Wednesday, 23 April 2014

Big push to explain Pioneer Generation Package to Singaporeans

Front-line staff in health care being trained; communications drive to start
By Charissa Yong, The Straits Times, 22 Apr 2014

A MAJOR effort is under way to explain the details of the Pioneer Generation Package to Singaporeans, after a poll found that many were in the dark about its benefits or did not feel assured by them.

About 1,000 front-line staff in public hospitals and polyclinics are being trained to help patients understand the package, and address their questions and concerns.

The training has begun and the communication drive will start in September. It will include more television and radio messages broadcast in different Chinese dialects, and the publishing of more non-English brochures for the elderly.

The Pioneer Generation Package is the centrepiece of this year's national Budget.

A telephone poll last month of 1,500 Singaporeans of all ages showed seven in 10 citizens had heard of it.

But among those who knew of it, two-fifths could not name any of its benefits, Senior Minister of State for Finance Josephine Teo said yesterday at a media conference with Senior Minister of State for Health Amy Khor.

The survey, however, showed a higher level of awareness among the pioneer generation: 85 per cent of the 244 pioneers polled had heard of it.

Both senior ministers chair the task force set up to raise awareness of the package, announced in the Budget speech in February. It will benefit 450,000 citizens aged 65 and older this year and who were either born in Singapore or became citizens before 1987.

The package includes Medisave top-ups and subsidies for outpatient treatment, and promises to pay part of seniors' MediShield Life premiums.

Mrs Teo said half of those surveyed felt more assured that the package would make health-care costs for pioneers significantly more affordable. One-third were unsure or neutral.

Said Dr Khor: "We are keenly aware that there is still a significant number of people whom we need to provide assurance to, and we need to do this in a multi- pronged approach."

As health-care services are often used by the elderly, settings such as hospitals and clinics are "good contact points" to connect with them, she added.

Dr Khor cited a 2012 Central Provident Fund Board study which found that more than eight in 10 people aged 62 or older use primary health-care services in a year.

Hospital and polyclinic receptionists are thus being trained to set out the benefits to pioneers when they register and when they are billed.

Expert on ageing Kanwaljit Soin said: "It's nice for pioneers who see a specialist to know at the counter that they'll be charged at a discounted rate."

But what is also important for seniors' peace of mind is a support network, like having people to take them to clinics, added Dr Soin, a former Nominated MP.

"You have to look at health-care costs as part of a much bigger package."

Tailoring info to suit senior citizens
Simple and bite-size messages will help avoid info overload: Task force
By Charissa Yong, The Straits Times, 22 Apr 2014

THERE is a certain art to telling senior citizens about the Pioneer Generation Package, said the two leaders of the task force handling its communication.

The process of informing and explaining the package to them needs to be tailored to suit their needs, such as producing brochures in larger font sizes and non-English languages.

Messages will also have to be simple and in bite-size form to avoid an overload of information, said Senior Minister of State for Finance Josephine Teo yesterday at a media conference.

She and Senior Minister of State for Health Amy Khor are chairing the task force.

For example, the word "subsidy" is not something many seniors are familiar with, said Mrs Teo. Often, they understand "discount" better, she added. "It's things like that; paying attention to what gets through to the pioneers. Otherwise, we'll be merrily thinking that we've explained, we've told them about subsidies, but... they don't know."

Both Mrs Teo and Dr Khor were laying out the challenges of explaining details of the package to about 450,000 pioneers aged 65 and older this year.

Experts on ageing have noted that many pioneers did not have much formal education.

One in four of them do not use print and online resources, which is why more television and radio channels will be used to get the message across, said Mrs Teo.

But she added that as 70 per cent of pioneers live in a multi- generational household, their family members can also help to tell them about the pioneer package.

Another challenge is the short memory of some pioneers, said Dr Khor. To overcome it, messages will be repeated in different settings, including the possibility of delivering them at getai performances, as was done at one such show in Hougang on April 13.

By June, all in the pioneer generation will receive a letter informing them that they are eligible for the benefits. They will also get a pioneer generation card by September which they can start using at polyclinics. "It works better because the elders will ask each other, have you got your card? They will show it to each other. That's a way to help them remember," said Mrs Teo.

