April 17th, 2012

Parliament Primer: Should housewives get pensions and free MediShield?

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The following is an excerpt of the debate on how to better support the needs of elderly women and healthcare concerns for Singaporean women, which took place during the Feb 28 and March 5-7 sittings of Parliament.

ELDERCARE

Grace Fu
Senior Minister of State for the Ministry of Information Communications and the Arts, and the Ministry of Environment and Water Resources; Member of Parliament for Yuhua; Chairman of the PAP Women’s Wing executive committee

For women who are caring for the elderly, the Budget to enhance the healthcare sector and additional subsidy for the healthcare of the elderly is welcomed by many. The significant increase in subsidy for nursing homecare, home-based care and monthly grant for foreign domestic helper provide assurance and relief to many Singaporeans who have elderly parents. It provides much emotional and physical support to the caregivers, many of whom are women.

For the older women, financial security is their biggest concern. The issue is that women tend to live longer, but have less savings for their retirement.

In general, Singapore women have a longer life expectancy than men. At age of 65 years, the retirement age, women can expect to live another 22 years (to 87 years old), four more years longer than men. In Singapore today, among the more elderly aged 85 years above, 7 out of 10 are women.

More elderly women live alone, as more remained unmarried, divorced or out-lived their spouses. The number of widows in Singapore is more than five times of widowers. Without the support of their spouses, the elderly women have to cope with their physical and financial needs on their own, especially those who do not have children to depend on.

Women have much lower average CPF balance. This is not surprising as women in the past tend to take up lower-paid jobs, had to leave for work to raise their families or may be full-time homemakers since their marriage.

I laud the budget for setting out a comprehensive package to support the elderly. It will benefit especially elderly women who do not have a safety net to fall back on. The increased healthcare subsidies and top-up to their Medisave accounts may not completely remove their financial burden. But with the enhancement in our social policies, such as a top-up to Medifund, it provides them with some assurance that they will not be left in a lurch when illness strikes.

The GST Voucher comprising cash, Medisave and U-save will give the older Singaporeans a peace of mind, knowing that the help will be permanently there and they can be assured that the Government and the society will give them the necessary assistance.

Lina Chiam
Singapore People’s Party’s Non-Constituency Member of Parliament

Older women in Singapore are a vulnerable group that needs more of our attention. Income security is a key concern for them. The economic development of Singapore was achieved in an incredibly short time – it means that older women today are less likely than their counterparts in the developed world to have gone to university. This has implications for their late-life employment.

Women are often the caregivers, not just of infants, but also of the elderly and the sick. Sometimes they are forced by circumstances to stop work in formal employment to devote themselves entirely to care-giving. Our retirement policies for this group of women seem to imply they are to depend on their husbands and children to support them in old age. But if they are unmarried, widowed, or have no children, there will be no one to care for them. Furthermore, women have longer life expectancies than men.

That is why I proposed the idea of pension credits in Singapore as an example of an instrument that may be more effective in protecting older women financially compared to labour market policies.

In countries like Sweden and Germany, pension credits or care-giver credits may be earned during time taken off from work for maternity leave or for the care of the elderly and the sick. These would be used to help women qualify for full pension and retirement benefits. There are various formulae to work out the exact benefits, but they usually take the woman’s last drawn salary and compute a supplement based on it for their pension accounts.

In Singapore, we may not want to adopt the idea of pension credits for women care-givers on a full scale. But currently no semblance of such scheme exists at all, and this is not sustainable. Otherwise, it is a contradiction that the Government encourages women to have more babies, but also expect them to remain in the workforce.

Other issues affecting older women also affect retirees in general, including men. Again, when compared to our counterparts in the developed world, the raising of our official retirement age has taken place at a faster pace.

The CPF should offer a higher contribution rates and interest rates at an earlier age, so that the effect of interest rates compounding will have a much larger impact on the individual retirement fund. If the concern is to better prepare Singaporeans for retirement, increasing CPF contribution when one reaches 50 may be too late.

