Long Term Healthcare Cost In Singapore – Are Subsidies Enough?

In a previous article, I wrote about the real issues which people face when having to care for a family member with disabilities at home. You can read the previous article here. Also, as what I have said previously, the purpose is to bring the issues of long term healthcare cost to the government. I have managed to contact the Agency for Integrated Care and Ministry Of Health and I attended a session on the enhanced Eldershield (Careshield life) to learn more about it as well as give my thoughts on the recommendations.

In this article, I will dive into the various subsidies available for this group of people and whether they are adequate? Also, I will talk about what we can possibly do to prepare for the future in the event if this happens to us or our loved ones.

On 6th February 2017, NCMP Mr Dennis Tan Lip Fong asked the Minister for social and family development: ” how many persons with disabilities and/or special needs are there in Singapore;”. The reply was as follow:

  • Student Population: 2.1%
  • 18-49 years old: 3.4%
  • 50 years and above: 13.3%
Based on the above statistics, this is almost 20% of the population with disabilities. It was further added that persons with sensory (blind and deaf) and physical disabilities would constitute half of the disability group. The remainder comprises those with Intellectual Disabilities and Autistic Spectrum Disorder. 
Furthermore, the committee in-charged of reviewing the Eldershield scheme estimates that 1 in 2 healthy people age 65 today run the risk of becoming severely disabled before they die. This is quite a high percentage and I can imagine if nothing is done in the future, it will be a disaster. 


Subsidies Available for Long Term Healthcare cost – Are they adequate?

There are various subsidies available which can alleviate the financial burden of those who need it.

To be honest, AIC and MOH has done a good job to try to set up a system and compile the information for subsidies into one place. Most subsidies can be applied through a medical social worker who will be assigned to each patient. All hospitals including community hospitals have full time medical social worker for this purpose. If you need subsidies for long term healthcare cost, do remember to approach one at your hospital.

Let’s take a look at the various subsidies available:

1. Foreign workers concession levy

The normal levy which is required to be paid for hiring a maid is $265. However, if we are hiring a maid to care for a family member with disabilities, the concession levy will be only $60.

2. Enhancement for Active Seniors (EASE)

EASE is a subsidised home improvement program offered by HDB. Improvement items such as grab bars in the toilet, slip resistent floor tiles and ramps can be installed to make your home more elderly friendly especially for persons with disabilities.

If you’re eligible, the cost is reduced from $2000+ to $100+ only depending on your HDB flat type. You can refer to HDB website here for more information.

3. Intermediate and long term care (ILTC) subsidies

This ILTC is the most common form of subsidy which covers both home care services such as home nursing and home therapy and residential services such as community hospitals and nursing homes.

What you can expect is at least 20% subsidy for nursing home if your household per capita monthly income is less than $2600. For home care services, it is at least 30% for household per capita monthly income of $2600 also. You can refer to the subsidies for ILTC here.

As much as there are subsidies already available, the cost is still a huge burden for families. Nursing homes in Singapore cost somewhere between $2500-$3000+ per month. Even with a 20% subsidy, the cost is still at around $2000-$2500+. Most nursing homes fees also do not include disposables such as diapers.

For those who brought their family members home and require home care services, I did check with some home care service providers on their cost and the estimate cost is as follow:

  • Home Medical – $223
  • Home Nursing – $95
  • Home Therapy – $125

The cost above is per session and before subsidies. After a 30% subsidy, as you can see, the cost will still be high.

4. Community Health Assist Scheme (CHAS)

The CHAS is essentially a card to get subsidies when we see a doctor at a private clinic. There are 3 different types of card namely the CHAS blue card, the CHAS orange card and the CHAS for pioneer generation  card.

The blue card is for low income households with household monthly income per person of $1100 and below while the orange card is for households with monthly income per person of $1,101 to $1,800. For pioneer generation, there is no income criteria so as long as someone qualifies as a pioneer generation person in Singapore, he or she will get all the CHAS subsidies.  There are subsidies for common illnesses, chronic conditions and even dental services. For more details on the scheme, you can refer to the CHAS website here.

