Development of value-based health service packages and Value-Based Payment methods for Health Promotion and Preventing diabetes among risk people of diabetes, Health Region 9

Abstract

This research aims to develop a model of health service for health promotion and disease prevention in people at risk of diabetes, linked to value-based payment, and to compare behavior modification in at-risk groups. This participatory action research (PAR) utilizes the PAOR process, which includes planning (P), Action (A), Observation (O), and reflection (R). The study is conducted in 4 purposively selected community hospitals: Hospitals A, B, C and D. A sample of 1,586 people from the diabetes risk group was selected using a purposive sampling method along with 16 purposive samples assigned responsibility for implementing measures to reduce the risk of chronic non-communicable diseases. The study period was from October 2022 to November 2023. Data were analyzed using descriptive statistics, Paired t-tests for analytical statistic, and content analysis for qualitative data. The results of this study include a model for organizing health service packages and a Value-Based Payment method for promoting health and preventing diabetes in people at risk, with the participation of network agencies responsible for implementing diabetes risk reduction measures. These efforts are aimed at driving the policy and operational measures under the NCD Board at the district and provincial levels. There was clear communication and understanding of guidelines, with participation in planning, decision-making, and evaluating results after implementing this model. It was found that the mean BMI and blood sugar levels significantly decreased after the intervention (p<0.001). From the results of this study, it can be concluded that the effectiveness of the behavior modification program for diabetes, combined with Value-Based Payment for health promotion and diabetes prevention, depends on its application in the context of health service units and participation in community-level networks.