A Comparative Study on Service Models and Health Care Costs in Palliative Care between Transferred and Non-Transferred Subdistrict Health Promoting Hospitals to Local Administrative Organizations in the Primary Care Network of Lampang Hospital
Keywords:
: Palliative Care Patients, Service Cost, Primary Care Network, Local Administrative OrganizationAbstract
This mixed-methods research aimed to: 1) explore the current situation and service models, and 2) compare the costs for palliative care services between Subdistrict Health Promoting Hospitals (SHPHs) that have been transferred or not to a Local Administrative Organizations (LAO) in the primary care network of Lampang Hospital. The study was conducted in two phases. Phase 1 involved examining the situation and service models of palliative care through in-depth interviews, using a semi-structured interview guide with 11 purposively selected palliative care providers. Data were analyzed using content analysis. Phase 2 focused on comparing service costs. Cost data were collected at both the service level and the individual patient level, including labor, materials, and equipment costs for the fiscal year 2024. Data were analyzed and presented using descriptive statistics. The results revealed as follows.
1. The policies, service referral systems, personnel, drug and non-drug supplies for palliative care patients were found to be aligned between transferred and non-transferred SHPHs. Although coordination issues were initially observed after the transfer, the implementation of a province-level Memorandum of Understanding (MOU) improved coordination efficiency.
2. A total of 148 home visit activities were conducted for palliative care patients, with an average patient age of 71 years. Most patients had moderate chronic illnesses, with no significant differences between the transferred and non-transferred groups. The total cost of services was 684,519.51 THB, with labor, capital, and material costs accounting for 98.11%, 1.59%, and 0.30%, respectively. The average cost per patient was 4,625.13 THB, and the cost per visit was 3,259.62 THB. The highest individual service cost was for opioid medications used for pain relief, at 7,481.65 THB per person.
Understanding individual patient-level costs provides insights into resource utilization for service provision, which can support more effective resource management and inform improvements in service models within the context of SHPH transfers to LAOs.
References
Aswateerakul, N., Wongkum, P., Puangpho, T., & Yodmongkol, P. (2013). A Guide for the Public: Palliative Care for End-of-Life Patients. Nonthaburi, National Health Commission Office (NHCO).
Chaikledkaew, U. (2014). Health Technology Assessment Manual for Thailand, Version 2. Development of the Health Technology Assessment Manual for Thailand. Nonthaburi: wacharin p.p. printing co., 978-616-11-1963-8. (in Thai)
Charlson, M. E., Pompei, P., Ales K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Disease, 40(4), 373-383.
Cohen, J. M., & Peterson, S. B. (1999). Administrative Decentralization: Strategies for Developing Countries. Colorado: Kumarian Press.
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and Conducting Mixed Methods Research. (3rd ed.). Los Angeles.
Department of Medical Services. (2020). Guideline for palliative care for healthcare professionals. Department of Medical Services Journal, 41(1), 19-22. (in Thai)
Department of Thai Traditional Medicine and Alternative Medicine. (2018). Manual for Integrated Palliative Care for End-of-Life Patients. Bangkok, Best Step Advertising. (in Thai)
Health Insurance Group. (2013). A Handbook on Unit Cost Analysis of Health Care Service. Bangkok: The Office of Permanent Secretary, Ministry of Public Health. (in Thai)
Health Data Center. (2024). Palliative Care Including Family Meeting and Advance Care Planning (ACP) with Patients and Families. Nonthaburi: Ministry of Public Health. (in Thai)
Keramatikerman, M. (2020). Efficacy of complementary and alternative therapies in cancer patients: A systematic review, Biomed J Sci & Tech Res, 29(1), 22126-9.
Khiaocharoen, O., Zungsontiporn, C., Khattiyod, T., Wanwong, Y., Baimuang, C. & Pannarunothai, S. (2020). Unit cost per disease methodology for Thailand: Micro-costing method. Journal of Health Systems Research, 14(2), 74-156. (in Thai)
Kulthanmanusorn, A., Saengruang, N., & Wanwong, Y. (2012). Evaluation of The Devolved Health Centers: Synthesis Lesson Learnt from 51 Health Centers and Policy Options. Retrieved January 11, 2025, from https://kb.hsri.or.th/dspace/handle/11228/4866 (in Thai)
Mack, J. W., Cronin, A., Keating, N. L., Taback, N., Huskamp, H. A., Malin, J. L., et al. (2008). Associations between end-of-life discussion characteristics and care received near death: a prospective cohort study. J Clin Oncol, 30(35) , 4387-4395.
