Asthma in Singapore: Guide to asthma treatment costs for children

If your kid has asthma, know that he or she is not alone. It’s one of the most common children’s ailments in Singapore — one in five kids here suffer from asthma. The good news is, it’s a condition that many kids outgrow. Asthma attacks can cease as kids get older.

So while your kid has asthma, the question is, how do you manage and treat the ailment? And how do you budget for it? Here’s a cost guide to living with asthma.

What are the common asthma symptoms?

Asthma is a chronic (long-term and recurring) disease where your airways have an inflammatory response to certain triggers. When this happens, the airways narrow, produce more mucus and become obstructed, resulting in wheezing, tightness in the chest and difficulty breathing.

If left undetected or not properly managed, asthma can cause permanent damage to the lungs and can even be fatal. So if your kid displays any of these symptoms of an asthma attack, it’s worth it to get them checked out.

Wheezing: A high-pitched whistling sound when your child breathes out.

Coughing: Particularly at night or early in the morning, and chronic coughing.

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Difficulty in breathing: This may be severe enough to affect normal activity, sleep or exercise. In older children it can happen after exercising.

Chest tightness: Happens especially with older children after vigorous exercise.

See-saw motion from laboured breathing: This is called “retractions”.

Lethargy: Feeling tired or weak.

Attacks typically happen when your child is exposed to triggers, like allergens (dust mites, pollen, mould, etc.) or environmental irritants (cigarette smoke, haze, fumes). Some kids are even sensitive to certain medications, chemicals in food e.g. MSG, changes in temperature, and even cold food/drinks.

However, not all asthmatic kids will display these symptoms, so you should also know the risk factors associated with asthma.

It’s a hereditary disease, so there’s a higher risk if you have a blood relative with asthma or allergies. Asthmatic children often also have associated allergies such as food allergies, eczema and allergic rhinitis.

What’s the usual route of asthma treatment in Singapore?

Once you suspect your child has asthma, based on the symptoms and risk factors listed above, you should take him or her to a clinic for diagnosis. After diagnosis, the condition can be managed with medication.

As asthma is a chronic condition, you will need to follow up at various points with regular visits to your child’s doctor. We’ll cover the costs and benefits of a GP vs paediatrician in a bit. Then there are the costs of hospitalisation to consider, in the worst-case scenario of your child needing to be hospitalised.

We’ll break down these steps and the costs involved in each:

Asthma testing & diagnosis

The following are the more usual ways of testing for asthma in children, and how much they cost:

Asthma medication

Once diagnosed, there are two types of medication available — relievers and controllers.

Relievers: Used as needed during an asthma attack, to quickly open up constricted airways. While they relieve the symptoms, they don’t treat the underlying cause.

Controllers (or preventers): For long-term treatment to manage the condition. These are steroids that are administered through an inhaler and have to be taken regularly. They keep the airways stable and prevent flare-ups.

All children with asthma will be given reliever medicine. If the asthma is not well-controlled, your child may have to use the reliever and the preventer medicine daily.

With very young children (under four years old) who cannot use an inhaler, you might opt for a nebuliser instead. This turns liquid medicine into an inhalable mist. The process takes 10 to 15 minutes and may have to be taken up to four times a day.

Asthma inhalers can cost anywhere from $14 to $150 for between 60 to 200 doses. If your child is serving NS, he can get his inhalers for free from the medical centre. Nebulisers cost from $100 and upwards for a bring-home Omron compressor, and more for medicine and consultations with your doctor.

Asthma treatment — GP vs paediatrician

Cost may be your biggest consideration when deciding between a GP and a paediatrician because your child is likely to require regularly check-ups or consultations for a long while. Here’s a quick look at the expected cost of a consultation.

Consultation type	Cost per consultation
Polyclinic	$6.90 to $53.50
GP (private)	$24 to $73.90
Paediatrician (private)	From $100 (video) to $180 (in person)
KK Hospital	$127 to $159

Apart from cost, you should also consider a few other factors.

Age and severity of condition: Your regular GPs can usually handle regular stuff like vaccinations and run-of-the-mill childhood ailments, but for more severe ailments or chronic conditions like asthma, you might find a paediatrician provides better health care. If your kid is very young, you might want to go to a paediatrician as they are specifically trained in treating babies and small children.

Relationship with the doctor: How you and your child relate to the doctor is very important especially if you’re going to be seeing him quite often. And if your child is very young, you would want someone who is able to understand him and coax replies out of him. This is crucial since young children aren’t the best at describing their symptoms or telling strangers how they feel.

Waiting time: Despite the fact that there are more adults than kids, the paediatrician is always more crowded than the GP, possibly because it does take longer to deal with children. If you have to have regular visits, long waits can be a real time-waster.

READ ALSO: 5 medical expenses that could occur in your child's first 6 years

Hospitalisation for asthma

In the event that your child needs to be hospitalised, a two- to three-day stay in a Class A ward at a public or private hospital can cost anywhere between $2,494 to $6,676.

You may want to refer to MOH for the cost of hospitalisation for asthma for other ward types.

Financial assistance for asthma treatment

Asthma is one of those illnesses that requires care for a lifetime so costs can add up quite a lot. Here are some subsidies you might be able to make use of.

