Singweratham Noppcha, Sriratanaban Jiruth, Komwong Daoroong, Maneechay Mano, Siewchaisakul Pallop
Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Healthcare (Basel). 2025 Aug 1;13(15):1884. doi: 10.3390/healthcare13151884.
: In Thailand, the transition of primary care units (PCUs) to Local Administrative Organizations (LAOs) has raised concerns regarding the potential impact on healthcare service delivery. This study aimed to compare health services between PCUs that have been transferred to LAOs and those that have not. : A total of 15 transferred PCUs (T-PCUs) and 45 non-transferred PCUs (NT-PCUs), matched by population within the same provinces, were purposively sampled. The study population consisted of the cumulative number of diabetes (DM) and hypertension (HTN) screenings retrieved from the National Health Security Office (NHSO) database from 2017 to 2023. The impact of the LAO transfer policy on health service delivery was assessed using generalized estimating equation (GEE) models. All analyses were performed using Stata version 15. : The result showed no significant difference in the population and size of PCUs. DM screening was non-significantly lower by 18.9% (AdjRR: 0.811), and HTN screening was lower by 18.6% (AdjRR: 0.814), when comparing T-PCU with NT-PCU. Similarly, the DM and HTN screening in T-PCU was non-significantly lower than NT-PCU when interacting with time. Both T-PCU and NT-PCU show decreases over time; however, the decrease was not statistically significant. : Our results show a non-significant difference in DM and HTN screening between T-PCU and NT-PCU. Therefore, decentralization did not clearly demonstrate a negative impact on the delivery of these health services. Further research is needed to consider other confounding and covariate factors for DM and HTN screening.
在泰国，基层医疗单位（PCUs）向地方行政组织（LAOs）的转变引发了人们对医疗服务提供潜在影响的担忧。本研究旨在比较已转至LAOs的PCUs和未转至LAOs的PCUs之间的医疗服务情况。
共选取了15个已转移的基层医疗单位（T - PCUs）和45个未转移的基层医疗单位（NT - PCUs）作为样本，这些样本在同一省份内按人口进行匹配。研究人群包括从2017年至2023年从国家健康保险办公室（NHSO）数据库中检索到的糖尿病（DM）和高血压（HTN）筛查累计数量。使用广义估计方程（GEE）模型评估LAO转移政策对医疗服务提供的影响。所有分析均使用Stata 15版本进行。
结果显示，基层医疗单位的人口和规模没有显著差异。与NT - PCU相比，T - PCU的DM筛查降低了18.9%（调整相对风险率：0.811），差异无统计学意义，HTN筛查降低了18.6%（调整相对风险率：0.814）。同样，在与时间交互时，T - PCU的DM和HTN筛查略低于NT - PCU，但差异无统计学意义。T - PCU和NT - PCU的筛查率均随时间下降；然而，这种下降没有统计学意义。
我们的结果显示，T - PCU和NT - PCU在DM和HTN筛查方面没有显著差异。因此，权力下放并未明显显示出对这些医疗服务提供的负面影响。需要进一步研究考虑DM和HTN筛查的其他混杂因素和协变量因素。
