By Salma Khalik, Health Correspondent

OLDER people who have felt marginalised in recent years as the Government focused on trying to raise birth rates, can take heart from the Prime Minister's assurance during his National Day Rally speech that the country is gearing up to cater to their needs.

In particular, Mr Lee Hsien Loong addressed the rising cost of health care facing older people, who are generally bigger users of medical services than the rest of the population.

One way to keep costs down is for patients to be treated in the correct setting. This is why, increasingly, public hospitals will work closely with step-down care facilities such as community hospitals and nursing homes, so patients can get cheaper care when they are recovering but are not well enough to return home.

This, together with the country's basic 3Ms health-care model - compulsory medical savings in Medisave, basic health insurance with MediShield and government aid for the poor with Medifund - will be enough to see people through their senior years, Mr Lee said.

Today, the majority of the population have some health insurance with MediShield. There is still a large segment of women who have never worked who do not have such coverage - but this is something they can and should remedy.

For as the Prime Minister said, people with both Medisave and MediShield will be able to afford subsidised care at public hospitals.

Unfortunately, there is a hole in the 3M umbrella: People who are 85 years and older - the age at which MediShield stops - are not covered, precisely at the point when they may need it most.

The Government needs to address this if people are not to worry unduly over health-care costs escalating beyond their means as they age.

Eighty-five years used to be so ancient an age that few people were expected to live that long. But things have changed.

In just the five years between 2000 and 2005, the number of people over the age of 85 has soared by almost a third, from 17,523 to 22,580. By now, the number would have risen again.

The argument against insuring the very old is that almost all will require some medical treatment. In order to provide them with sufficient coverage, the premiums will be beyond the means of most people. Therefore, there is no point providing them with insurance coverage.

The annual premium for 84-year-olds now stands at $1,123, compared to $615 for a 79-year-old. Those in their 90s might then have to pay over $2,000, or even more.

But this is no reason to write off people in the over-85 age group. Instead, ways might be found to help them stay insured.

All the arguments in favour of health insurance that we have heard rehearsed over the years to encourage people to get coverage applies even more to the elderly.

They are the ones who will need help to pay their hospital bills. If they are not insured, the burden would fall on their children.

The high cost of uninsured health care could be one reason why children dump their elderly parents in hospitals and nursing homes and stop paying their bills - another problem cited by PM Lee in his Rally speech.

One way to avoid having the young and healthy pay more than their share in footing the medical bills of the old and infirm, is for people to buy into an 'advance elderly insurance scheme' at a younger age - say at 60 when they are still working and contributing to Medisave.

They could put in a lump sum payment of, say $5,000, that would provide them with basic medical insurance beyond the age of 85. Those who do not have that much in their Medisave could get their children to help top it up.

By putting in the money early, the amount would earn some interest in the 25 intervening years. Furthermore, while people are generally living longer, not everyone will survive beyond 85. So those who do will enjoy the pooling of resources that comes with insurance. Once we plug this gap for the over 85-year-olds, we will have a system that covers all more effectively.

To encourage more people to keep their elderly parents and grandparents in the community and out of homes, it might also be worthwhile to provide for parent-care leave - very similar to the six days of childcare leave that parents of young children get.

People looking after the elderly have to find time to take them to the doctor, and perhaps even stay home occasionally to look after them when they are sick.

Just as Singapore wants to help young couples have more children, it should also reward children for being filial and help them care for their aged parents.

Most children would want to take care of the people who brought them up. They do not need to be bribed to do so, just as parents of young children would not have more babies just for the additional six days off a year.

But giving them some help would make it easier for them to provide the care the elderly need, and at the same time, teach the younger generation of the value that society places on the elderly.

This article was first published in The Straits Times.