Ms Lee Bee Wah, an MP for Nee Soon GRC, told The Straits Times that it was good to engage the pioneers in dialect, "the medium many are most familiar with". But, she added, it was a shame that seniors no longer have a dedicated radio station they can turn to for news in Chinese dialect.

Manage it well or risk eroding public trust
By Basskaran Nair, Published The Straits Times, 21 Apr 2014 

IN HIS speech to the Administrative Service on March 26, Minister for Finance Tharman Shanmugaratnam was reported to have said that the Government faces a challenge retaining the public's trust. He also noted that today's environment is more complex, with competing interests and rising expectations. He pointed to the Pioneer Generation Package as a case in point.

The minister was right to draw attention to the problem.

The Pioneer Generation Package has been generally well-received. Some components of the Pioneer Generation Package will be easy to implement. The 450,000 beneficiaries will get annual Medisave top-ups of $200 to $800, and more flexibility to use their Medisave for a wide range of outpatient treatments. They will also get additional benefits, subsidised bills at specialist outpatient clinics and polyclinics, and qualify for the Community Health Assist Scheme (CHAS).

But there is a potential trust deficit issue. This lies in its centrepiece, MediShield Life. Subsidies will be given according to age. At age 65, the subsidies start at 40 per cent of the premium and 60 per cent by age 90. Those aged 80 and above this year have their premiums fully covered through premium subsidies and Medisave top-ups. Those who have moderate to severe functional disabilities will get cash assistance of $1,200 a year.

However, several aspects of the programme could undermine public trust.

The first factor is the cost of the premium. The Ministry of Health has given an assurance that under MediShield Life, the pioneer generation will not pay more out of pocket than they do under today's MediShield. While this may be true in the initial period, there is concern that after a few years, the premiums will go up.

Look at MediShield's current track record - premiums have gone up on the flimsiest of reasons.

Mr Sia Cheong Yew, a former Straits Times senior editor from the pioneer generation, wrote to the Forum page saying he was shocked when his insurer increased his premium from $1,879 to $2,900 upon renewal, a jump of more than 50 per cent.

The reasons given were the enhanced benefits announced by the Government, increasing medical costs and a desire to serve customer needs.

He added that there was no way for anyone to challenge what the company had proposed without specific data such as total premiums against total claims. As for customer needs, these had not even been discussed with customers.

There is a need for the Government to step in to prevent an erosion of trust when it comes to the setting of premiums for MediShield-related insurance plans.

Even though these are private sector insurers, they ride on state-operated basic MediShield plans, and the public expects the Government to regulate premium rises.

It is not clear at present how these MediShield integrated plans will be dovetailed with the new MediShield Life, but it is fair to say Singaporeans will be expecting an even closer level of scrutiny of premium hikes under MediShield Life.

In Singapore, the Government is the price setter in most parts of the economy. In the property market, for example, land cost is the main factor in the cost of a property, and this is largely dictated by government valuers.

For the Pioneer programme, the basic cost ingredients will similarly be determined by the Government. They include doctors' fees, the illnesses covered and a host of other deliverables.

The nagging concern is that, even with a 50 per cent subsidy, the final premium over the years would be just as high, if not higher, than the present MediShield.

The second possible trust issue lies in the fact that the Pioneer Generation Package is at least a 30-year programme. Thirty years is a long time in politics.

While this government has committed its word and budget to the Pioneer Package, there is no certainty that future governments will honour the programme. And what about implementation? Will qualifications and benefits chop and change at will?

I would suggest that a permanent secretariat with a 30-year mandate be put in place. This secretariat can consist of people from both public and private sectors.

Recall two decades ago when the Government announced that it would use its Budget surpluses to increase every citizen's stake in Singapore, expand the assets of its citizens and double the shareholder base. That asset enhancement programme had as its centrepiece the privatisation of profitable government companies every two to three years. After the SingTel privatisation, the committees were disbanded and the ambitious, long-term plan on asset enhancement by increasing shareholder base petered out. A permanent secretariat, not a committee, should therefore be incorporated from the outset.

The Pioneer Generation Package is a good move to "reward" pioneers for their sacrifice. But pioneers also want assurances that the premiums will be kept affordable; and that the programme will be as long-lived as has been promised.

The writer, a retired public relations professional, teaches media and public policy at the Lee Kuan Yew School of Public Policy, National University of Singapore.