MediSave

Parents can use their MediSave to pay for their kid’s asthma treatment. (It’s one of the 19 chronic conditions that are covered.)

There are limits though. Every year, you can withdraw up to $500 or $700 per MediSave account, from up to 10 immediate family members’ accounts. You also have to co-pay 15 per cent in cash for each claim. Finally, you have to visit one of the MediSave approved clinics.

MediShield Life

Yes, you can claim asthma treatment under MediShield Life, but only for hospitalisation in public hospitals.

You can claim $800 a day for admission into a normal ward (which means you typically need to co-pay about three per cent to 10 per cent of the bill). You will also need to pay a deductible of $1,500 to $3,000 before your MediShield Life coverage kicks in. There’s a claim limit of $150,000 per year but no limit to the amount you can claim in your lifetime.

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Child Development Account (CDA)

You can use your child’s CDA to pay for her outpatient treatments.

Chas — Community Health Assist Scheme

For lower income households, check to see if you’re entitled to Chas (Community Health Assist Scheme). Under this scheme, you pay subsidised rates at Chas GPs and dental clinics for common illnesses and some chronic conditions like asthma. All family members who live with you benefit from this as well.

Factor	Chas Blue	Chas Orange
Average household income (per person)	$1,200 and below	$1,201 to $2,000
Annual value of home (for households with no income)	$13,000 and below	$13,001 to $21,000
Subsidy per visit	$80	$50
Annual subsidy cap	$320	$200

MediFund

For low income families, yes, you can use MediFund to help offset your hospital bills. Approach the Medical Social Workers at public hospitals — their MediFund Committee will decide how much help to give based on your financial and social circumstances and that of your family as well as the size of the medical bill.

READ ALSO: HSA reviews asthma drug Singulair after children suffer from side effects, anxiety

Drug subsidies and schemes

The Ministry of Health drug subsidies for certain types of common drugs, and some asthma drugs are on the list. You can ask your doctor for the subsidised drugs to save on medication costs.

Specialist outpatient clinic subsidies

If your child is a Singaporean or a PR, you can get between 50 per cent and 70 per cent subsidy at specialist clinics at public hospitals if:

• you get referred by a polyclinic or a public hospital where your child is already a subsidised patient
• are a Chas cardholder referred by your Chas doctor
• don’t pick your specialist

Important note on asthma and health insurance

If you’re thinking of getting a health insurance policy for your kid to help with the financial burden, know that most insurance companies will not cover asthma as it is considered a pre-existing condition.

If they do, it may be at a higher premium and with a lower limit on claims. Or they may enforce a moratorium period of about one to two years during which you can’t claim for any treatment related to the pre-existing condition.

So the earlier you buy health insurance for your child, the better. If you bought the policy before your kid developed asthma, you can claim for treatment.

Note that the government’s basic health insurance, MediShield Life, is only sufficient to cover B1 and C Class wards at public hospitals. If you want your kid to stay in a higher ward or private hospital, you’ll have to top up in cash (unless you already got a health insurance policy for your kid early on).

Other tips on managing asthma

Asthma can’t be cured, but it can be managed so your child can have a normal life. Since you know the common triggers of an asthma attack, the first thing to do is to protect your child from them.

Environmental allergens

These include dust mites, dust, pollen, etc. and the culprits are usually beds, pillows, soft furnishings and curtains. Do away with as much of these as possible, e.g. replacing upholstered furniture with leather and curtains with blinds. Clean/wash pillowcases and sheets frequently with hot water, and use protective air-tight mattress covers and pillow cases.

You might also want to get rid of furry stuffed toys, rugs and open book shelves (which collect dust). Keep the doors and windows closed to keep out pollen if your child is sensitive to it. And obviously, if she’s allergic to pets, keep their contact to a minimum.

Environmental allergens

This group includes cigarette smoke, haze, fumes and mould. Unfortunately you can’t do that much about these, apart from keeping your kid away from potential triggers. Use air-conditioning to regulate the temperature at home and keep mould at bay.

Drug allergies

Make sure your child’s doctor knows he has asthma so he can avoid the drugs that trigger attacks.

Chemicals in food

Feed your child fresh food, avoid processed foods. Read food labels carefully to keep your child away from artificial food colouring and preservatives. They can still have their treats — just be vigilant with reading labels.

Exercise-Induced Asthma (EIA)

Children with EIA wheeze or cough when they exercise. That’s because their airways are especially sensitive to changes in temperature and humidity, especially cold, dry air.

Your kid should still exercise, though. She can participate and excel in any sport she likes. Footballer David Beckham has asthma and it hasn’t stopped him from going pro!

To manage this condition, inhale preventative medication 15 minutes before exercising, and warm up and cool down properly to make changes more gradual. Swimming is particularly good for asthmatics. Breathing moist, warm air helps to keep airways open and protects against asthma attacks.

Healthcare in Singapore isn’t always cheap. And asthma demands long-term medical care. But with this much help to defray costs, you can rest assured your child will be well cared for.

READ ALSO: Asthma patients less likely to die from coronavirus

This article was first published in MoneySmart.