Comparison of Care Models and Costs for Bedridden Older Adults under the Primary Care Network of Lampang Hospital between Transferred and Non-Transferred Subdistrict Health Promoting Hospitals to Local Administrative Organizations

Abstract

This mixed-methods research aimed to study the situation and care models for bedridden older adults and to compare the care costs between subdistrict health promoting hospitals (SHPHs) that had been transferred to local administrative organizations (LAOs) and those that had not. The study was conducted in two phases. Phase 1 explored the situation and care models using a qualitative approach. Six purposively selected key informants were interviewed in-depth, using a semi-structured interview guide, and data were analyzed using content analysis. Phase 2 compared the costs of care using a quantitative approach, using activity-based costs from the provider in the fiscal year 2024. Costs included labor and equipment, recorded through a cost data form, and analyzed with descriptive statistics. The results were as follows.

1. The care models for bedridden older adults were similar between transferred and non-transferred SHPHs. Both received personnel support from the parent hospital, using referral and follow-up programs through the home-based continuing care system. However, during the early phase of transfer, limitations in resource support from the parent hospitals were observed.

2. Among 299 bedridden older adults (M = 74 years) receiving home visits, the median direct cost per person was 2,240.48 THB for transferred SHPHs and 2,228.24 THB for non-transferred SHPHs. Activity-based costs for green-level patients included four activities, with median costs ranging from 167.24 – 1,003.46 THB and 164.72 – 1,250.12 THB per person for transferred and non-transferred SHPHs, respectively. For yellow-level patients, 13 activities were identified, with median costs of 76.97 – 461.81 THB and 72.34–434.07 THB per person, respectively. For red-level patients, 15 activities were identified, with median costs of 64.73–424.73 THB and 64.29–424.29 THB per person, respectively.

Activity-based cost data play a crucial role in guiding appropriate resource allocation and cost management, taking into account the complexity of services required for bedridden older adults to maximize efficiency and health benefits.