The Comparison on Budget Allocation of The National Health Security Fund between Before and After Transferred the Tambon Health Promoting Hospital to The Phuket Provincial Administrative Organization

Abstract

This mixed-methods study aimed to: (1) examine and compare the allocation of public health service budgets under the National Health Security Fund (NHSF), and (2) compare the unit costs of services provided by Tambon Health Promoting Hospitals (THPHs) before and after their administrative transfer to the Phuket Provincial Administrative Organization (PAO). The study was conducted in two phases. In Phase 1, the research focused on the budget allocation processes and changes pre- and post-transfer. Both qualitative and quantitative methods were employed. Three THPHs—representing small, medium, and large facilities—were purposively selected, along with 10 financial officers responsible for budget management. Qualitative data were collected via in-depth interviews and analyzed through content analysis. Quantitative data, drawn from NHSF expenditure records, were analyzed using descriptive statistics and presented as frequencies and percentages. Phase 2 assessed changes in unit costs of health services in fiscal years 2022 and 2023. This included analysis of labor, material, and equipment costs, using a standardized data collection form. Data were summarized using descriptive statistics (totals, percentages, and means). Key findings included:

1. Budget Allocation Changes: Before the transfer, budgets were allocated through agreements within the Contracting Unit for Primary Care (CUP), covering medical and non-medical supplies. After the transfer, allocation was overseen by the Provincial Health Board (PHB), resulting in structural changesmost notably, direct transfers from the National Health Security Office (NHSO) for health promotion and disease prevention (P&P) services. Post-transfer, allocations for medicines and non-medical supplies decreased by 13,140.63 to 160,643.74 THB (a reduction of 8.97% to 17.95%), while direct funding from NHSO increased by 26,506.25 to 1,540,597.27 THB (an increase of 57.10% to 329.10%).

2. Cost Comparisons: Total public health service expenditures decreased slightly after the transfer, from 13,279,044.06 THB to 12,992,762.78 THB. Labor costs, however, increased by 893,622 THB (10.25%). Unit costs of several services rose, notably maternal health promotion, which increased from 1,183.16 THB to 1,810.97 THB. 

These findings indicate that the budget allocation system is currently in a transitional phase. Continuous monitoring of public health service costs is crucial to ensure cost control, efficiency, and equitable service delivery across THPHs of varying sizes—thereby minimizing financial and operational disruptions in local health systems.