Presentation (CTI)

OBJECTIVES: Healthcare affordability is commonly accessed through system-level financing subsidy, and expenditure indicators. However, these measure may obscure how affordability is experienced within households managing multiple care obligations. This conceptual paper develops as household-level framework for examining how healthcare financing rules shape access decisions among 'sandwiched' household in Singapore, defined here as working adults who may simultaneously support older parents, children, and their own healthcare needs.
METHODS: A structrured policy-mapping approached was used to identify financing and access decision points in Singapore's healthcare system, including subsidy eligibility, means-testing, co-payments, compulsory savings, insurance coverage, and family-based payment assumptions. These policy features were organised into a conceptual decision pathway linking eligibility rules to household resource allocation, treatment protestation, delayed care, and perceived affordability. The framework was further informed by health economics, outcomes research, and household decision-making concepts re3levant to affordability and access.
RESULTS: The framework identifies three mechanism through which affordability barriers may emerge despite broad healthcare coverage. First, eligibility threshold may create discontinuities between formal subsidy entitlement and household capacity to pay. Second, co-payment and savings-based financing structures may shift affordability decisions from th e healthcare system to families. Third, family responsibility assumptions may create trade-offs between timely treatment, preservation of savings, and intergenerational caregiving obligations. These mechanisms suggest that affordability is not only a system-level financing outcome but also a household-level allocation process.
CONCLUSIONS: This conceptual framework supports a more patient-centre red and equity-sensitive approach to evaluating healthcare affordability. Applying a household decision lens can health policy makers identify hidden access barriers and design financing policies that better reflect how families make healthcare choices under constraints in Singapore and other rapidly ageing Asia-Pacific health systems.