Medical Information Center. (2024). Report of Patients Diagnosed with Code Z51.5. Medical Information Center of Lampang Hospial. (in Thai)
Monpolsri, E., Singweratham, N., Dithaprawat, B., Phaekhuntod, S., & Jatturakasem, N. (2022). A model of complimentary care of Dhammanamai principles on palliative care for cancer patients. Journal of Boromarajonani College of Nursing, Surin, 12(2), 114–129.
National Health Security Office, Thammasat University. (2017). Cost Evaluation of Palliative Care Services in Health Region 7. NHSO.
Netipothi, W. (2006). The Political Process of Public Health Decentralization in Thailand: studying the Case of Primary Care Units. Health Systems Research Institute. (in Thai)
Nursing Division, Office of the Permanent Secretary, Ministry of Public Health. (2018). Guidelines for the Development of Nursing Service System: Service Plan. Pathum Thani: Sia Tawan Publishing Company. (in Thai)
Office of Public Accounting Standards. (2014). A Guide for Unit Cost Calculation of Public Services for Fiscal Year 2557 B.E. Bangkok: The Comptroller General's Department. (in Thai)
Office of the Decentralization to the Local Government Organization Committee. (2021). Guidelines for Transferring Missions of The Chaloem Phrakiat 60th Anniversary Nawaminthrachini Health Station and Subdistrict Health Promoting Hospital to the Provincial Administrative Organization.Bangkok: The Prime Minister's Office. (in Thai)
Pairojkul, S., Thongkhamcharoen, R., Raksasataya, A., Sorasit, C., Nakawiro, P., Sudsa, S., et al. (2001). Integration of specialist palliative care into tertiary hospitals: A multicenter point prevalence survey from Thailand. Palliative Medicine Reports, 2(1), 272-280.
Pitayarangsarit, S., Tosanguan, J., & Sumalee, H. (2010). The Role of Local Administrative Organizations in Health Promotion and Policy Recommendations for Decentralization of Health Promotion. (Research Report). Health Systems Research Institute. (in Thai)
Riewpaiboon, A., Kheawcharoen, O., Batsungnoen, P., Wongphan, T., Techakehakij, W., ingweratham, N. et al. (2018). Cost Analysis of Health Promotion and Disease Prevention Services. Bangkok: Faculty of Pharmacy, Mahidol University. (in Thai)
Saengmano, S., Siriwohan, S., & Phichai, K. (2014). Problems of transferring district health promoting hospitals from the ministry of public health to local government organizations in Chiang Mai province. Journal of Graduate Research, 5(2), 25–35. (in Thai)
Singweratham, N., Phodah, T., Techakehakij, W., Bunpean, A., Siechaisakul, P.,Nawsuwan, et al. (2023). A comparison of the unit costs of health care services providers with and without tranferred to the local administrative organization of the tambon health promoting hospitals. Princes of Naradhiwas University Journal, 15(3), 251-264. (in Thai)
Sriratanaban, J., Singweratham, N., Komwong, D., & Maneechay, M. (2024). Assessment of population health impacts from the transfer of sub-district health promoting hospitals to the provincial administrative organizations in 2023: Phase 1 potential warning signs. Health Systems Research Journal, 18(2), 152-172.
Srivanichakorn, S. (2008). Over-crowding problems in hospitals. Journal of Health Systems Research, 1(3-5), 216-223. (in Thai)
Supasarn, P., & Wisesrith, W. (2019). Study of unit cost and activity based costing of nursing care for palliative care in cancer patients, Nang Rong hospital, Buriram province. Journal of The Royal Thai Army Nurses, 19, 158–165. (in Thai)
Suppatheerathada, C. (2020). Policy recommendations for budget allocation as subsidies to System of Public Health Centers to Local Government Organizations. Health Systems Research Journal, 3(1), 113-130. (in Thai)
Techaatik, S., & Nakham, P. (2010). Studying and monitoring the development of the transfer system of public health centers to local government organizations. Nonthaburi, Health Systems Research Journal, 3(1), 113-130. (in Thai)
Vankun, P., Saramunee, K., & Chaiyasong, S. (2021). Cost of palliative care for cancer patients of a community hospital in Khon Kaen province. Journal of Health Systems Research, 15(3), 310-325. (in Thai)
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