The Development Model of Health Service Delivery for Long-Term Care in Community by the Primary Health Care System and The Local Health Assurance Fund, Maha Sarakham Province

Abstract

Background and Aims: Thailand is now seeing a full-blown aging population. Elderly people often have more chronic ailments, are largely dependent, and have limitations in their everyday activities. As a result, they need medical and public health care. The government has established policies to support and reform the aged health care system in terms of home/community care and self-care in the primary health care system with a variety of innovations, as the trend toward an older population and the need for health care without caregivers both grow. Therefore, a model for creating long-term healthcare services for the elderly in the community should exist to maximize the effectiveness and efficiency of public health services for the aged. This research aims to develop a model for the development of long-term health services for the elderly in the community through the primary health care system and the local or regional health insurance fund in Maha Sarakham Province.

Methodology:  This study uses a combination of methodologies. Phase 1 is qualitative research in which the action research hypothesis is determined by applying the PDCA quality cycle concept to the 1,400-person target group. The population and a 400-person sample are being studied in phase two, which involves quantitative research. Phase 3 is qualitative research, which involves developing a development model and having 12 experts use the Delphi technique to evaluate and confirm (Expert Verify).

Results: (1) To create a model for delivering long-term health services for the elderly in the community through the primary health care system and the health insurance fund at the local or regional level, the pertinent target groups took part in each stage of the PDCA quality cycle process. With a mean value of 4.30 and a standard deviation of 0.51 for the sample group, the research findings indicated that the primary health care system and the health insurance fund at the local or regional level in Maha Sarakham Province were developing long-term health services for the elderly in the community at a good level overall. (2) The community's provision of long-term elderly health services was influenced by five factors: the transfer of sub-district health promotion hospitals to the provincial administrative organization (PAO); health communication with the community and society; management of the local administrative organization's sub-fund (LTC); involvement of network partners in the community; and the needs and expectations of the benefits to be received. The five predictive factors had a statistically significant (p<0.05) multiple regression value of 0.715, and taken together, they may predict a 63.70 percent increase in the community's long-term elderly health care (R2=.637, F= 29.739). (3) The primary health care system and the health insurance fund at the local or regional level, Maha Sarakham Province, then create a development model for long-term health services for the elderly in the community through the following two main components: 1) Development of long-term health services for the elderly in the community, which consists of five main components and 38 sub-components; and 2) Components of factors and conditions that influence the development of long-term health services for the elderly in the community, which consists of five main components and forty sub-components.

Conclusion: The primary health care system and the health insurance fund at the local or regional level, Maha Sarakham Province, have developed a model for long-term elderly health services in the community that has been effectively assessed and enhanced. This model has a high degree of appropriateness. Order to build a robust and creative primary healthcare system in Thailand may result in the creation of policy ideas to maximize the potential of the primary healthcare unit network by integrating with the health insurance fund locally for efficiency.