Estimating cost of long term care

ส ำนักงำนวจิัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย

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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

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Outline

Background

Cost of Long term care

Long term care at Lamsonti

Objective

Methodology

Result


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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


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Cost of Long Term Care

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Source: OECD(2007) Conceptual Framework and Methods for Analysis of Data Sources for LTC Expenditure


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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)

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Long-term care expenditures

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Souce: Westerhout & Pellikaan (2005)


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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


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Long 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


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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


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References:: Dependency information of Lamsonthi Hospital in 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 LTC programmeTotalLevel of dependence


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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 Environment Health Care

-Prevention

-Curative -Rehabilitation

Oversee by

Chief District Officer



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Psychiatrist

Care giver

Community nurse

In-patient Nurse

Family Donor

Pharmacist

Physiotherapist

Tambon Authority Organisation

Doctor



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Specific case



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Paid Care givers in every sub-district (39)

Specific case


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Prepare patient to go back home


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Modified house


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From Bed-ridden to mobility


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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

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Objective

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

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Costing method of Ministry of public health Thailand

Health I

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Supporting Cost Centre

Service Cost centre

Full cost Full cost

Full Cost

Cost Centres Identification T

raditio

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eth

od

Accrual basis Accounting

Allocation factor


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Methodology

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-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


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Cost of Lamsonthi hospital in 2012

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ส ำนักงำนวจิยัเพือ่กำรพฒันำหลกัประกนัสุขภำพไทย เครือสถำบันวจิยัระบบสำธำรณสุข

Labor Cost Material Cost Capital Cost Total Cost

59% 39% 2% 100%


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Cost of Long term care service unit in 2012 H

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Unit Cost Labour Cost Material Cost Capital Cost Total Cost

Long term care service 2,278,418 2,233,282 - 4,511,700

Unit: Baht


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Unit Cost from Lamsonthi hospital

Average cost

per day

Average cost

per month

Average cost

per year

( 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

Long term care service costing

Level of dependence

The number of

members of LTC

programme

Weight

The number of

members of LTC

programme

(Weighted)

Total Cost The number of

days served.

Note: Delphi method was used to get Weight (Level of workload) of

Physiotherapist teams


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Unit Cost of LTC from Formal Caregiver

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Note: Delphi method was used to get Weight (Level of workload) of Formal

Caregivers from opinion of Physiotherapist teams

Average cost

per day

Average cost

per month

Average cost

per year

( 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

Level of dependence

The number of

members of LTC

programme

WeightThe number of

members of LTC

programme

Total Cost The number of

days served.

Long term care service costing


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Total Unit Cost per day of LTC (Formal Caregiver + hospital)

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Mild dependent32 9 42

Moderate dependent46 18 64

Severe dependent66 35 101

Level of dependence Total cost per day

Lamsonthi hospital Community

Average cost of Long term care service


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Thank you.

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Economy & Finance

Estimating cost of long term care