Level Categorization of Sub-district Health Promoting Hospitals in Thailand, 2017

Abstract

Thailand’s sub-district health promoting hospitals (SHPH) are considered primary care health units, responsible for Thai citizens’ health at the sub-district level. SHPH has played a significant role in the Thai public health. At present, there are as many as 9,871 SHPHs across the kingdom. So far, SHPHs have been classified based on the administrative zones of the Ministry of Interior (MOI). This has created the diversity in the provision of public health services, as each zone has different number of people, villages, and schools, resulting in different needs for health resources. At present, the Ministry of Public Health has classified SHPHs into three levels, based on the number of the population, which may or may not correspond with the resources needed by each sub-district. The aim of this study was to classify of the SHPHs in the proper way, so as to make them more responsive to the local health care need, which would help increase the efficiency of the service and fairer allocation of healthcare resources. This research employed a descriptive cross-sectional study. SHPHs were selected based on the simple random sampling technique. Online questionnaires were sent to 833 SHPHs across Thailand. Data collected were those indicators expected to affect the allocation of resources. The data collection was done during April to July 2017. The two-step cluster analysis was utilized to analyze the data. The results showed that there were other factors contributing to the effectiveness of the allocation of healthcare resources, in addition to the number of population, and those factors were found to be the number of villages, schools, childcare centers, the number of children, school children, and the number of senior citizens, and these factors were found to be significantly related to the categorized SHPHs levels. It is hence more effective to incorporate these factors into the classification of the hospitals. This study suggests that SHPHs be classified into 4 groups, namely, (1) small SHPHs, Medium-size SHPHs, large, and Extra-large SHPHs, based on the results of our statistical analysis coupled with the opinions of the relevant stakeholders and high-level executives. Our analysis of the ratio between the healthcare personnel and the number of persons under their responsibility revealed that the personnel in large and extra-large hospitals were required to handle the number of patients 2-3 times higher than those of the personnel under the small hospitals. This has created unfairness, which implies that more and adequate healthcare resources should be allocated to large and extra-large hospitals. Based on our findings, it is recommended that (1) other factors such as areas along the border, backcountry areas, and distance be incorporated as salient factors in determining the level of sub-district hospitals, which would make better classification, and (2) the results of this study should be distributed and made accessible to relevant stakeholders and related bodies, and forums for discussion and active participation should be facilitated. This would make better criteria for the classification --- more efficient and fairer in terms of resources allocation, resulting in better healthcare services for Thai citizens at large.