The development of an operational model for direct disbursement of medical expense in healthcare units under the Buriram provincial public health office

Abstract

     This action research aimed to study the development of an operational model for direct disbursement of medical expense in healthcare units under the Buriram provincial public health office. The study applied the PAOR action research framework. The samples consisted of 2 groups: 1) 12 samples from network participants and 2) 47 samples from health insurance officers selected by purposive sampling. Quantitative data was collected by the questionnaire and focus group discussion guidelines. Data was collected between October 2025 to March 2026. Data analysis was performed by descriptive and comparative analysis was performed by paired t-test with a significance level of 0.05. Qualitative data using content analysis.

     The research findings the showed the development of an operational model for direct disbursement of medical expense in healthcare units consisted of 5 components 1) Management & Capacity Building 2) Eligibility & Service Management 3) Data Management & Pre-Claim Audit 4) Claim Management & Follow-up 5) Monitoring, Evaluation & Improvement. After implementation of the model, participants demonstrated significantly improved knowledge regarding direct billing for medical treatment expenses and significantly higher levels of success factors related to direct billing operations (p-value<0.001).