Free adult diapers to improve life quality of elderly people

Dr Jadej Thammatacharee
Secretary-General of National Health Security Office (NHSO)
 
In May, the National Health Security board (NHSB) approved the introduction of adult diapers into the benefits package of the Universal Coverage Scheme (UCS).
 
This new benefit targets adults and elderly persons living with incontinence and bed-ridden patients. We estimate that around 53,300 people will be direct beneficiaries.
 
I would like to explain more about a behind-the-scene process, in the span of 13 years, that led us to introduce this new benefit.
 
In 2010, Health Intervention and Technology Assessment Program (HITAP) released a study on the necessity and impact of providing people with free adult diapers.
 
The study highlights the high benefits of people's access to diapers, especially in the groups of people living with disabilities and dependent elderly persons.
 
These people often have little income as they can’t work properly due to their health conditions.

Giving them free diapers will certainly reduce their financial burdens and improve their life quality.
 
If the government provides them with free diapers, the study finds, it will help reduce their household expenses up to 21,664 baht per year (based on the diaper prices during the study period.)  
 
The study’s release prompted civil society groups to call for the government to include adult diapers in its healthcare schemes.

They campaigned for the need for free diapers in several events, including the NHSO’s public hearings.

The movement encouraged the NHSO to launch a study on the advantages and implementation of including free adult diapers in UCS' benefits package.
 
The study reviewed how other countries initiated policies to support people needing free adult diapers.
 
The United Kingdom, for example, implements the policy through local governments which procure adult diapers and distribute them to disabled and elderly people through local health funds.
 
On the other hand, the Swedish government provides subsidies to disabled people who can use the fund to purchase diapers by themselves. 
 
Local governments of Japan support disabled and elderly people in three ways: purchasing and distributing free diapers to them directly, handing them coupons that can be used to buy diapers at the stores, and providing them with monthly subsidies that cover the cost of diapers.

These case studies show that local governments play vital roles in ensuring access to adult diapers.
 
This approach is applicable to Thailand, where local governments play a major role in improving the welfare and well-being of local people.
 

In addition, Thailand has an existing mechanism and platforms open for collaboration between local governments and central government organizations like the NHSO.
 
In 2017, the NHSO launched the “Long Term Care Fund” to financially assist local governments in caring for bed-ridden patients and elderly persons.
 
We also initiated another program called “Local Health Fund” which distributes financial resources to local governments running health programs. 
 
The local governments are close to communities and know their health problems.

Engaging them in UCS helps the NHSO allocate funding to solving the right health problems in the local context.
 
Decades of local governments' involvement in the health system is our strength.

When we began planning for the introduction of adult diapers in UCS' benefits package, we thought of having local governments leading the implementation.
 
Involving health units, such as public hospitals and elderly care centers, is also necessary as they have health data of patients under their care.
 
In the end, we decided to introduce the new benefit through Long Term Care Fund and Local Health Fund, in which local governments and health units can submit proposals to the NHSO to get the fund for purchasing and distributing diapers for their target groups.
 
The implementation plan was finally approved by the NHSO board in early May.

It happened because we had an evidence-based study to convince the board committee. 
 
Leadership also played a vital role. Deputy Prime Minister and Minister of Public Health Anutin Charnvirakul, also the NHSO board’s chairman, learned about the need for free diapers during the NHSO's public hearing and pushed forward the new benefit right away. 
 
After the approval, all relevant parties took action immediately.
 
The Department of Health under the Ministry of Public Health has collaborated with the NHSO to identify the targeted beneficiaries and designed the care plan for them.

We agreed that each recipient should get three diapers a day.
 
Care managers, public health staff and local governments have provided the NHSO with individual health data that show the number of people needing adult diapers.
 
This number will be presented in the revised care plan which will be submitted to the regional committee of the Long Term Care Fund or Local Health Fund, who will then approve the fund for the purchase of diapers.
 
Throughout this ongoing process, we expect that adult diapers will be handed to the target groups across the country from July onward.

The purchase of the items will cost around 91.5 million baht in total. 
 
Access to adult diapers links to our preparation for an aging society, in which the health system must be redesigned to provide people with long-term care and necessary health items.

We have planned to add more items for elderly people soon.
 
But it will not take over a decade as we have established financial mechanisms, including the Long Term Care Fund and  Local Health Fund, that open the channels for relevant players to get support from us.
 
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