Worker-backed care-giving fund for the very old, infirm proposed TDRI ADVISER CALLS FOR SCHEME TO IMPROVE LIVES OF ELDERLY

Release2016-09-21

UNDER a newly proposed healthcare programme, Thais aged 40-65 would be obliged to pay Bt414 a year to help finance a new fund designed to improve the quality of life of the very old and infirm, who are growing in number.

Worawan Chandoeywit, adviser on social security to the Thailand Development Research Institute, floated the idea yesterday, based on research that found long-term-care expenditure for this group would increase by 235 per cent from Bt59.52 billion in 2017 to Bt199.72 billion in 2037.

During the period, the number of Thais older than 60 will have risen to 20 million from 11 million at present.
Understanding that this fund should not add to the government’s fiscal burden, the model asks for contributions mainly from the working-age population as well as local administrative bodies.

“It’s meant to be an alternative for the needy, without adding to the fiscal burden,” Worawan said. “We realise that if the government has to shoulder the cost alone, this will never happen. All parties should lend a hand, and this will surely improve elderly people’s quality of life.

“Some workers who make contributions may not live long enough to use the fund, but eventually this will benefit all households. Every household now has at least one elderly member.”

Worawan’s research covered households with sick and very old members in 12 provinces, tracking expenses on care-giving as well as medical supplies and equipment.These elderly folk need 100 hours of care-giving services per month on average, at an average monthly cost of Bt15,000. These expendi tures are entirely covered by the families, as Thailand’s three health-insurance systems cover only medical treatments.

Some families with access to government insurance schemes thus opt to keep elderly members in hospital. If there were assisted services at home, more hospital beds would be freed up and hence the government’s medical expenses would decline.
The government’s medicalcare plan for the civil service costs Bt60 billion per annum,while the universal-coverage scheme will cost about Bt123 billion in 2017. Under the Social Security programme, health expenses were estimated at Bt30 billion in 2015.

Under Worawan’s model, of Bt59.52 billion in expenditures in 2017, actual expenses of the elderly would be Bt20.785 billion if local administrative bodies agreed to shoulder a similar sum. Therefore, the contribution from the working population would amount to Bt14.98 billion.

The model will be forwarded to the National Health Security Office. If it is accepted, the NHSO might establish a new department for elderly care, or a new law may be required if a separate unit is needed under the Public Health Ministry to supervise this matter.

The fund is meant to help finance the care-giving and supplies and equipment, for example Bt5,000 for a wheelchair and a 50-per-cent allowance for a caregiver. Private-sector contributions would also be welcomed. The expenses as well as nurs-ing homes and other related services would fall under the supervision of a newly established regulatory committee.

Worawan is hopeful that her proposal will win support from local politicians, for whom the elderly are key voters.
“Some local governments organise tours for the elderly. That spending could be shifted towards this long-term scheme. The local governments should play a bigger role in this area, like those in many countries,” she said.


First published: The Nation on Wednesday, September 21, 2016