financing old age needs in singapore - tsao foundation · medifund eldershield severe disability...
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Dr Phua Kai HongAB cum laude SM (Harv), PhD (LSE) Lee Kuan Yew School of Public PolicyNational University of Singapore
Financing Old Age Needsin Singapore
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Overview
• Introduction• Financing health and long term care
needs in Singapore• Financing the continuum of long term
care and integrated health services• Towards an optimum balance to integrate
financing policies for old age needs? • Conclusion
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ADVERSELIFESTYLE
• Cigarette smoking
• Physical inactivity
• Poor diet• Alcohol overuse
HIGH-RISKDISEASES• Hypertension• Diabetes• Hyperlipidemia• Obesity
END-STAGE ORGAN DAMAGE
• Heart attack• Stroke• Peripheral artery
disease• Chronic renal
disease• Eyesight failure
GENETICFACTORS• Age• Family history
DISEASE ETIOLOGY IN AGEING POPULATION - The Need for Medical Action or Prevention
Source: Goh LG. MOH, CPG, 1/2011
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Singapore’s Hybrid System: An Optimum Public-Private Mix?
Seeks to avoid either extremes Welfare StateTax-funded/Social insurance- ‘Free’ services- Low quality- Inefficiency
Free MarketFee for service Private insurance - Moral hazard - Adverse selection - Inequity
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Health Care Financing Strategies
Instill personal and family responsibility(Cost-sharing)
+Ensure future sustainability with ageing
avoid inter-generational problems(Savings)
+Enhance risk-pooling and social protection
(Insurance)+
Target subsidy and equitable distribution(Taxation)
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Medisave
Medishield
Medifund
PRIMARYCARE
ACUTECARE
CATASTROPHIC CARE
FinancingMethod
PrivatePayment
CompulsorySavings
Social/PrivateInsurance
PUBLIC SUBSIDIES
Source: Dr. Phua Kai Hong
Taxes PUBLIC HEALTH SERVICES
Eldershield
Eldercare fund
Health and Long Term CareFinancing in Singapore
(Eldersave?)
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The Public-Private Mix in Health and Long Term Care Facilities
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Primary Prevention Primary Care Acute CareStep‐down
care/ Rehabilitation
Community/ Home Care Palliative Care
Continuum of Intermediate and Long Term Care Services –
How to Pay for Integrated Care?
Community hospital Day rehabilitation Social day care with rehabilitation servicesHome careNursing homesDementia day care Hospice care
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LTC Funding - How to Pay?
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Current Health and Long Term Care Financing Schemes
3 M frameworkMedisaveMediShieldMediFund
EldershieldSevere disability insuranceSeverely disabled persons (> 3 of 6 ADLs)Monthly cash payout of $400 for up to 72 months
Interim Disability Assistance Programme for Elderly (IDAPE)$100 or $150 per month for up to 72 monthsIneligible for Medishield due to age or pre-existing disability
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Source: Ministry of Health
(What is the Optimum Level?)
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Medical Means Testing in 2009
• To achieve allocative efficiency and equity- Target subsidies to the poor- Shift well-off from subsidized services
• To recover costs of public expenditure
Prices based on income/wealth- Linked to tax and employment data- Proxy by housing type
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Government Subsidy PolicyILTC Subsidy Framework
- Means-tested
Monthly $120 FDW grant
- Households with frail or disabled elderly
- Per capita monthly income cap of $2,200
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Source: Ministry Of Health
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Integrating Health Care by Levels of Care
Faezah Shaikh Kadir. Singapore Family Physician 2011; 37(3):15
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Integrated Care in Action
Faezah Shaikh Kadir. Singapore Family Physician 2011; 37(3):15
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http://www.aic.sg/silverpages/default.aspx
Regional Long Term Care Health Services
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Source: Ministry Of Health
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Recent Issues in Financing Eldercare• Inflation and higher costs of care • Widening disparities in incomes/wages • Inadequate coverage of financing
- higher deductibles and co-payments- unadjusted low claim limits and benefits
• Adverse selection in private insurance- ‘cherry-picking’ by insurers/providers- mandatory coverage in Medishield (2006)- opting-out of risk pools (Eldershield)- impact of private Integrated Shield Plans?
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The Unfinished Agenda –Long Term Care Financing?
1983 Blue Paper – National Health Plan1984 Medisave1990 Medishield1993 Medifund1993 White Paper - Affordable Health Care2000 Eldercare Fund2002 Eldershield2006 Enhanced Medishield/Private Insurance
? Enhanced Eldershield/Private Insurance
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An Integrated Approach to Financing Care in Old Age
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Long Term Care in the Future: Integrated Care in Integrated Resorts?
Sin Taxes in SIN City ?