If the aim is to increase contribution at all, the earlier the better. Increasing CPF contribution only at the age of 50 makes little policy or financial sense, especially at a time of their life when their salaries may actually start to dip. This leaves the older worker with less disposable income, at a vulnerable point of their lives in terms of health and for other potential costs.

Tharman Shanmugaratnam
Deputy Prime Minister, Minister for Finance and Manpower, and Member of Parliament for Jurong GRC

The Silver Housing Bonus, in fact, will help older women significantly. For retiree couples where the husband had worked and the wife was either a homemaker or worked for short periods, moving from a 3- or 4-room flat to a studio apartment will provide a significant boost to their CPF LIFE payouts.

If the husband was a median income earner, let us say, which if you look at the wage profile of median income earners in the past, it was not very high. If the husband is a median income earner, his RA balances would typically have been slightly above half of the Minimum Sum. Therefore, when they take advantage of the Silver Housing Bonus Scheme, because his RA balances already above half of the Minimum Sum, he would be able to take substantial cash proceeds out, besides getting higher CPF LIFE payouts.

So they move to a smaller flat, put some money into the CPF to reach the Minimum Sum, but still a substantial amount of cash comes out, and they get significantly higher CPF LIFE payouts for the rest of their lives. So the husband and wife benefit.

The CPF also encourages – this is an important point – family support, particularly within the immediate family. For instance, the Minimum Sum Topping-Up scheme provides tax incentives for members who top up the CPF of their wives and mothers. The number of top-ups today is not large, but we are thinking of ways to improve and simplify the current schemes to encourage more top-ups.

However, this does not solve the problem for widowed homemakers with little savings, or poor elderly couples who do not own a home. For these groups, we must help them in other ways. Through ComCare, which we have expanded by providing rental flats, which MND is building more of; and by partnership with the community, which we are also doing more of and also finding more ways of supporting the community as it gets involved.

So that is a very important area of work for those whom the CPF scheme cannot serve their needs – widowed homemakers or those who are very poor and cannot afford a home, not a large group, but an important group – we have to find other ways to help them, and we will.

HEALTHCARE FOR WOMEN

David Ong
Member of Parliament for Jurong GRC

I would like to ask the MOH to help promote and encourage MediShield coverage for women aged 65 and above.

The number of working women in Singapore lags behind many countries. We have about 65 per cent women working here versus about 80 per cent in Norway. Hence, the number of women having little or no CPF is estimated to be easily about 30 per cent. Correspondingly, a majority of the 170,000 women aged 65 and above will have no MediShield coverage.

Sir, I would like to ask MOH if our current MediShield coverage is adequate, given the rise in medical and healthcare costs. Can the Ministry do more with its MediShield coverage for our Elite Seniors and senior women?

Gan Thiam Poh
Member of Parliament for Pasir Ris-Punggol GRC

I would like to request that the Ministry considers providing free MediShield coverage to the lowest 20th percentile of Singapore citizens whose per capita income is about $750 and below, and to all homemakers looking after children up to the age of 17.

A serious illness can wipe out one’s Medisave and cash savings. Yet many poor families do not have any catastrophic medical insurance as they are struggling to meet more urgent daily expenses. Homemakers, children and the elderly are particularly vulnerable as they do not have incomes. Housewives sacrifice their earning opportunities to care for their children and the elderly at home. Yet, day in day out, they are doing work which, if monetised, is worth thousands of dollars a year.

In many single-income families, housewives tend to scrimp and save and overlook their own medical insurance. Senior citizens in the lowest income groups have to face many issues. If they are working, their pay may have already been cut as their job responsibilities are reduced. If they are already retired, they worry about making their savings stretch. Either way, insurance premiums would be higher and less affordable to them. Currently, the annual premiums for MediShield start from $33. I hope the Ministry would consider assisting them by helping to pay for their coverage.

I would like to seek a clarification pertaining to my suggestion on free MediShield coverage for the low-income group and homemakers. 92 per cent of Singaporeans are covered under MediShield. May I ask the Minister, what about the remaining 8 per cent? I suppose out of this 8 per cent, there will be those that come from the low-income group and this also includes the homemakers from this group. How will the Ministry ensure that it reaches out to these Singaporeans so as to encourage them to get insured, though there is a Medisave top-up?

