Purchasing Community-Based Long-Term Care Services Under Thailand’s Universal Coverage Scheme: A Provider’s Perspective

Introduction: Thailand has implemented community-based long-term care (CBLTC) under the Universal Coverage Scheme (UCS) to support family caregiving and enhance the quality of life of dependent older adults. This study aimed to examine the CBLTC purchasing arrangements at the subdistrict level and the challenges that arise under these arrangements. Methods: The qualitative case study method based on a health financing framework was adopted. Semi-structured interviews were conducted with 40 key informants from selected subdistricts in Nakhon Pathom Province, along with representatives from central and regional levels in Thailand. A thematic analysis was conducted using both inductive and deductive approaches. Results: Findings revealed major challenges under the CBLTC purchasing arrangements, including budget constraints, misalignment between the payment and workload of volunteer caregivers, misalignment of service provisions outlined benefit package, and lack of monitoring system. Conclusion: The findings highlight the need to improve CBLTC purchasing arrangements under the UCS to enhance the efficiency of provider payment mechanisms and address the needs of dependent older adults and support family caregiving.