For our HMP671 class on Global Health and Aging today, Jersey organized a site visit to Chelsea Retirement Community. Having only read about these community living arrangements, but never been to one until today, I must admit it was a mind-blowing experience.
The entire campus was built on a 58-acre plot, housing roughly 500 seniors. More impressive was the extensive range of living options; Craftsman-style Cottages, ranch-style Garden Apartments, skilled nursing center, assisted living suites and studios, and Alzheimer'r care residence. The interior of these buildings were incredibly well-maintained, decorated with bright wallpapers, peppered with '50s movie posters, and extremely high-tech. I remember stepping into a home theatre which can house roughly 100 people for a movie that is activated by a one-touch button! There were also numerous cafes and very brightly-lit dining halls with each resident's name tag clearly placed in front of their seats. The newest initiative at CRC was the implementation of a dorm-style dining facility where residents had an allocated cap of meals per week and swiped their card to enter the dining hall ( sounds familiar?!). They also had the luxury of food-to-order option, rather than simply being subjected to whatever was on the chef's plate for the day.
Of course such living arrangements were only available and affordable for the middle-class denizens, but it really set me wondering if this form of housing arrangement will be possible in Singapore. Having seen so many destitute Singaporean elderly people living in isolation in their one own room flat, and being left under the aegis of the neighborhood moral centers for the elderly...what I had witnessed today was simply miles apart! (no pun intended) Land scarcity, ageism, funding, and immature skills and experience in developing these facilities are just some of the challenges I can foresee moving forward.
I've recently learnt that the Singapore Housing Development Board, together with the Third Council for Aging, have been lobbying for studios for elderly, retirement villages. Not too long ago, I also wrote a paper criticizing the lack of consistency in how the current policies for aging-in-place have been instituted. Given the land scarcity in the Singapore, the model of CRC which revolves around plenty of open spaces and greenery to encompass the 7 elements of wellbeing, is simply not possible. I would imagine that this idea when extrapolated to Singapore, will just morph into another high rise building stacked with elderly people. Minimal exercising space, minimal outdoor activities. Besides, there is still an unspoken stigma against elderly housing in Singapore, and private developers aren't really interested to enter this market. The government ought to incentivize the private developers to put aside land for these retirement villages. We also have much to learn from other countries which have much expertise with managing assisted living options and integrating the entire continuum of care in a single retirement village. Learning to respect the autonomy and independence of our elderly is sadly a concept that many Asian societies have neglected. Aging and the progressive waning of cognitive, physical abilities are always deemed to work in hand.
That aside, today I spoke to a number of entrepreneurial HMP alumni at a networking dinner who had set up their own consulting, legal, healthcare services mid-career. This has set me thinking....
Tuesday, April 13, 2010
Wednesday, February 10, 2010
Copycat: Health Care Financing Programs are Alike
Before I studied health care issues, health care plans didn't make any sense to me. Now all the health jargon doesn't confuse me as much, although the inconsistencies in many health care systems still throw me off. This piece is for my fellow Singaporeans who are having difficulties understanding what you are getting yourselves into!
MediShield
P.S. Both Health Savings Account (HSA) in the U.S. and MediShield in Singapore are similar health insurance plans used in financing of catastrophic care services such as hospitalization and physician services.
Medishield is a high-deductible catastrophic insurance plan meant to cover individuals for catastrophic services such as hospitalizations and physician services. It is financed based on risk-pooling principles for lower income Singaporeans. With high deductibles and no coverage for preventive care, psychiatric treatment, mental health, Medishield protects itself from liability by operating on insurance underwriting principles, aka experience rating. Essentially, if a patient has been receiving treatment before joining Medishield, Medishield policy can exclude that illness.
Medic-tionary for deductible: The initial costs not covered by insurance policies. For example, if deductible for a policy is $2000, any single/bundled procedure costing less than $2k will NOT be eligible for reimbursement. You are responsible for paying that out of your pocket.
Premiums are automatically deducted from another savings account, Medisave (more another time), and all enrollees in Medisave are automatically enrolled in Medishield. There is a pass option for individuals to opt out. Medishield, however, only covers up to 80 years old, and thus cannot be considered as a supposed safety net for elderly people. Lifetime maximum claims also exist.
