Mr Deputy Speaker
How we view and ultimately support the long-term care of the vulnerable in our society should be a reflection of what Singapore values. Care recipients are our parents, our partners, our neighbours, and perhaps even ourselves.
Every Singaporean hopes that when frailty comes, they can look to a system of support, which includes not only from family and loved ones, but from the society that we live in: through a national system that spreads the risk equitably, offers dignity, and lightens the load on those who give care. As a developed, wealthy country, the principle of shared responsibility through Careshield Life should rightly form one of the key pillars of our social safety net, providing financial support for Singaporeans faced with severe disability. This is why the Workers’ Party has supported it conceptually since its inception in 2020.
As the scheme matures and as our society continues to age, we must ensure that it continues to embody the spirit of fairness and solidarity that should be a bedrock of a truly caring society. Where we can do more, we must do more.
Strengthening Long-Term Care Support in Singapore
Careshield Life marked a shift from its predecessor, Eldershield, by extending coverage to provide for lifetime monthly payouts from when an insured becomes severely disabled, and being compulsory for younger cohorts.
Since Careshield Life was first debated in Parliament in 2018, we have seen significant increases in the cost of living, off the back of global events like the pandemic, wars and geopolitical tensions.
The increase from 2% to 4% of the annual growth rate of Careshield Life payouts is thus welcome, as an acknowledgement that long-term care costs have outpaced inflation.
Even with payouts for the severely disabled, costs for long-term care are still significant, with 2024 numbers indicating that it can cost on average between $1,800 to $2,500 a month for home-based long-term care, depending on care intensity and subsidies, rising to an estimated average amount of $2,200 to $4,200 a month before subsidies for institutional-based care such as in a nursing home.
Given that long-term care costs have been outpacing general inflation since, the increase in payouts will be welcome by families. However, could the Minister explain ongoing and future monitoring mechanisms and calculations, for Singaporeans as policyholders to better understand what would be taken into consideration for the government to once again assess whether the current payouts are adequate? After all, we can anticipate that any future increases in payout rates would also have consequent increases in premiums, and thus a direct impact on Singaporeans as we continue to age. Thus I would like to repeat the call made by LO Pritam Singh in his speech when CareShield Life was introduced and debated in this house in 2018, where he asked the government to reveal actuarial principles, and to publish investment returns and premium adjustment factors regularly.
Gender-differentiated premiums
On premiums, I note that while premiums will go up to support the changes to the scheme, the government has put in place various support measures. However, I wish to today again bring up the issue of gender-differentiated premiums, because how we price care says something about how we value those who provide it. This is not a new point, and Workers’ Party MPs shared their concerns about this when Careshield Life was introduced in this House in 2018.
Women pay higher premiums, and this is still the case, with the reasoning that women live longer and claim more. Given that Careshield Life has been running for 5 years now, and the ministry would presumably now have some data about claimants under the plan, could the Minister share whether the assumptions that women would claim more, and for longer, have been borne out?
Even if the actuarial reasoning and data makes sense, actuarial fairness is not always the same as social fairness. Applying a strict actuarial lens when deciding to charge women more for enrolment in this compulsory plan does not take into account the following factors.
First, women in Singapore have lower lifetime earnings and smaller CPF balances on average. MOM’s 2023 Gender Pay Gap Report found that women earn 14.3% less than men on a gross basis, with an adjusted gap of 6%. CPF Board data also shows that women’s balances at age 55 are approximately 55% lower than men’s.
It is widely accepted that career decisions have a significant impact on the gender pay difference, and that societal, cultural or even biological factors mean that women in Singapore continue to shoulder more caregiving work compared with men. It is often the default position that women are the ones who reduce their working hours, turn down promotions or increased responsibilities, or even leave the workforce altogether in order to care for a parent, spouse, child, sacrificing income, retirement adequacy and sometimes even at the expense of their own health.
Add to this that globally, women live longer but spend more years in ill health. Studies show they spend about 12 per cent more of their lives in poor health than men. Closing this gender health gap could add over US $3 billion annually to Singapore’s GDP by 2040.
So when we ask this very same group – women – to pay more for CareShield Life, we risk deepening structural inequities. The caregiver who has spent years enabling others to work is, in effect, asked to bear a greater cost for the very care safety net her unpaid labour helps sustain. This can also be compounded by findings in jurisdictions like New South Wales in Australia which noticed that while both women and men experienced disability at similar rates, women only made up 37% of claimants of its national disability insurance scheme. One of the more sobering findings was that because women shoulder more of the care work in the family, they end up with less time to manage their own disabilities and take on the administrative work associated with disability claims. Could the Minister clarify whether a similar picture exists in Singapore, and if so, what is being done to address this additional challenge?
Just as importantly, by making women pay more, are we sending a signal that society does not provide for both men and women at the same rate? Women could be perceived to be penalised financially for two things they cannot control: living longer and providing the majority of unpaid care. When a woman reduces work hours to care for an ageing parent or a disabled relative, she loses income, retirement savings, and then pays higher premiums for the privilege of having provided that unpaid care. This is not risk pricing; it is compounding disadvantage.
