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The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms

Siranee Intaranongpai, David Hughes, Songkramchai Leethongdee

The International Journal of Health Planning and Management, Volume: 27, Issue: 4, Pages: n/a - 326

Swansea University Author: David Hughes

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DOI (Published version): 10.1002/hpm.2113

Abstract

The authors examine the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003–2005 and 2008–2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for p...

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Published in: The International Journal of Health Planning and Management
ISSN: 0749-6753
Published: 2012
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URI: https://cronfa.swan.ac.uk/Record/cronfa11274
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spelling 2011-10-01T00:00:00.0000000 v2 11274 2012-06-12 The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms f1fbd458e3c75d8b597c0ac8036f2b88 David Hughes David Hughes true false 2012-06-12 FGMHL The authors examine the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003–2005 and 2008–2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as ‘power followed the money’, and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools—strategic plans, targets, KPIs and benchmarking—that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Journal Article The International Journal of Health Planning and Management 27 4 n/a 326 0749-6753 Thailand, health reforms, universal coverage, primary care 31 12 2012 2012-12-31 10.1002/hpm.2113 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2011-10-01T00:00:00.0000000 2012-06-12T11:19:25.3185083 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Siranee Intaranongpai 1 David Hughes 2 Songkramchai Leethongdee 3
title The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms
spellingShingle The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms
David Hughes
title_short The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms
title_full The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms
title_fullStr The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms
title_full_unstemmed The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms
title_sort The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms
author_id_str_mv f1fbd458e3c75d8b597c0ac8036f2b88
author_id_fullname_str_mv f1fbd458e3c75d8b597c0ac8036f2b88_***_David Hughes
author David Hughes
author2 Siranee Intaranongpai
David Hughes
Songkramchai Leethongdee
format Journal article
container_title The International Journal of Health Planning and Management
container_volume 27
container_issue 4
container_start_page n/a
publishDate 2012
institution Swansea University
issn 0749-6753
doi_str_mv 10.1002/hpm.2113
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
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description The authors examine the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003–2005 and 2008–2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as ‘power followed the money’, and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools—strategic plans, targets, KPIs and benchmarking—that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time.
published_date 2012-12-31T03:13:50Z
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