Comparison of Health Service Delivery for Dependent Older Adults between Subdistrict Health Promoting Hospitals Participating and Not Participating in the Long-Term Care Fund in Lampang Province

Abstract

This mixed-methods study employed a convergent parallel design. The objectives were to examine models of health service delivery and compare the costs and effectiveness of health service delivery for dependent older adults between Subdistrict Health Promoting Hospitals (SHPHs) participating and not participating in the Long-Term Care (LTC) Fund for Older Adults with Dependency under the National Health Security System in Lampang Province. The study was conducted in two phases. Phase 1 involved a qualitative investigation of service delivery models among long-term care system managers or personnel responsible for services for older adults with dependency. A purposive sample of 12 participants was recruited. Data were collected through in-depth interviews, using a semi-structured interview guide, and analyzed using content analysis. Phase 2 involved a quantitative comparison of the costs and effectiveness of service delivery during fiscal year 2024. Data were collected using cost-recording forms, covering material and home-visit costs together with records of Activities of Daily Living (ADL) scores. The sample consisted of 292 older adults with dependency. Data were analyzed using descriptive statistics including frequency, percentage, mean, as well as median and inferential statistics, including the Sign Test and the Mann–Whitney U Test. Results were as follows:

1. Service delivery models: Both groups primarily emphasized home-based health care, conducted ADL assessments, and provided continuity of care through the Continuity of Care (COC) program. SHPHs participating in the LTC Fund had clearly defined management mechanisms and a fixed annual bundled budget of 10,442 baht per person. Paid caregivers conducted regular home visits in accordance with individualized care plans. In contrast, SHPHs not participating in the LTC Fund had unclear supportive policies, did not develop individualized care plans, and relied on internal budgets supplemented by resource mobilization from civil society organizations.

2. Service delivery costs: The median total cost differed significantly between SHPHs participating and not participating in the LTC Fund (p-value < .001). Regarding effectiveness, the median ADL scores showed no significant differences within or between the two groups before and after receiving services.

In conclusion, management under the LTC Fund maintained ADL scores at a level comparable to that achieved through usual care while incurring lower total costs, indicating greater cost-effectiveness.

Therefore, local administrative organizations that have not yet participated in the LTC Fund should be encouraged to participate in it, and promote the public health system's financial sustainability.