By Tan Weizhen, TODAY | Posted:
26 April 2012 0611 hrs
SINGAPORE: A prominent professor here has warned
that the Republic's financing scheme for the intermediate- and
long-term care (ILTC) sector will not be enough for Singaporeans to
meet basic costs for such services, as the clock ticks down on the
silver tsunami which will hit the Republic by 2030.
Lee Kuan Yew School of Public Policy Professor Phua Kai Hong, an
authoritative figure in the region on healthcare policy and
management, first voiced his concern about ElderShield, which is
the sole national insurance scheme for intermediate and long-term
care, at a closed-door discussion earlier this month.
Speaking to TODAY, he reiterated that the scheme is "completely
inadequate". Said Prof Phua: "People are calling our hospitals a
First World sector, but that our long-term care is Third World
standard. Besides the over-reliance on voluntary welfare
organisations, patients' families and cheap labour, the financial
structure in this sector needs to be thoroughly re-looked."
He added that Singapore's existing 3M framework - Medisave,
MediShield and Medifund - are "rigged towards hospital care".
Among other appointments, Prof Phua had undertaken healthcare
consulting assignments for international organisations such as the
World Bank and the World Health Organisation, as well as the health
ministries of various countries including Singapore.
Prof Phua's concerns were unanimously shared by industry players
and Members of Parliament TODAY spoke to, with one of them
describing the situation as a potential time bomb even as the
Government is ramping up the infrastructure in the sector and
raising subsidies especially for low- and middle-income
households.
Adding that the issue is "right at (the) doorstep", NTUC Eldercare
general manager Lim Sia Hoe cautioned: "The Government must show
urgency. We don't have the luxury of time. The longer we wait, the
more difficult it is."
The Ministry of Health (MOH) had announced previously that it is
reviewing the Eldershield scheme next year.
In response to TODAY's queries, an MOH spokesperson said it
recognises that "the cost of caring for the elderly over a period
of time can be significant".
On the increased subsidies, the spokesperson noted that around
two-thirds of the population "will benefit from some form of
financial assistance" when the changes take effect in the third
quarter.
Among other measures, the MOH will also absorb goods and services
tax for healthcare services for all subsidised ILTC patients, while
cash payouts and qualifying income for the Interim Disability
Assistance Program for the Elderly will also be increased for
low-income disabled elderly who were unable to join ElderShield at
its inception.
Nevertheless, the spokesperson acknowledged that insurance coverage
"also plays an important role in ensuring the sustainability of our
healthcare financing system".
She said: "MediShield and ElderShield provide a basic level of
protection against severe illnesses and disability. Those who wish
to obtain higher coverage may purchase ElderShield Supplements
provided by private insurance providers ... We will continue to
refine our aged care financing framework to make care more
affordable for our elderly."
The ElderShield scheme was launched in 2002 as an affordable severe
disability insurance scheme that provides basic financial
protection to those who need long-term care.
In 2007, the Government increased the monthly payout from S$300 to
S$400, and the maximum payout period from 60 to 72 months.
Singapore citizens and permanent residents with Medisave accounts
are automatically covered under ElderShield at the age of 40,
unless they opt out.
According to industry players, the ElderShield payout is
insufficient: Patients' bills are at least twice that amount.
Calling for the cap on the payout period to be abolished, they said
that the scheme should also cover not only those who are severely
disabled and unable to perform three activities of daily
living.
Said former Nominated MP and private orthopaedic surgeon Kanwaljit
Soin: "The payout should be as long as the person is alive. It will
even out in the end as some people will die earlier and others,
later."
There should also be more flexibility in the scheme - for example,
the amount of payout should be pegged to the level of care
needed.
Sengkang West MP Lam Pin Min, who chairs the Government
Parliamentary Committee for healthcare, said that the payout should
be reviewed regularly, taking into account inflation.
Higher payouts will entail higher premiums and Dr Soin suggested
that co-payment from Singaporeans be capped at 20 to 30 per cent -
a level that Prof Phua concurred was optimal according to past
studies.
Most observers TODAY spoke to felt the Government should take the
lead in this area, even though private insurers should ultimately
come into the picture.
Said Prof Phua: "It is a relatively new issue so a lot of private
insurers are waiting for the Government to come in and set
directions." He noted that the Government has to make projections
and set a basic package on how much is needed for long term
care.
Former NTUC Income CEO Tan Kin Lian pointed out that that
consumers' interest is best protected by the Government being
involved in setting the framework to determine the eligibility for
a claim. Said Mr Tan: "The insurance company can be quite strict in
interpreting the eligibility to the detriment of the consumer."
- TODAY
