review, with minor revisions suggested to enhance its policy relevance and broaden its stakeholder perspective.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

management; health insurance; marketing

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

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[1] 1. Innes GK, Lambrou AS, Thumrin P, et al.: Enhancing global health security in Thailand: Strengths and challenges of initiating a One Health approach to avian influenza surveillance. One Health (Amsterdam, Netherlands). 2022; 14: 100397. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Gyllstrom E, Gearin K, Frauendienst R, et al.: Local health department factors associated with performance in the successful implementation of community-based strategies: A mixed-methods approach. Am. J. Public Health. 2015; 105(Suppl 2): S311–S317. PubMed Abstract | Publisher Full Text | Free Full Text

[3] 3. Kelly TR, Machalaba C, Karesh WB, et al.: Implementing one health approaches to confront emerging and re-emerging zoonotic disease threats: Lessons from PREDICT. One Health Outlook. 2020; 2: 1. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. Hinjoy S, Wongkumma A, Kongyu S, et al.: An assessment of epidemiology capacity in a one health team at the provincial level in Thailand. Vet. Sci. 2016; 3: 30. PubMed Abstract | Publisher Full Text | Free Full Text

[5] 5. Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, et al.: Human disease from influenza A (H5N1), Thailand. Emerg. Infect. Dis. 2004; 11(2): 201–209. PubMed Abstract | Publisher Full Text | Free Full Text

[6] 6. Young BE, Chen M: Influenza in temperate and tropical Asia: A review of epidemiology and vaccinology. Hum. Vaccin. Immunother. 2020; 16: 1659–1667. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Beitsch LM, Rider NL, Joly BM, et al.: Driving a public health culture of quality: How far down the highway have local health departments traveled? J. Public Health Manag. Pract. 2013; 19(6): 569–574. Publisher Full Text

[8] 8. Inmuong U, Charerntanyarak L, Furu P: Community perceptions of health determinants in Khon Kaen Province, Thailand. Southeast Asian J. Trop. Med. Public Health. 2009; 40(2): 380–391. PubMed Abstract

[9] 9. Riley WJ, Helen P, Duffy G, et al.: Realizing transformational change through quality improvement in public health. J. Public Health Manag. Pract. 2010; 16(1): 72–78. PubMed Abstract | Publisher Full Text

[10] 10. Marshall AI, Witthayapipopsakul W, Chotchoungchatchai S, et al.: Contracting the private health sector in Thailand’s Universal Health Coverage. PLOS Glob. Public Health. 2023; 3(4): e0000799. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Mays GP, McHugh MC, Shim K, et al.: Institutional and economic determinants of public health system performance. Am. J. Public Health. 2006; 96(3): 523–531. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Tangcharoensathien V, Limwattananon S, Patcharanarumol W, et al.: Achieving universal health coverage goals in Thailand: The vital role of strategic purchasing. Health Policy Plan. 2015; 30(9): 1152–1161. PubMed Abstract | Publisher Full Text | Free Full Text

[13] 13. Harinasuta C, Sornamani S, Migasena P, et al.: Socio-economic, health and nutritional status of the villagers in the Nong Wai irrigation area, Khon Kaen, Northeast Thailand. Southeast Asian J. Trop. Med. Public Health. 1976; 7(4): 601–621. PubMed Abstract

[14] 14. Kok MC, Dieleman M, Taegtmeyer M, et al.: Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2015; 30(9): 1207–1227. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Atkinson JA, Vallely A, Fitzgerald L, et al.: The architecture and effect of participation: A systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination. Malar. J. 2011; 10. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Bhattacharyya OK, Estey EA, Zwarenstein M: Methodologies to evaluate the effectiveness of knowledge translation interventions: A primer for researchers and health care managers. J. Clin. Epidemiol. 2011; 64: 32–40. PubMed Abstract | Publisher Full Text

[17] 17. Rajatanavin N, Witthayapipopsakul W, Vongmongkol V, et al.: Effective coverage of diabetes and hypertension: An analysis of Thailand’s national insurance database 2016-2019. BMJ Open. 2022; 12(12): e066289. PubMed Abstract | Publisher Full Text | Free Full Text

[18] 18. Sripho B, Butsorn A, Chaikhunwatthana A: Underlying Data.xlsx. Dataset. figshare. 2024. Publisher Full Text

Factors affecting fund performance management of the local health security fund committee, Sisaket province

Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Methods

Population and participants

Study tools

Tool monitoring

Data analysis

Ethical consent

Research results

General information

Factors affecting the management of the performance of the Sisaket Local Health Security Fund Committee

Table 1. Correlation analysis of factors influencing Local Health Security Fund Committee performance, with 324 variables.

Factors affecting the FPM of the Sisaket Local Health Security Fund Committee

Table 2. Regression coefficients analyze the power of predicting factors to predict the performance of the Sisaket Local Health Security Fund Committee.

Discussion

Conclusion

Recommendation

Data availability statement

Ethics and consent

Acknowledgement

References

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