Assessing Cliff Effect of Healthcare Costs for Households That Marginally Exceed Orange CHAS Subsidy Threshold
Ministry of HealthSpeakers
Summary
This question concerns Ms Elysa Chen’s inquiry about the cliff effect for households marginally exceeding the CHAS Orange subsidy threshold and the potential for additional graduated tiers. Minister for Health Ong Ye Kung responded that the Ministry of Health monitors affordability via post-subsidy bills, noting that CHAS Green cardholders' 90th percentile chronic care costs are approximately $550 annually. He explained that the existing three-tier CHAS structure balances targeted support with scheme complexity, while MediSave usage further reduces out-of-pocket expenses. The Minister stated that the Ministry does not track specific out-of-pocket proportions as requested but maintains an appeals process for those marginally exceeding income thresholds. These appeals allow for case-by-case assessments to ensure healthcare remains affordable for households transitioning between different subsidy tiers.
Transcript
56 Ms Elysa Chen asked the Coordinating Minister for Social Policies and Minister for Health (a) whether the Ministry has assessed the cliff effect faced by households who marginally exceed CHAS Orange subsidy thresholds resulting in markedly higher healthcare costs despite modest income differences; and (b) whether the Ministry will consider additional graduated subsidy tiers to smooth the subsidy taper.
57 Ms Elysa Chen asked the Coordinating Minister for Social Policies and Minister for Health what proportion of patients who are in the $2,000 to $3,500 per capita household income range pay out-of-pocket healthcare expenses exceeding 10% of their monthly household income for chronic disease management.
Mr Ong Ye Kung: The Ministry of Health (MOH) does not specifically track out-of-pocket costs in the manner requested by the Member. However, we do monitor affordability through post-subsidy bills for each Community Health Assist Scheme (CHAS) tier. Based on 2024 data, the 90th percentile annual post-subsidy bill for chronic conditions of CHAS Green cardholders is about $550, or less than $50 per month. The out-of-pocket amount would be lower after taking into account claims from MediSave 500/700 and Flexi-MediSave. CHAS Green cardholders have per capita household income (PCHI) of at least $2,300.
In designing subsidy tiers, MOH balances the need to vary subsidy levels and support for different income segments, and scheme complexity. For CHAS General Practitioner visits, there are three CHAS tiers and another two tiers for Pioneer Generation and Merdeka Generation cardholders. This structure smoothens and targets government subsidies to a reasonable degree without being overly complicated.
For individuals who marginally exceed PCHI thresholds of a better CHAS tier, they may appeal and we will assess their circumstances on a case-by-case basis.