亚开行-泰国基于国家社区的老年人长期护理计划的经验教训（英文）-2020.11-25页_1mb

Summary of Thailand's National Community-Based Long-Term Care Program for Older Persons

Core Content

Thailand is experiencing rapid population aging, with the percentage of people aged 65 and over expected to increase from 9% in 2010 to 25% in 2040. The proportion of those aged 80 and over, who are most likely to require long-term care (LTC), is projected to rise from 2.2% in 2015 to 10.7% by 2050. This demographic shift has prompted the government to develop a community-based LTC system to address the growing care needs of older persons.

Main Objectives

• To provide coordinated care for older persons, including health and social services.
• To support aging in place, ensuring that older people can live independently in their homes and communities.
• To reduce the burden on family caregivers by utilizing trained community caregivers and care managers.
• To create a sustainable and integrated LTC system through policy development, financial mechanisms, and workforce training.

Key Components of the Program

Care Services

The program offers services in three broad categories:

• Care Management: Includes assessment, care planning, case conferences, and monitoring.
• Social Care: Covers assistance with daily living, transportation, home environment modifications, and economic support.
• Health Care: Provides treatment, nursing, rehabilitation, palliative care, and medical equipment.

Caregivers

• Community caregivers receive 70 hours of training and provide 2–8 hours of in-home care per week.
• Caregivers are either volunteers or paid workers, with 75% of districts initially relying on volunteers.
• Caregivers assist with daily activities, monitor health changes, and communicate with families and other service providers.

Care Managers

• Care managers are trained professionals (nurses, physiotherapists, social workers) responsible for assessing care needs and developing care plans.
• They coordinate with 5–10 caregivers and manage service delivery.
• Most care managers are currently recruited from community health promotion hospitals.

Program Implementation

• Launched in 2016 with a target of 100,000 beneficiaries in 1,000 subdistricts.
• The program has scaled up annually, with the target increasing to 193,200 beneficiaries by 2018.
• The National Health Security Office (NHSO) oversees the program, working with Local Administration Organizations (LAOs) and the district health system.
• The Local Health Fund (LHF) is used as a matching fund to support the program, drawing from the Universal Coverage Scheme (UCS).

Financial Mechanism

• Funding comes primarily from the UCS, managed by the NHSO.
• Budget for 2016: B600 million ($19 million) for 100,000 beneficiaries.
• Budget for 2018: B1,159 million ($36.5 million) for 193,200 beneficiaries.
• The annual budget per person varies depending on the level of dependency:
  • Group 1: < $122.26
  • Group 2: $91.70–$183.40
  • Group 3: $122.26–$244.53
  • Group 4: $152.83–$305.66

Challenges and Limitations

• Financial Constraints: Local governments face challenges due to limited authority under decentralization laws, which restrict their ability to fund new programs.
• Service Integration: There is limited integration between health and social care services, with health services being more systematically delivered than social ones.
• Coverage Gaps: Some services, such as instrumental activities of daily living support, economic assistance, and legal support, are underutilized or not fully implemented.
• Workforce Management: The reliance on volunteers raises concerns about equity and sustainability. Paid caregivers have shown better performance in the first three years.

Governance and Coordination

• No single government body oversees the LTC system comprehensively.
• The Ministry of Public Health manages health services, while the Ministry of the Interior oversees LAOs, which are responsible for coordinating and delivering services at the subdistrict level.
• The Ministry of Social Development and Human Security is responsible for the Act on Older Persons, which promotes and protects the rights of older people.

Next Steps

• Expand the program to cover more subdistricts and include older persons under 60 who meet LTC criteria.
• Improve integration of health and social services through better coordination and information sharing.
• Develop a more robust legal framework and governance structure for LTC.
• Enhance the quality management system, including the creation of an online database for monitoring and evaluation.
• Explore fiscal sustainability through new funding sources such as local taxes or tax transfers.
• Create age-friendly communities and environments to support LTC goals.

Conclusion

Thailand's community-based LTC program is a pioneering effort in Asia, leveraging its strong volunteer tradition and public health infrastructure. While the program has made significant progress, it still faces challenges in financial regulation, service integration, and workforce management. Continued investment, policy refinement, and coordination across sectors are essential to ensure the program's long-term success and sustainability.