Gan Kim Yong
Minister for Health, Government Whip, and Member of Parliament for Chua Chu Kang GRC

I am not sure free MediShield coverage is the best approach. Low-wage workers who qualify for the Workfare Income Supplement Scheme (WIS), can get an average of $1,000 in payouts, which is paid partly in cash and partly into their CPF accounts, including Medisave.

The total of the WIS payout into Medisave and the worker’s own Medisave contribution from his salary, is more than sufficient to pay for the MediShield premiums for himself, his non-working spouse and two children. For a 51-year old earning $1,500 per month, he would have a total Medisave contribution of $1,700 per year, compared to the total premiums of $516 for his whole family. This approach encourages self-sufficiency while supporting their basic healthcare needs, including premium payments for MediShield.

Out of the 8 per cent (ie, Singaporeans not covered under MediShield), a significant number of them may have good reasons why they opted out. We do not know the exact numbers because they do not tell us the reasons for opting out. Some of them would already have insurance coverage by their employers; some would have bought their own health insurance, so they do not see the need to continue with the MediShield. Not all the 8 per cent are from the low-income group.

But for the really low income and those with no income at all, rather than giving them free MediShield insurance, we have many other ways to help them. One way is through our Medifund, through subsidies directly from our health institutions, which can support them. Because for this low-income group, or if the whole family has no income or on public assistance, joining an insurance scheme may not be the most sensible thing for them. So it is better for us to provide direct intervention and subsidise them, and support them when they really need healthcare services.

Lily Neo
Member of Parliament for Tanjong Pagar GRC

I have always been an advocate of preventive healthcare, and I hope that we can do more on this area. For example, the chronic diseases which can prevent renal failures and stroke and early detection of breast cancer or pre-cancerous stage of the cervix that can prevent eventual death. Breast cancer is the commonest cancer for women and, in view of rising expectancy of age, could MOH step up the promotion in getting better participation of women in cancer screening in order to save lives?

Ellen Lee
Member of Parliament for Sembawang GRC

In the case of mammogram screening, there are conflicting views whether it does help to detect breast cancer. The current state of mammography is just too painful for women to bear, even for those who have the highest threshold of pain.

I believe that the Ministry is already having an uphill task persuading women to go for screening for all types of cancer. I ran a heavily subsidised mammogram screening project with eight other organisations for the past two years. The efforts we have put in have also not yielded the desired outcome. Fewer than 20,000 women in the age group of 50 to 69 who had not done screening before or were not screened for three years responded to our roadshows and mailers. Of these, a few were tested positive and sought treatment.

The Ministry launched the Integrated Screening Programme in 2008 to encourage and support screening for early detection and management of disease. How many women have responded positively to this programme? What were the rates of detection? Was there funding or subsidy for women who took part in this Programme? Is the programme ongoing and how could one enrol for it? If persuasion does not work, can the Ministry consider working out a scheme whereby women who reached 55 and have gone for certain screening would be allowed to buy medical insurance at half the premium payable?

Amy Khor
Minister of State for Health; Mayor of South West District; Deputy Government Whip; Member of Parliament for Hong Kah North SMC

I have asked HPB to convene a Women’s Health Advisory Committee, which I will chair, to improve screening and follow-up rates amongst women.

This Committee will help HPB plan and implement a holistic Women’s Health Programme, which will adopt a life-stage approach and seek to equip women of all ages with the necessary knowledge and skills to improve their health. In addition, we will build up a pool of women Health Ambassadors who focus on women’s health issues. We plan to launch this on Mother’s Day this year, and we target to reach out to one million women in Singapore, over three years.

Read the full transcripts here, here, here, and here.

One Comment ...

  1. Francisco

    Good morning:

    My name is Francisco Gómez-Sánchez, Peruvian lawyer and researcher in women’s rights. I appeal to you today because I elaborate my PhD thesis, which deals with the rights of the housewife, from their access to Social Security. In view of this, I want to find out whether your country has developed legislation on the subject or legal research has been conducted in relation to such matters.

    I appreciate the guidance you can give me.

    Thank you!

    #3419

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