5. Seniors mobility and enabling fund (SMF)

The SMF is a fund which subsidises 3 groups of items and services. They are home healthcare items, assistive devices and transport. For home healthcare items and assistive devices, the income criteria is household monthly income per person of $1800 and below while for transport it is $2600 and below. For more information on the SMF, you can refer to AIC website here.

Long Term Healthcare Cost In Singapore – Are Subsidies Enough?

Indeed there are already various schemes which act as social safety net to support those who are burdened with long term healthcare cost in Singapore. However, I would think the schemes mostly benefit more for the extremely low income people only. For those with middle class income, it is hard to get help on this.

In a survey which I conducted previously, I asked the percentage of subsidies which people receive for the most common scheme which is the ILTC. To my surprise, most people do not receive or do not know such scheme existed and a minority get low subsidies amount with some lower income households getting higher subsidies amount.

For middle class households, the financial burden and stress is real. Some are just slightly above the income level criteria and most of them are in situations where their parents become disabled suddenly and the children have to take up the responsibility. While the children want to give the best for their parents, they also have to plan ahead for their future especially with the high cost of owning a home and also having their own children in Singapore.

To me, it is a negative cycle that if more and more people are caught up in this situation and the young adults cannot move ahead in life, there will be more social problems in the future.

What can we do to prepare?

While we hope for more schemes to support those with disabilities, we may also do our part especially if we are still healthy now. Getting hit by critical illness and becoming disabled is more real than we think. 

1. Be insured with Eldershield (Careshield life from 2020) or disability income insurance

Firstly, we can look into getting Eldershield or disability income insurance. Eldershield is an auto opt in scheme when we reach 40. The basic plan pays out $400 per month for up to 72 months (6 years) in the event of disability if we cannot perform 3 out of 6 daily living activities. There are supplement plans which offer higher monthly payouts for life also. Aviva, NTUC income and great eastern provide the supplement plans. You can refer to MOH website here for more information on Eldershield.  

Starting from 2020. there will be a new enhanced Eldershield which is renamed as Careshield life. All those born on or after 1980 will be included in this compulsory scheme which pay out $600 pr month for life in the event of severe disability. I’ve written a separate article for Careshield life which you can read here

For disability income insurance, it can be bought separately and can possibly replace our income in the event of disability. The premiums may be quite high so make sure you can afford it before purchasing. 

2. Term plans which covers critical illness

The second and most important thing we can get for ourselves is to purchase an insurance with critical illness and total permanent disability coverage. There are probably about 36 critical illness covered which includes stroke, heart attack and many of the different cancers. A Straits times article recently wrote about a study which suggest that working adults in Singapore have inadequate cover if critical illness strikes. The study by Life Insurance Association (LIA) showed that an average working adult in Singapore only has critical illness cover of just $60,000 which is well under the LIA recommendation of $316,000. 

I would think the problem is people generally buy whole life policies and the premiums are too much if we want to get a high coverage. Buying a term insurance with critical illness will be much more affordable. It probably will only cost around $1000-$1500 a year to be insured sufficiently with term insurance for those 30 years old and below so its good to get some term insurance if you’re still young.

Conclusion

This ends the 2 part series on creating awareness on the issues of long term healthcare cost in Singapore. The government actually has a 3rd enabling masterplan to support persons with disabilities but how long all these will get implemented is another question. The ageing population problem in Singapore is real. Disability is real too and that’s why we have all the wheelchair accessible initiatives all around the nation now.

I understand that there is an ongoing review for the various support schemes under the health ministry. I feel that some of the middle class families still fall through the cracks when it comes to support for unforeseen circumstances. Family members becoming disabled is one of them and this often comes with huge long term healthcare financial burden to deal with. Hopefully we will see more support along the way as our society progresses. Nevertheless, it is impossible for the government to support everyone as it would mean the younger generation have the bear the cost instead.

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