MPs size up communication challenge
Challenges include language barrier and explaining complex schemes
By Nur Asyiqin Mohamad Salleh And Charissa Yong, The Straits Times, 23 Apr 2014

SINGAPORE is undertaking the biggest public communications blitz in recent memory as the Government sets out to explain the details of the Pioneer Generation Package to seniors.

The drive to explain its health-care benefits will involve grassroots volunteers and health-care workers in the thousands.

But while the Government has tackled far more difficult subjects in the past, such as the introduction of GST in 1994 and various rounds of CPF cuts during the recession years, the current effort is daunting for two reasons, said a dozen MPs and experts interviewed yesterday.

These are the complexity of the health-care schemes in the package with their many concepts and the difficulty of effectively reaching out to the seniors, often requiring face-to-face explanations.

"It may take 18 months for us to fully reach out to all the people involved. We cannot expect this communication process to be short-term," said Chua Chu Kang GRC MP Zaqy Mohamad.

The $8 billion Pioneer Generation Package, the centrepiece of the national Budget, will benefit 450,000 people aged 65 and older this year.

But it is an uphill task in some ways. For one thing, seniors are struggling to understand the technical concepts and intricacies behind the schemes, said Marine Parade GRC MP Tin Pei Ling.

"It is a bundle of benefits that even young and educated people take a while to grasp. We cannot throw words like MediShield Life, premiums, top-ups at senior citizens. These are jargons we have to simplify for them," she said.

Further, details for some of the benefits will be hammered out only in the coming months.

Also, communicating to the elderly is challenging as most speak Chinese dialects, not English, and some are illiterate.

But unlike CPF cuts, which are controversial changes politicians had to coax and convince the public to accept, the bundle of benefits for pioneers is widely welcomed, the MPs noted.

Tampines GRC MP Irene Ng does not foresee a problem getting people to accept it politically.

"The difficulty lies in explaining it to the seniors. I always tell them, 'Don't worry if you can't remember all these details. Just remember this: You don't have to worry about medical costs. Have that peace of mind. Come and see me if you have problems with medical bills'."

A government survey of 1,500 Singaporeans last month found seven in 10 have heard of the package. But of those aware of it, four in 10 do not know its benefits.

This, say the MPs and experts, can be improved by engaging seniors on their own turf.

Face-to-face sessions are most effective, MPs added.

Some, including Nee Soon GRC MP Lee Bee Wah and Pasir Ris-Punggol GRC MP Zainal Sapari, have ramped up efforts to meet and speak to seniors at places where they congregate, such as coffee shops, senior citizen corners and void decks.

"You cannot wait for them to come online or read the news.You have to go and find them, be there to listen and ease any worries," said Mr Sapari.

The SARS crisis in 2003 saw Chinese dialects making a short-lived comeback on local television to keep the elderly informed.

The preferred channel then was the mass media, not community interaction, noted Ang Mo Kio GRC MP Seng Han Thong.

"It's the opposite with the Pioneer Generation Package, which requires us to be closer to the ground. With Sars, we tried to avoid contact or gatherings. "Also, the message then was 'Be worried, take care of yourselves.' Now, we tell people, don't worry, we'll take care of you."


There are two groups of seniors that I've seen. One group doesn't really want the details, they just want to be reassured that they will be taken care of. So... we say: Don't worry, just go to a clinic. And if all else fails, come to the MP. The more savvy group wants to know the details. What happens when MediShield Life kicks in? How about co-payments? So we need to find out what they really want.

- Marine Parade GRC MP Tin Pei Ling

We have to assure them that there will always be help for them in the future. So you have to win their trust and confidence.

- Nee Soon GRC MP Lee Bee Wah

Assurance is a first step in building up the trust that the Government is taking care of them. Many are worried about the costs incurred should they seek medical help. This is precisely where the package comes in and is aimed at.

- Dr Tracy Loh, visiting fellow at the National University of Singapore communications and new media department

The publicity campaign seems to target mainly the pioneer generation. As a result, the younger generation may think this is none of their concern. In fact, they have also benefited from the policy, although indirectly.

