estimating cost of long term care
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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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ส ำนักงำนวจิัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย
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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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ส ำนักงำนวจิัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย
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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
ส ำนักงำนวจิัยเพื่อกำรพัฒนำหลักประกันสุขภำพไทย
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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
Long Term Care in Lamsonti
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Psychiatrist
Care giver
Community nurse
In-patient Nurse
Family Donor
Pharmacist
Physiotherapist
Tambon Authority Organisation
Doctor
Long Term Care in Lamsonti
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Specific case
Long Term Care in Lamsonti
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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
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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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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
Health I
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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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ส ำนักงำนวจิยัเพือ่กำรพฒันำหลกัประกนัสุขภำพไทย เครือสถำบันวจิยัระบบสำธำรณสุข
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