Health Service Delivery within the Area Health System Model for Promoting Equity among Older Adults in Thailand

Abstract

This study aimed to explore the patterns of health service delivery within regional health systems that promote health equity among older adults under Thailand’s universal health coverage scheme. A qualitative case study design was employed, using in-depth interviews with 18 key informants comprising eight regional and provincial health administrators and ten health practitioners at district and primary care levels from area health region 2 and 3. Participants were purposively selected based on their involvement in health service management for the elderly. Data were collected using a semi-structured interview guide developed from the Six Building Blocks Plus (SBBP) framework, which covers seven components: health service delivery, health workforce, health information systems, access to essential medicines, health financing, leadership and governance, and community participation. Data were analyzed through content analysis to identify core categories and thematic analysis to synthesize systemic mechanisms influencing health equity among the elderly. The findings revealed that regional health systems played a crucial role in fostering equity through four key mechanisms: area-based management and health financing that enhance service accessibility, evidence-informed budgeting at the regional level, governance and leadership that strengthen monitoring and coordination, and public and elderly participation in planning processes. Overall, the study highlights that regional health systems can drive sustainable equity for the ageing population through decentralized management, transparent information use, and multi-sectoral collaboration.