Towards Fairer, More Transparent Premiums
In view of the above, I hope that we could consider the following:
First, greater transparency,
Second, mandatory periodic review triggers of premium structures.
Third, explore how best we can close the gender gap.
On transparency, the Ministry should publish actuarial data regularly, including average claim duration, payout levels and fund solvency, as it currently does for MediShield Life. Publishing such data of what is after all a national insurance scheme will allow the public to be better understand the financial reasons as to why policy shifts occur when they do, and to equip us in this House with a full picture as we strive to understand the tradeoffs to be made within the policy.
Second, given that we are announcing the doubling of payout increases five years after the scheme started, I believe that it would help the public to understand at what point we would need to review the adequacy of payouts, given changing costs of care.
Additionally, the longevity gap between men and women has narrowed over the last two decades from about six years, to around 4.4 years today. If this narrowing of life expectancy between men and women continues, and if we were to succeed in our aims to close the gender health gap, it would be remiss not to ask whether there is still a place for gender-based pricing.
We therefore hope that the government can commit to reviewing this policy when a specific threshold is crossed. This could take the form of a review of gender-based premiums that gets triggered when the differences in payouts narrow to a specific threshold on average over a few years. The exact threshold should be determined by actuarists with access to full data, and the threshold should be published. And when that threshold is crossed, a mandatory review of the existing policy should take place.
Finally, we need to work towards greater equity in the form of exploring gender-neutral premiums. After all, MediShield Life already does so, and we should explore how CareShield Life can be structured to phase towards this approach, once we have adequate claims experience available.
If we accept that CareShield Life is a national insurance rather than a commercial insurance product, given the constraints that women face, there is value in building equity into the design of the scheme, rather than attempt to patch up any inequalities using subsidies or adhoc support of cash offsets.
A baseline protection against disability should be universally accessible to all Singaporeans, and inherently it does not sit right to penalise a group (that is, women) by making us pay more for what are often factors beyond our control. After all, globally, it has been found that women have a higher prevalence of disabling conditions such as arthritis.
And to achieve our aims towards a HealthierSG, I hope too that we continue to work on various preventative and early-intervention initiatives to address the various health challenges that women face, to do what we can to minimise women’s time in ill-health and address these concerns about a double or even triple whammy facing women as we age.
These suggestions are not about favouring one group over another; they are about ensuring that the principle of shared risk applies equally to everyone, and to address any systemic issues at the root that may be causing the inequity. Our goal should not be to rebalance inequity with subsidies, but to explore how we can remove inequity from the structure itself.
Underwriting Criteria Reinstatement
One of the changes in this Bill too is the reinstating of the underwriting criteria for those born before 1980 which means those with severe pre-existing disabilities would no longer be able to sign up for the scheme.
Given this is a finite group who may already currently live with severe disabilities, I would like to seek clarification on what support would be available to these individuals who may in the future be faced with an unexpected exigency, for example, in the form of suddenly losing coverage under their own plans which were meant to cover their long-term care needs. In this case, would the ministry be willing to consider any appeals on an exceptional basis to be included in the scheme after the reinstatement?
Finally, financial protection is only one part of the long-term care story. For many families, day-to-day realities and challenges of caring for loved ones means a constant juggling of the invisible mental load and unpaid work involved in caregiving, arranging for services, balancing work, while simultaneously facing exhaustion and burnout.
And for caregivers who take on much unpaid and unseen work, it bears reiterating what my colleague Aljunied GRC MP Gerald Giam said during this year’s Committee of Supply debate: care recipients and carers have different needs, and that our support system needs to reflect this.
A 2023 survey found that more than 40% of caregivers in Singapore are at risk of depression. The typical caregiver is a married woman between the ages of 45 to 60, simultaneously holding full-time employment, spending an average of an extra 6.7 hours on caregiving a day. These details alone should cause alarm, and we must urgently build stronger, more holistic support for them, with solutions that better capture and respond to the time, skill and emotional resilience needed in their unpaid care work. This can take the form of accessible interventions targeted at their realities rather than add to their workload, whether it is in form of mental health support or rallying better social connections within the community.
Underscoring this, during the launch of our Caregivers’ Wishes initiatives last week, we heard many stories from Singaporean carers and recipients, with a common thread of caregivers needing not only more financial support, but more time, skills and understanding. Giving this support is not charity, it is an investment in our society’s care resilience.
From Insurance to Solidarity
To conclude, Mr Deputy Speaker, after our transition from Eldershield to Careshield Life, the next step is to ensure that Careshield Life remains true to its founding purpose: to stand beside every Singaporean in times of need.
This means ensuring:
- Premiums grow transparency and remain affordable
- Gender-based differences are regularly reviewed as our care needs and demography changes, and
- Caregivers are given training, respite, and recognition beyond financial means.
A truly caring nation should not measure support only in actuarial tables, but in how we treat and support those who give and those who need care.
Let us continue towards our goal of a system that reflects our shared values of fairness, inclusion and solidarity, so that every Singaporean, regardless of gender, income or circumstance, is able to live and age with dignity and support. I support the Bill. Thank you.
