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    Published on 4 February 2024

    A National University Cancer Institute, Singapore study found that financial literacy is key to bracing people for unexpected medical costs.

    Mr Abdul Rashid was diagnosed with acute myeloid leukaemia in April 2023 at the age of 31. It was only then that he realised that his insurance policy had lapsed, leaving him unable to afford his medical treatment which amounted to about $150,000. Fortunately, with the help of a medical social worker from National University Hospital (NUH), the firefighter with the Singapore Civil Defence Force successfully obtained financial assistance for his treatment, which reduced his out-of-pocket expenses to around $5,000.

    Ms Alexis Koh, Principal Medical Social Worker, NUH, who assisted him in the management of his cancer treatment costs, said, “It is important that we proactively communicate with patients about the cost of cancer treatment and engage them on mobilising their financial resources and other avenues of financial support. Patients and families with difficulties can reach out to their doctors and medical social workers for assistance.

    Mr Abdul Rashid (left) , with Ms Alexis Koh, a Principal Medical Social Worker at NUH, who helped him mobilise various channels to cope with his treatment costs. Mr Abdul Rashid (left) , with Ms Alexis Koh, a Principal Medical Social Worker at NUH, who helped him mobilise various channels to cope with his treatment costs. 

    Mr Abdul Rashid’s case is not unique in Singapore, where cancer is a leading cause of death, accounting for 23.9 per cent of deaths in 2022 per cent of deaths in 2022. While the percentage of cancer-related deaths has been going down over the years — an indication that treatments are improving and people are living longer — many Singapore residents like Mr Abdul Rashid do not feel they would be able to afford cancer treatment and its associated costs if diagnosed.

    This was revealed in a study helmed by the National University Cancer Institute, Singapore (NCIS) Institute, Singapore (NCIS) and local thinktank Research For Impact Singapore (RFI). Sponsored by DBS Bank, the ongoing three-part study aims to examine the level of financial preparedness of Singapore residents to manage cancer.  Preliminarily findings by the research team shed light on how financial knowledge can affect an individual’s ability to navigate and cope with the challenges posed by cancer treatment and care. 

    “The financial impact of cancer is a real but poorly-understood and infrequently acknowledged concern in cancer care and survivorship,” said Dr Jen Wei Ying, clinical lead of the study and Consultant, Department of Haematology-Oncology, NCIS.  “Our data shows that cost concerns are prevalent, even in respondents who do not have a cancer diagnosis.”

    In its initial phase, researchers conducted a perception survey of 1,200 Singapore residents. The next stage of the study involves qualitative research to gain deeper insights from stakeholders such as cancer patients and their caregivers, medical social workers and oncologists.

    Here are four key findings from the survey:

    1. Less than half of respondents who had never had a cancer diagnosis, believe they can afford to manage a cancer diagnosis

    In general, 47 per cent of Singapore residents with no prior history of cancer diagnosis think that they have the finances to cope with a cancer diagnosis. A good majority (71 per cent) of the same group are not confident that their existing health and/or critical illness insurance policies would fully cover the cost of treatment.

    Survey findings also suggest that people are not clear of what cancer entails, from the disease incidence to treatment costs, and healthcare financing. “Financial preparedness to meet the challenges of critical illness is something that should be addressed as part of a holistic, total approach to preventative health and well-being,” said Dr Jen. She added, “Policymakers, financial institutions, the healthcare industry and, critically, all Singapore residents, must share responsibility in mitigating the financial burdens of critical illness.”

    2. Concerns about cost may impact treatment decisions

    About a third of respondents (32 per cent) expressed concerns over the cost of cancer care. These include those in both the lower- and middle-income groups. Furthermore, those without critical illness insurance coverage cited unaffordable premiums as the main reason for not having it. These factors may affect people’s decision making when it comes to getting treatment after a cancer diagnosis.

    3. People are unsure about their insurance coverage

    Respondents recognise the importance of having sufficient insurance coverage to help in coping with medical emergencies financially. However, many of those who have health insurance are not sure of their coverage such as the illnesses covered, co-payment, the sum insured and exclusions. 

    Beyond specific policy coverage, the study team found that there also needs to be more awareness in healthcare changes. For example, only 33 per cent of respondents were aware of the changes to the Cancer Drug List, which impacts the cost of cancer treatment and insurance premiums.

    4. It is crucial to improve financial literacy

    The survey found that those who perceived themselves as highly financially literate were less likely to anticipate delaying or foregoing cancer treatment due to cost concerns. Thus, improving financial knowledge will give people the confidence to prepare for unexpected medical expenses and loss of income.

    “Our early findings reinforce that financial literacy can have wider impacts for long-term health and welfare. Empowering consumers to develop their own financial capability and understanding of the policy and insurance environment is a critically important foundation for decision-making in a healthcare system like Singapore, where both public and private stakeholders play a key role in supporting household well-being,” said Dr Joanne Yoong, CEO and Principal Economist & Behavioural Scientist, Research For Impact, and Adjunct Professor, Centre for Behavioural and Implementation Science Interventions at the Yong Loo Lin School of Medicine (NUS Medicine).

    In consultation with Dr Jen Wei Ying, clinical lead of the study and Consultant, Department of Haematology-Oncology, NCIS; Dr Joanne Yoong, Adjunct Professor, Centre for Behavioural and Implementation Science Interventions, NUS Medicine and Ms Alexis Koh, Principal Medical Social WorkerNUH.