In a Parliamentary debate on 10 July 2018, several Members of Parliament (MPs) from the Workers' Party (WP) raised several concerns regarding a few aspects of the new CareShield Life policy proposed by the Government.
Among the main issues raised by the WP MPs were the seemingly gender-biased premium imposed on policyholders and whether or not the new policy is truly adequate in providing coverage for basic long-term care in old age.
Premium policy should be "gender-neutral"
MP Leon Perera highlighted that his Workers’ Party colleagues have discussed a review of the proposed gender-based CareShield policy in favour of a "gender-neutral" one with the Chairman of the Healthcare Government Parliamentary Committees (GPC).
Male policyholders aged 30 will have to pay S$206 in premium before subsidies, while the amount for female policyholders aged 30 will have to pay S$253.
MP Leon Perera speaking on CareShield in Parliament.
Speaking to the House, MP Perera said, "I strongly support this call in the name of inclusivity and in parallel with the scheme’s philosophy of each cohort looking after itself. It will mean men will pay more and women less. Let it be so."
In line with MP Perera's suggestion, Chairman for the Health GPC, Dr Chia Shi-Lu said during the debate that additional premium support should be given to women policyholders, as "Singaporean women tend to have lower average Medisave balances than men".
MP Associate Professor Daniel Goh also raised concerns regarding the potential gender bias in the proposed CareShield premium policy.
He highlighted that "the first concern with inclusivity is that women pay significantly higher premiums compared to men, [that is,] 25 percent higher.
I find it objectionable that women are being penalised for something that is not within their control, being born women, when lifestyle choices within the control of individuals are not being treated as risk factors for premium calculation," he argued.
Associate Professor Daniel Goh speaking on CareShield in Parliament.
He highlighted that "CareShield Life is to be a publicly administered, compulsory insurance providing for universal social protection.
Why then are we splitting the population divisively into men and women? Why are men paying only for fellow men who become disabled, and women paying only for fellow women who become disabled?"
In response to the concerns raised by the WP MPs, Senior Minister of State for Health, Dr Amy Khor explained that women will be charged higher premiums under CareShield Life as they have a longer lifespan compared to men.
She elaborated that in 2017, the average life expectancy at birth for women is 85.2 years, in comparison to that of men, which is 80.7 years.
Dr Amy Khor speaking on CareShield in Parliament.
Dr Khor added that "[...] five healthy women at age 65 are expected to become severely disabled by the end of their lives, compared with two in five healthy men at age 65."
Not only that, women in their old age have a higher likelihood of remaining in disability for a longer period compared to men of a similar age bracket.
"Based on a longitudinal survey of older Singaporeans in 2009 and 2011 to 2012, researchers [have] estimated [that] women aged 60 are expected to spend 7.8 years requiring assistance with any of the activities of daily living compared with 2.6 years for men aged 60.1," she said.
Consequently, the women will draw on CareShield for a longer period should they become severely disabled, she said.
Definition of "severe disability" should be revised
Policyholders of CareShield Life will receive lifetime cash payouts when they have been "certified to be unable to independently perform three out of six activities of daily living (3-ADLs), namely eating, bathing, dressing, transferring (from a chair to bed, for instance), going to the toilet, and walking or moving around", according to TODAY Online.
MP Sylvia Lim has raised concerns regarding the rigidity of the 3-ADLs test.
"The CareShield Life proposal has much potential to be a strong social safety net for our people. This is a great opportunity which should not be squandered," she said, concluding her statement after proposing a "unisex" premium to ensure the universality and inclusivity of the scheme.
Sharing an experience of one of her resident who has since passed away, Ms Lim noted that this resident, Mr K, was suffering from an advanced stage of kidney failure and already had his leg amputated earlier due to diabetes. The insurer later decided to discontinue Mr K’s Eldershield benefits as the insurer’s panel doctor had assessed that he could perform all of the six activities of daily living “although partially”.
"When I appealed on his behalf for a re-assessment, the insurer wrote back to him to fill up another claim form. Meanwhile he was admitted to a hospice. When I saw him there, he requested me to write to the insurer to say that he would not be filling up the form as he was in the hospice. Eventually, his daughter filled up the form, and I understand that the hospice doctors assisted to get his Eldershield benefits restored. But within a month, he was dead." said Ms Lim.
She noted she do not know what rigorous standard is applied to determine if a potential ElderShield claimant is disabled enough, but when she read about the ElderShield premiums in the billions that have been collected over the years, it struck her how Mr K and his family have apparently been abandoned in their time of need.
Ms Lim asked, "Is the experience of Mr K an aberration?" and said, "If this is going to be the experience that will be carried over to CareShield Life, it would be unacceptable."
MP Png Eng Huat of Hougang echoed MP Sylvia Lim of Aljunied Group Representative Constituency (GRC)’s call for a Government review of the definition of "severe disability," specifically to consider reducing the 3-ADLs criteria.
Addressing the Speaker of the House, he said that "not being able to do just one of the six activities of daily living (ADLs) is already a challenge for most of us in this House, yet one must demonstrate the inability to perform three ADLs".
MP Png Eng Huat speaking on CareShield in Parliament.
Source: Channel NewsAsia
"The 2018 review of ElderShield calls for expanding the insurance coverage to achieve greater inclusivity. Would it not be reasonable to expect the enhanced scheme to have a more inclusive definition of severe disability as well?"
He drew a comparison to Japan's criteria for long-term care insurance, which is deemed to be one of the most lenient across countries in the review report, subsequently questioning why Singapore's criteria appears to be the "least lenient" among them.
Process of setting premiums should be more transparent, Government subsidies encouraged
MP Chen Show Mao of Aljunied GRC urged for transparency with regards to how the premiums are set by the Government.
He said that this is because the WP embraces "the principle of risk pooling" to address the growing needs of long-term care for those Singaporeans who, whether through age, illness or circumstance, become severely disabled.
MP Chen Show Mao speaking on CareShield in Parliament
He argued that despite having a higher initial cash payout of $600 per month compared to the $400 currently payable under Eldershield, the extent to which long-term care can be obtained "will depend on the mix of care alternatives available and how much they cost — home nursing, foreign domestic workers, a bed in a nursing home, a place in daycare centres, et cetera".
Thus, MP Chen proposed Government intervention for groups in need whenever necessary, adding that an "eco-system rich in disability-care options, as well as effective policies" should be designed in order to supplement the CareShield Life scheme.
MP Goh echoed similar sentiments regarding Government intervention.
He stated that subsidies should be given out in order to ensure that the CareShield Life balancing act "does not exclude or disenfranchise any Singaporeans".
CareShield, a mandatory policy from age of 30 years old
Starting 2020, it will be mandatory for Singaporeans and Permanent Residents born between 1980 and 1990 to enrol in the CareShield Life scheme. Those born after 1990 will be enrolled upon reaching 30 years of age.
Policyholders will pay annual premiums until they are 67 which are subject to change.
The CareShield Life premiums will go up by 2 per cent every year for the first five years, and will be adjusted as needed after that.
CPF members may use Medisave to pay the premiums.
CareShield Life will give claimants higher payouts of S$600 a month, which increases over time and will go on for a lifetime, in comparison to the S$300 to S$400 payouts by ElderShield which will only continue for up to five or six years.