Insufficient care given to the elderly and chronically ill in Singapore
Written by Ng E-Jay
27 April 2012
There is woefully insufficient care given to the elderly, chronically ill and terminally ill in Singapore.
Hospitalization expenses are supposed to be taken care of by medisave and medishield, but that has proven inadequate as healthcare costs have escalated sharply over the years, far outstripping the overall inflation rate. Private hospitalization insurance is also expensive, which only the well-off can afford. In this regard, the Singapore Democratic Party (SDP) has proposed to overhaul our healthcare system to a single-payer system co-funded by the government in which hospitalization bills are capped at $2,000 per annum for each person and the rest is paid for by the state.
Equally important however is post-hospitalization care and long term care for the terminally ill, as well as the elderly who have lost their ability to move, feed, bathe and clothe themselves, or otherwise function as effectively as their younger or healthier counterparts.
Eldershield is the government scheme that is supposed to allow families to care for elderly folk or people who have been involved in accidents, who have lost their mobility and can no longer take proper care of themselves. It is designed to provide a monthly payout in the event that an individual loses the ability to perform at least 3 out of the 6 Activities of Daily Living (ADL) as defined by the healthcare and insurance industry. The monthly cash payouts can then be used to hire maids to care for the patient, or to purchase medicine and other supplies.
Unfortunately, the current Eldershield scheme only offers a payout of $400 dollars per month, which is drastically inadequate given that medical costs have risen so sharply in recent years. It can only cover barely a fraction of the costs incurred in having the patient cared for by a long term care facility.
Even hiring a maid to take care of the elderly patient at home costs much more than $400 per month if we factor in meals and living expenses needed to support the maid, as well as other expenses like transport costs and maid agency fees. And we have not even considered costs of medication yet, which itself can run into the thousands of dollars.
The sum of $400 is clearly insufficient to help families who have to take care of an elderly member of the household who cannot perform at least 3 out of the 6 ADLs. There is an urgent need to increase the cash payout so that these families need not suffer so much financial hardship.
In addition, the current payouts only last for 72 months. In this enough? With proper medical care, some old folks even if they have lost their mobility or who might have suffered serious illness or accidents in the past might still live a long time. The payouts should cover for the whole life of the patient, and not just 72 months, or else the families will once again be in trouble when the payouts expire.
The payout amount should also not just be fixed amount, but instead it should be an amount pegged to the level of care needed, including the medicines that the elderly patient has to take to sustain life.
Healthcare expert Professor Phua Kai Hong of the Lee Kuan Yew School of Public Policy has been interviewed by the media recently. He said that the Republic’s financing scheme for the intermediate and long term care (ILTC) sector will not be enough for Singaporeans to meet the basic costs of using such services.
Prof Phua also said that our Eldershield scheme is “completely inadequate”.
“People are calling our hospitals a First World sector, but 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,” said Prof Phua.
Prof Phua’s concerns are unanimously shared by industry players and Members of Parliament, with one of them describing the situation as a potential time bomb.
There is an urgent need to revamp our Eldershield system, just as there is also a pressing need to revamp our hospitalization insurance system.
In this regard, I would like to apply SDP’s healthcare proposals to the Eldershield scheme too. The Eldershield scheme should be overhauled to become a single payer insurance scheme co-funded by the government.
Under my proposal, upon diagnosis of inability to perform 3 out of the 6 ADLs, the government will pay for the FULL medical and long term care needs including hospice care or by other long term care facilities, subject to co-payment of $3,600 per year (or $300 per month) by the family of the patient to prevent abuse and ensure responsible use of long term care facilities.
The money for this proposal will come from increased personal and corporate income taxes, and reduced defence spending.