In 2005, Medishield was reformed after being in operational deficit. 1) Caps on each treatment reimbursement were raised. For instance, Intensive Care Unit reimbursement was increased from $300 per diem to $500 per diem. Lifetime maximum claims were upped to $200k from $120k. 2) Raised Deductibles and 3) Raised premiums. Risk-pooling is maximized in Medishield with experience rating and automatic enrollment.
http://www.cpf.gov.sg/cpf_info/publication/REFORMMEDISHIELD.asp
* For members who join MediShield before age 60, there is a 10% premium discount for every ten years of coverage.
In a way, this model cleverly makes use of citizen's reluctance to make extra effort to opt out. Anyway, if one doesn't see cash moving outright from our pockets, but instead from Medisave accounts, then the Why-Not? attitude is prevalent. Furthermore, the premiums are so low, an average of $2.50 per month for those below 30 years of age, that you won't even notice the money missing from your Medisave account!
Point being: Know the benefits coverage you are entitled to under MediShield and buy private insurance policies that complement, and not overlap, those existing benefits.
MediShield
P.S. Both Health Savings Account (HSA) in the U.S. and MediShield in Singapore are similar health insurance plans used in financing of catastrophic care services such as hospitalization and physician services.
Medishield is a high-deductible catastrophic insurance plan meant to cover individuals for catastrophic services such as hospitalizations and physician services. It is financed based on risk-pooling principles for lower income Singaporeans. With high deductibles and no coverage for preventive care, psychiatric treatment, mental health, Medishield protects itself from liability by operating on insurance underwriting principles, aka experience rating. Essentially, if a patient has been receiving treatment before joining Medishield, Medishield policy can exclude that illness.
Medic-tionary for deductible: The initial costs not covered by insurance policies. For example, if deductible for a policy is $2000, any single/bundled procedure costing less than $2k will NOT be eligible for reimbursement. You are responsible for paying that out of your pocket.
Premiums are automatically deducted from another savings account, Medisave (more another time), and all enrollees in Medisave are automatically enrolled in Medishield. There is a pass option for individuals to opt out. Medishield, however, only covers up to 80 years old, and thus cannot be considered as a supposed safety net for elderly people. Lifetime maximum claims also exist.
In 2005, Medishield was reformed after being in operational deficit. 1) Caps on each treatment reimbursement were raised. For instance, Intensive Care Unit reimbursement was increased from $300 per diem to $500 per diem. Lifetime maximum claims were upped to $200k from $120k. 2) Raised Deductibles and 3) Raised premiums. Risk-pooling is maximized in Medishield with experience rating and automatic enrollment.
http://www.cpf.gov.sg/cpf_info/publication/REFORMMEDISHIELD.asp
* For members who join MediShield before age 60, there is a 10% premium discount for every ten years of coverage.
In a way, this model cleverly makes use of citizen's reluctance to make extra effort to opt out. Anyway, if one doesn't see cash moving outright from our pockets, but instead from Medisave accounts, then the Why-Not? attitude is prevalent. Furthermore, the premiums are so low, an average of $2.50 per month for those below 30 years of age, that you won't even notice the money missing from your Medisave account!
Point being: Know the benefits coverage you are entitled to under MediShield and buy private insurance policies that complement, and not overlap, those existing benefits.
Opening Thoughts
Last post I wrote on Blogger was in 2007, but mainly on tangential issues such as my lifestyle and the people I met. Just carefree thoughts of an undergrad and as a teenager. As I embrace the coursework in Health Management and Policy here at the University of Michigan-Ann Arbor, many a time have I experienced frustrations in health care inequity.
Join me as I read, speak, and breathe my thoughts on health care, and share my frustrations on why health care is such an intriguing but difficult social issue. This blog should incorporate lots of international vignettes, given my background as a native Singaporean and a graduate student in the United States. Cross national comparisons are excellent ways to challenge paradigms and modify learning models- and I will strive to do that over here. Health care is probably frustrating for most people who do not understand its stylized jargon. I hope this blog can make some of these health care issues more accessible for you.
I hope this will be an enjoyable and enlightening read!
Join me as I read, speak, and breathe my thoughts on health care, and share my frustrations on why health care is such an intriguing but difficult social issue. This blog should incorporate lots of international vignettes, given my background as a native Singaporean and a graduate student in the United States. Cross national comparisons are excellent ways to challenge paradigms and modify learning models- and I will strive to do that over here. Health care is probably frustrating for most people who do not understand its stylized jargon. I hope this blog can make some of these health care issues more accessible for you.
I hope this will be an enjoyable and enlightening read!
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