Elderly amputee who was denied Eldershield benefits dies weeks after authorities reconsidered his case

40916

The Government’s stance on public healthcare insurance schemes like Eldershield and Careshield Life have riled many Singaporeans, especially as it was reiterated in parliament this week that the authorities collected a hefty $3.3 billion in premiums and only paid out $133 million to policyholders.

In the midst of the parliamentary debate on this hot topic, Workers’ Party chairman Sylvia Lim shared the story of an elderly resident who was denied help from Eldershield until it was too late.

The opposition MP revealed that the resident, an amputee who was suffering from advanced kidney failure, was an Eldershield policyholder until the scheme revoked his benefits since he could “partially” perform 6 activities of daily living (ADLs).

The Government considers individuals severely disabled and will pay out insurance benefits when they can do three out the following six ADLs: washing themselves; dressing themselves; feeding themselves; using the toilet by themselves; moving indoors by themselves; moving from a bed to an upright chair by themselves.

Even though the resident was so sick that he could only do these activities “partially,” the authorities decided to discontinue his benefits.

When Lim stepped in to appeal the decision on the resident’s behalf, she was told that the resident must fill out more paperwork. Since the resident was languishing in a hospice at this time, his daughter had to do the necessary. A month after the authorities decided to restore his Eldershield benefits, the resident died.

Lim shared in Parliament:

“This resident, Mr K, was suffering from an advanced stage of kidney failure and already had his leg amputated earlier due to diabetes. The insurer later decided to discontinue Mr K’s Eldershield benefits as the insurer’s panel doctor had assessed that he could perform all of the six activities of daily living “although partially”.
“When I appealed on his behalf for a re-assessment, the insurer wrote back to him to fill up another claim form. Meanwhile he was admitted to a hospice. When I saw him there, he requested me to write to the insurer to say that he would not be filling up the form as he was in the hospice.
“Eventually, his daughter filled up the form, and I understand that the hospice doctors assisted to get his Eldershield benefits restored. But within a month, he was dead.”

The resident’s brother, Facebook user GJ GJ, spoke up on social media and said that his brother passed away in May this year. Revealing that they belong to a low-income family, GJ shared that his sister-in-law went “from one institution to another and (kept) getting turned down bec we never met their protocol”.

Adding that his young nieces who are in their 20s were the ones who kept the household running, GJ added that the paperwork his family had to fill out before receiving help was unbelievable and that his brother struggled before he passed:

Expressing concern for other ailing policyholders like Mr K, Lim asked as Parliament convened on Tuesday:

“Mr Speaker, I do not know what rigorous standard is applied to determine if a potential ElderShield claimant is disabled enough. When I read about the ElderShield premiums in the billions that have been collected over the years, it struck me how Mr K and his family have apparently been abandoned in their time of need. Is the experience of Mr K an aberration? If this is going to be the experience that will be carried over to CareShield Life, it would be unacceptable.
“I am concerned that the “3-ADLs test”, which will exclude disabled persons facing high medical and care costs, would leave them in a lurch. By the time a person is unable to do 3 ADLs, one is in dire straits. One is either headed towards a nursing home or needs someone to provide care full-time. Before one reaches this stage, if Careshield can give some payouts, then it is likely that the disabled person can continue to be looked after at home with some part-time help. The payouts will fulfill a very important gap, to enable the disabled person to age in place and not tie up another nursing home bed.”

Lim stressed that the new Careshield Life scheme – a mandatory scheme which will be imposed on all adults age 30 and above from 2020 – must review eligibility requirements for payouts so that policyholders receive adequate care and assistance and are not abandoned in their time of need despite paying exorbitant premiums for years:

“I would like to emphasize the point that CareShield Life will be a compulsory scheme, and young Singaporeans will have to pay 37 years of premiums. With this looming fact in mind, CareShield must have meaningful coverage, and my view is that the “3-ADLs test” needs to be reviewed and readjusted to serve this end.”

Former Senior Minister of State for Health Chee Hong Tat responded to Lim that increasing payouts and lowering the claims criterion could make premiums more expensive.

Chee also claimed that the Government is not making “profits” even after it collected $3.3 billion in Eldershield premiums and only paid out $133 million and said: “This balance amount is not profit, it is to meet future liabilities.”

Netizens responding to Mr K’s story were angered and called such insurance schemes “scams”:

 

The government’s responses in the debate greatly frustrated several Singaporeans who have slammed the authorities for trying to “squeeze more blood” from citizens:

Govt still claims it is not making profits after collecting $3.3 billion in Eldershield premiums and only paying out $133 million