How Can We ‘Actuarially’ Care More?
This last month has made me think about insurance more than I ever had in the past.
For 1.5 years since we became a social enterprise (from a ground-up initiative) and with staff on payroll, I have not been able to get group health coverage of my team at Hush TeaBar. Because the team is entirely made up of differently-abled persons — 4 are Deaf and 3 are PMHIs (persons with mental health issues). 2 of the PMHIs have depression and the other has bipolar. Even when I finally aired my frustration on Facebook last month and with many coming forward with their super agents, it still came down to ‘actuarial science’. “The issue is more with the PMHIs than with the Deaf”, said an executive of an international insurance company. Actuarial science apparently assesses them higher in risk probability. When I politely reminded her that maybe the ‘science’ needs to catch up with the reality of the increasing challenge of mental health issues in our society, and also perhaps to see this as a disruptive innovation for a new market potential, she said she will review my request again and respond after. She didn’t.
Then last week, I was acquainted with the term ‘actuarially sound’ that came up in the CareShield Life discussion in Parliament (Parliament: CareShield Life to get $100 million to help cover those with disabilities, Straits Times, 10 July 2018). I welcome this national insurance scheme that is providing a social safety net for our rapidly ageing population and also understand the actuarial assessment that women will have to pay 23% more in premiums than men when it launches in 2020 because we live longer than men, and are expected to need longer years of disability support in old age.
Yet, this is a convenient truth that’s hard to swallow because of the lack of totality in consideration. The 2015 Survey on Informal Caregiving by MSF found more female caregivers (60%) than male caregivers (40%). On average, caregivers spend 38 hours caring or ensuring care for care recipients — spousal caregivers put in as much as 52 hours. It also noted that “the negative impact of caregiving on the health and work of the caregivers has been well-documented”. And the physical well-being of spousal caregivers is more negatively impacted than the children and ‘other’ caregivers. The study also shed light on the stress (yes, mental health issues!) and financial problems faced by caregivers.
Therefore, if we wish to use ‘science’ to calculate premiums for this long-term care insurance scheme based on the gender-based differentiation, we must similarly use ‘science’ to calculate the economic value that women contribute in caregiving (children, parents, grandchildren, spouses), as well as the impact on their financial security and health — and remunerate accordingly. Otherwise, I fear we are moving backwards in social equality and progress when we selectively decide what is convenient to include, and what is also convenient to ignore.
I’m not hopeful that I will go far with the group cover for my Hush team with the private insurers even if I take comfort that MediShield covers their pre-existing conditions, including psychiatric ones. Yet I will not stop trying because we must continue to work with insurers (public or private) to find new ways to ‘actuarially’ care more, and fairly, for every member of our society.