กลยุทธ์การบริหารทรัพยากรสุขภาพให้เกิดความคุ้มค่า : ประสบการณ์ของพยาบาล กลุ่มงานประกันสุขภาพ โรงพยาบาลศูนย์1,2

Pachara Peerapadhanapong; Areewan Oumtanee

Authors

Pachara Peerapadhanapong Faculty of Nursing, Chulalongkorn University
Areewan Oumtanee Faculty of Nursing, Chulalongkorn University

Keywords:

health resource management strategies, nurses in health insurance departments, qualitative research

Abstract

This qualitative descriptive study aimed to explore strategies employed by nurses in the Health Insurance Department of a regional hospital to ensure efficient health resource utilization. Twelve professional nurses with a minimum of five years’ experience in the Health Insurance Department of a regional hospital, along with formal training in health resource management, were purposively selected as key informants. Data were collected through in-depth interviews, direct observations, and field notes. Data analysis was conducted using Braun and Clarke’s thematic analysis, and the trustworthiness of the data was ensured following Guba and Lincoln’s criteria.

The findings revealed five key strategies for efficient health resource management by nurses in the Health Insurance Department: 1) Cost analysis to reduce financial risks, where nurses evaluate costs and returns to prevent financial losses from health service delivery; 2) Appropriate budgeting and control, involving the establishment of guidelines to align budget utilization efficiently with organizational goals; 3) Ensuring compliance with fund entitlement standards, where nurses verify that services meet fund requirements to secure appropriate reimbursements; 4) Adapting practices to align with reimbursement criteria, which includes making operational adjustments in accordance with fund regulations and procedures; and 5) Active involvement in service planning and development, where nurses participate in designing new services and improving existing ones to address public needs and optimize resource use.

The findings of this study can be applied to promote the proactive role of nurses in the Health Insurance Department in planning, cost analysis, and resource management under the constraints of benefit schemes. In addition, the results may support hospital administrators in developing service systems and practical guidelines to prepare nurses for future roles.

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