Estimating cost of long term care.

สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย
HealthInsuranceSystemResearchOffice
HealthSystemResearchInstitute
Unit Cost for Long Term Care:
Lamsonti District
Workshop on Long Term Care Policy For Elderly in Thailand
The United Nation/ Royal Thai GovernmentJoint team on Social Protection
26 September 2013
Thaworn Sakunphanit
Utoomporn Wongsin
Santi Labbenchakul
1

Outline
 Background
 Cost of Long term care
 Long term care at Lamsonti
 Objective
 Methodology
 Result

3
Thailand: 91% of LTC are provided by family
Source: National Statistic Office
Source: OECD(2011) Help Wanted? Providing and Paying for LTC
OECD: size of family care giver is
at least double that of the formal
care workforce

Cost of Long Term Care
4
Source: OECD(2007) Conceptual Framework and Methods for Analysis of Data Sources for LTC Expenditure

Cost of Long Term Care
• Probability for requirement of the Long
term care is very low
• However, the cost of not well managed
Long term care is very high
• Study in Bangkok (Worawet,2009) :
– Average cost in Nursing home was 18,000 Baht
per month (600 $US)
– Cost for Paid care giver was 8,000 – 11,000 Baht
per month (266-366 $US)
5

Long-term care expenditures
6
Souce: Westerhout & Pellikaan (2005)

HealthSystemResearchInstituteHealthInsuranceSystemResearchOffice
Modified Barthel Index
The Modified Barthel Index, which was developed by Ministry of
Public Health, consists of 10 items with 20 scores that measure
a person's daily functioning specifically the activities of daily living
and mobility.
Level of dependence Score
Level 1 Mild dependent More than 12
Level 2 Moderate dependent 5-11
Level 3 Severe dependent 0-4

HealthSystemResearchInstituteLong Term Care in Lumsonthi District
Lamsonti
- A District in Lopburi province
- Chief district Officer is appointed from Central Gov
Local Governments
- 7 Tambon Administration Organizations
Health Care:
- 1 Community Hospital
- 7 Health Centres

Total Population: 26,284
Population > 60 years old: 2,169
Impairment assessment by Modified Bartel ADL index
- Independent to mild 92%
- Moderate impairment 7%
- Severe impairment 1%
Long term care in Lamsonthi is provided by “Formal” Care
Giver (paid by local gov) and Heath Care Team
Population in every age groups can enjoy Long term Care
services include mental disorder
Long Term Care in Lamsonti

HealthSystemResearchInstituteHealthInsuranceSystemResearchOffice
References:: Dependency information of Lamsonthi Hospitalin fiscal year 2012
Dependency Information of Lamsonthi District
(Fiscal year 2012)
Elderly (more than 60 years) Non- elderly
Mild dependent 99 142 241
Moderate dependent 44 21 65
Severe dependent 24 13 37
Total 167 176 343
The number of members of LTCprogramme
TotalLevelof dependence

Social care
by Local
government
Health care by
health
facilities
Empower
family care
HOME BASED
Integrated district
care system
Long Term Care in Lumsonthi District
Care givers
EnvironmenHealth Care
-Prevention
-Curative
-Rehabilitation
Oversee by
Chief District
Officer

Psychiatrist
Care giver
Community nurse
In-patient Nurse
Family
Donor
Pharmacist
Physiotherapist
Tambon Authority Organisation
Doctor

Specific case

Paid Care givers in every sub-district (39)
Specific case

Prepare patient to go back home

Modified house

From Bed-ridden to mobility

HealthSystemResearchInstitute How Much did Lumsonthi Spend
for the Long Term Care?
• Preliminary result of Cost Accounting Study for
the Long term care in Lumsonthi
• Long Term Heath Care Expenditure
– Hospital cost for LTC: 150,000 $us/year in 2012
• Average unit cost per case: 32 $US per case
– Health centre cost for LTC
• Long Term Social Care Expenditure
– Salary Paid care giver: 200 $US per month
– Other Tambon administration costs
18

Objective
• Estimate cost per day of Community
Based (Home care) Long Term Care at
Lamsonti
19

Costing method of Ministry of public health Thailand
Supporting Cost
Centre
Service Cost
centre
Full cost Full cost
Full Cost
Cost Centres
Identification
Traditionalmethod
Accrual basis
Accounting
Allocation
factor

MethodologyHealthInsuranceSystemResearchOffice
-Cost of LTC form hospital: Adjust cost accounting of Lamsothi
hospital, which used a traditional costing method of Ministry of
public health
- Adjust direct cost of Operating Unit
- Cost centre for long term care
- Other cost centres
- Adjust allocation factor of Supporting units (cost centres)
- Calculate full cost of Operating units (cost centres).
-Determine workload of long term care for different level of
independence to calculate unit cost per day.
-Cost of LTC of health center: Estimate cost from time and
material which are supported by Health center.
-Cost of “Formal” Caregiver : Estimate cost of caregiver from salary
of caregiver

Cost of Lamsonthi hospital in 2012HealthInsuranceSystemResearchOffice
สำนักงำนวิจัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย เครือสถำบันวิจัยระบบสำธำรณสุข
LaborCost MaterialCost CapitalCost TotalCost
59% 39% 2% 100%

Cost of Long term care service unit in 2012
UnitCost LabourCost MaterialCost CapitalCost TotalCost
Longtermcareservice 2,278,418 2,233,282 - 4,511,700
Unit: Baht

Unit Cost from Lamsonthi hospital
Averagecost
perday
Averagecost
permonth
Averagecost
peryear
(1) (2) (1)*(2) (3) (4) (4)/(3) ((4)/(3))*30 ((4)/(3))*12
Mild dependent 241 1 241 2,635,926 81,639 32 969 11,624
Moderate dependent 65 1.5 97.5 1,066,402 23,414 46 1,366 16,396
Severe dependent 37 2 74 809,372 12,337 66 1,968.16 23,618
Total 343 413 4,511,700 117,390
Longtermcareservicecosting
Levelofdependence
Thenumberof
membersofLTC
programme
Weight
Thenumberof
membersofLTC
programme
(Weighted)
TotalCost Thenumberof
daysserved.
Note: Delphi method was used to get Weight (Level of workload) of
Physiotherapist teams

Unit Cost of LTC from Formal Caregiver
Note: Delphi method was used to get Weight (Level of workload) of Formal
Caregivers from opinion of Physiotherapist teams
Averagecost
perday
Averagecost
permonth
Averagecost
peryear
(1) (2) (1)*(2) (3) (4) (4)/(3) ((4)/(3))*30 ((4)/(3))*12
Mild dependent 53 1 53 176,667 18,968 9 279 3,353
Moderate dependent 23 2 46 153,333 8,385 18 549 6,583
Severe dependent 9 3 27 90,000 2,543 35 1,062 12,741
Total 85 126 420,000 29,896
Levelofdependence
Thenumberof
membersofLTC
programme
Weight
Thenumberof
membersofLTC
programme
TotalCost Thenumberof
daysserved.
Longtermcareservicecosting

HealthSystemResearchInstitute Total Unit Cost per day of LTC
(Formal Caregiver + hospital)
Mild dependent 32 9 42
Moderate dependent 46 18 64
Severe dependent 66 35 101
Levelofdependence Total cost per day
Lamsonthi hospital Community
Average cost of Long term care service

Thank you.

Estimating cost of long term care.

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