Voice from the ‘Ground’

A letter received by the Straits Times following the interview that was published last Saturday. I must say I am encouraged that these are important issues impacting the lives of Singaporeans we are discussing and that open dialogue will help us as we review policies to improve healthcare for Singaporeans. I hope we can continue the review of our health system with top-down policy and academic input blended with real-life bottom-up ground experiences. Our policies must not only find favor amongst academics and public intellectuals, but they must improve the situation on the ground, and only patients and their families can attest to this.


Thank you for this article. It is much appreciated. Dr Lim has articulated so well what has been on my mind for a few years now.

I have been struggling with the very real spectre of the dual demands of providing for my mother’s healthcare when the time comes and my children’s education. Dr Lim’s recommendations give legitimacy to the competition for family resources, which is the only resource individuals have unless his recommendations are seriously considered & taken up.

Bear with me while I relate my situation to illustrate my thoughts. I am sure that I am not the only one in such a situation. And it could be used as a discussion for a healthcare model.

At present my parents’ healthcare needs are covered by the generous pension scheme. But when my father passes away, my mother is totally uncovered wrt to healthcare costs, which in turn means that I am totally liable for her healthcare. Medical insurance did not make sense in the past and does not make sense now as she is 77 years old & has pre-existing conditions which make premiums too expensive due to the many exclusions there are. Post-pension medical bills are likely to wipe me out. While I have medical insurance, bought at a prudent time, I do wonder if my children would have to help me with my premiums or my co-payment bills in time, especially if I am wiped out from my mum’s projected bills.

If it happens that my own children share my future medical bills, it will be entrenching the cycle of successive generations footing their parents’ medical bills. How can a family like mine get help with my mother’s future medical bills? Especially so that they do not adversely affect subsequent generations?

My idea is for some help for her (and others like her) bills. The downside is a fairly large outlay for all the seniors who would need such assistance. The upside is that this would be an investment for future generations not to be mired in parents’ healthcare costs.

The actual mechanics of such a public outlay versus the private costs could be worked out accordingly. The devil will be in the details about the number of people who qualify and the share of how much each person gets according to age, needs or both. The outlay would also need to include the group of people who are older, ill & without medical insurance. But this would be a “one-off” in a manner of speaking, because once this group is taken care off, the rest of us would be able to take care of ourselves with medical insurance. It seems like a no-brainer to me.

Another great idea that Dr Lim raised is that of nations which top-up medical bills after patients co-pay their portion. Our model is the complete opposite – that of deductibles & insurance co-payment shares with the rest of the medical bill borne by the patient and, or the family. The mindset created here of the family being the first line of support also makes me feel guilty to even support Dr Lim in this as it looks like I’m looking for handouts.

Something a doctor friend specializing in geriatrics, shared about our current healthcare model rings so true in the light of the interview with Dr Lim: that the family is the first line of support (our current government’s position of self-reliance) but she also contends that they should not be the ONLY line of support, as is the case right now when public subsidies & assistance only come in after the family has exhausted its resources. How then do they weather other storms? Surely there will not be one medical bill to be paid per family. The current model could potentially place a lot more people in dire straits and could cost the state a huge public assistance bill.

Let’s not kid ourselves, there will always be a swathe of those needing help in many forms, but a huge proportion of any population is self-reliant and proudly so. This however does not negate the need for Singapore to become more a gracious & compassionate society. After all the measure of a developed nation is how it treats the most needy of its people. And Dr Lim’s recommendations would go a long way towards this end. This would be a #1 we should strive for unreservedly.

Dr Lim recommends that a re-think of our current model is timely and prudent. I couldn’t agree more & would add that it is somewhat overdue. He and others like him have my full support.


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