- Associate Professor Foo Tee Tuan, deputy director of UniSIM Centre for Chinese Studies, SIM University

How to reassure Ah Pek on the Pioneer Package
By Jeremy Lim, Published The Straits Times, 21 May 2014

AMID the euphoria of the Pioneer Generation Package (PGP) announcements, it is hard to be a wet blanket. In fact, it seems almost churlish to question the package of medical subsidies the Government has committed to giving the "pioneer generation", or those aged 65 and above.

But before the headlong rush into implementing the package, it would be timely to step back and ask whether there are aspects that can be done differently. I do not doubt the Government's sincerity and commitment. At the same time, one cannot help but wonder whether the package will fully achieve its twin objectives of providing our pioneers with not only lifelong medical care but also financial peace of mind.

The great artist and inventor Leonardo da Vinci elegantly articulated: "Simplicity is the ultimate sophistication". For the PGP, simplicity is vital. The scheme targets citizens who are educationally, linguistically and socially diverse. Policymakers have to deliver messages simple enough to be understood and yet powerful enough to resonate.

If one does not understand, it is difficult to feel reassured.

A recent survey highlighted that seven in 10 Singaporeans had heard of the PGP but more than half admitted they did not know or understand the benefits. The statistics among the target group, the pioneers, I suspect would be even more modest.

It is striking that in rolling out the PGP, the Government has found it necessary to establish a task force, helmed by two ministers, which has prioritised communicating the benefits to the intended recipients. Co-chairman of the task force, Senior Minister of State for Health, Dr Amy Khor, described last month plans to train 1,000 front-line staff and said that the Government would be "running through with them the various questions and concerns that Singaporeans may have regarding health-care subsidies and also to help them address some of these questions and concerns to provide reassurance to patients".

Perhaps the challenge really lies in the complexity of the design. From a policy perspective, the PGP sits on top of the existing 3M (Medisave, MediShield, Medifund), Chas (Community Health Assist Scheme) and CDMP (Chronic Disease Management Programme) schemes, which arguably, most Singaporeans do not fully understand anyway. In the proposed system, there are multiple tiers of subsidy depending on whether the presenting disease is deemed "simple" or "complex", whether the disease is included in the CDMP, and so on.

The contrast with many countries with universal health coverage is stark. The message should be simple: At the point you need health care, concentrate on getting well; don't worry about money. In many schemes globally, there are no co-payments required, or if there are, these are in the form of fixed amounts with annual limits. In Singapore, the individual's co-payment can soar while the Government's share (subsidy amount) is capped.

Australia announced in its Budget last week that the government would impose a A$7 (S$8.20) co-payment for each visit to the general practitioner, up to a total of A$70 a year for concessional patients.

No caveats depending on type of disease, no exclusions depending on housing type or income. Just a simple A$7 figure to understand and remember.

This brings me to the second point. It is better to frame the scheme to be viewed through the lens of the pioneer and not the policymaker.

While $9 billion is an admirable commitment to the health- care needs of the pioneer generation, the pioneer would much rather know what he needs to pay individually rather than the amount the Government subsidises.

Imagine the thoughts running through the mind of a pioneer: "Yes, it is good to know there is a $28.50 per visit subsidy for a common illness like a cough or cold, but how much do I need to pay? Nothing? $10? $20? More?"

In stores, it is clever marketing to highlight a large discount - but what really matters to the customer is what he pays, not the discount. The Government's concerns over unanticipated costs and the instinct to safeguard public coffers are understandable and perhaps even natural.

But to the Singaporean living on $1,000 a month, a mis-estimation of the medical bill by $50 is 5 per cent of all he has; to the Government, the same mis-estimation occurring for even 10 per cent of our pioneers is $2.25 million, or barely a quarter of a per cent of the $9 billion allocated.

Perhaps the risk of getting the numbers wrong is a yoke easier borne by the Government's accountants than by elderly Singaporeans.

The PGP is the cornerstone of the Government's 2014 Budget. The Government has correctly read the minds of the pioneer generation that fears around health care weigh heavily.

The political will is there to make a difference; Prime Minister Lee Hsien Loong has declared to the pioneer generation that he and his Government will "make medical care always affordable for you".

Let's design the PGP such that every Singaporean in the pioneer generation can easily understand and use it, safe and secure in the comforting reassurance of a nation's gratitude.

The writer is a partner in the global consulting firm Oliver Wyman.

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