| Popis: |
Background Singapore is ageing rapidly and has one of the longest life expectancies in the world. Long-term care also represents one of the largest financial risks of the elderly, as the risk of disability increases with age. ElderShield, a long-term care insurance scheme provides payouts up to six years for elders with severe disability - having three or more ADL disabilities. The six years of coverage might be insufficient due to increases in the duration of the disability.Methods In this paper, we studied all elders admitted to community hospitals in Singapore from 1996 to 2005, linked with national death records until December 2011. We modelled their survival risk after discharge from community hospitals using Cox proportional hazards regression, taking into account ADL disability, health status and other sociodemographic covariates. Results Individuals with higher ADL disability counts have a higher hazard ratio (HR: 1.28,1.76,2.09 for mild, moderate and severe disability respectively compared to those with no disability), being in a higher subsidy ward class (HR: 1.13 and 1.41 for moderate and high subsidy respectively compared to no/low subsidy) and had greater comorbidity burden (HR: 1.33, 1.74, 2.74 for mild, moderate and severe comorbidity burden respectively compared to those with no comorbidity burden). We also found that survival probabilities for individuals with two disabilities were not statistically different from those with 3+ ADL disabilities. In addition, more elders with severe disability were living for longer than six years.Conclusions Our results indicated that individuals with ADL disability might be living longer. This has possible implications on long-term care policies in the context of ElderShield insurance as it uses severe ADL disabilities as the criteria for payout, capped at six years. In 2020, Singapore expanded to CareShield Life with lifetime cash payout if severely disabled. Ensuring fiscal sustainability and affordable premium is challenging for any government, especially with Singapore's rapidly ageing demography. We conclude that the expansion of coverage from six years to lifetime coverage is timely as Singaporeans are living longer and disability risk increases with age. These payouts will be helpful for the disabled elders and their family, protecting them against some financial risk. |
