2nd Edition of Public Health World Conference (PHWC) 2026

Abstract

As the population ages and health care costs rise globally, middle-income families increasingly face financial and caregiving pressures that challenge traditional assumptions of economic security. Policy frameworks prioritize the support of the low-income population, so an increasing number of working adults are insufficiently protected. This study examines the inequalities in access to healthcare faced by the middle-income individuals who simultaneously support dependent children and elderly parents - in Singapore's urban healthcare system.

Despite Singapore's internationally recognised health efficiency and universal coverage mechanisms, middle-income families may face, face structural vulnerability due to subsidy eligibility thresholds, cost-sharing requirements, and the increasing burden of chronic, chronic disease and long-term care. These pressures are compounded by factors such as time constrain and caregiving responsibilities that impact care-seeking behaviour, preventive health, health care utilisation, and exposure to financial risk.

Using Singapore as a case study, this research draws insights from the social determinants of health frameworks, the health care access pathway model, and the policy implementation literature to examine how financial, temporal, informational, and supply constraints interact in health care use. The study interprets median income vulnerability as a blind spot for equality within targeted social welfare systems, which may inadvertently create exclusion zones for households that are not poor enough to qualify for assistance but are insufficiently protected against health financial shocks.

The findings highlight the need to expand the health equity framework beyond poverty-focused models , models to include the vulnerability of middle-income populations in aging societies. Policy implications include redesigning subsidy thresholds, strengthening carer support mechanisms, simplifying navigation between systems and improving financial protection for chronic and long-term care needs. By illuminating the experiences of an underserved population, this study contributes to global debates about equitable access , access to health care and sustainable care planning in rapidly aging urban environments.