Bridging health and social care: Governance insights from Thailand's S-TOP intermediate care pilot

Intermediate Care (IMC) provides intensive rehabilitation to prevent long-term disability among partially dependent individuals. Demand for IMC in Thailand is rising, yet governance frameworks remain underdeveloped. The Seamless Health and Social Services Provision for Elderly Persons (S-TOP) project, a Japan International Cooperation Agency (JICA) pilot, aimed to strengthen IMC governance by improving service delivery for older adults.

To explore and compare the governance models of IMC in two pilot sites in Thailand from the viewpoints of health and social service providers.

We explored IMC governance within JICA pilot sites through a qualitative comparative case design. We gathered data from 13 in-depth interviews, site visits, and document reviews. Using thematic analysis, we compared different governance patterns from the provider's perspective to understand how local contexts shape implementation, transdisciplinary teamwork, and overall governance.

Two distinct governance models emerged, both perceived by stakeholders as having achieved integration of health and social care. The lead organization model enabled direct service creation and flexible resource allocation, while the shared governance model leveraged strong health care networks and community altruism to coordinate care within the national framework. Despite differing in seniority structures, with one based on position and the other on age, both models enhanced service accessibility and promoted health equity through tailored, community-based systems.

Community-based IMC governance succeeds when aligned with local structural and cultural contexts. The integration of health and social care requires adaptable mechanisms, whether through local government leadership or collaborative health care networks, while respecting culturally embedded decision-making norms.

The lead organization model suits decentralized settings with strong local government. The shared governance model suits centralized settings with robust health care networks and cultural assets like age-based seniority and altruism. Health administrators should cultivate transdisciplinary teams that integrate professional expertise with community knowledge and respect local decision-making norms.