OBJECTIVES: The number of confirmed COVID-19 cases in Thailand were almost 4 million, with 128 deaths from the disease and rising continuously. Tambon Health Promoting Hospitals (THPH), a primary care unit focusing on proactive problem solving at the individual and community levels continuously, were also affected by the COVID-19 pandemic. This study is to assess the impact of the COVID-19 pandemic on primary healthcare service unit costs at THPHs from the provider’s perspective in Thailand and to investigate the surge capacity management at THPHs during the COVID-19 pandemic.

METHODS: This study is mixed methods including the quantitative part of costing analysis and the qualitative part of in-depth interviewing the healthcare personnel at the THPHs. Thirty-six THPHs included in this study were varied by size (S, M, and L) and location across 6 regions in Thailand. The average unit costs (total costs/ No. of utilization) of primary healthcare services were estimated by the activity-based costing technique using standard costing approach and discussed by the context of THPHs. Multivariate log-linear regressions were employed to investigate the impact of the COVID-19 pandemic on the average unit costs of primary healthcare services. Content analysis was used to understand the relevant reasons between the changes in costing and the surge capacity at the THPHs.

RESULTS: Switching from a normal situation (in the year 2019) to the COVID-19 pandemic (in the year 2020 and 2021), this resulted in decrease in expected average unit costs of primary healthcare services at 53.98% (35%-132%) and 13.67% (39%-123%), respectively. Surge capacity of the THPHs needs the efficient networking between the healthcare team and the local government in the province regarding to the differences in THPH’s context.

CONCLUSIONS: The severity of COVID-19 pandemic could impact the resources used and working process to preserve accessibility to primary healthcare services.