Governance of a City-State
The Future Legislative Landscape Relating to Civil Society in Singapore

The elderly Singaporean is increasingly hard pressed when it comes to healthcare. Our Singapore healthcare financing model emphasizes, in addition to government subsidies, employment, 3Ms and family. The latter three may no longer be sturdy pillars.

Singapore prides herself as a traditional society, where there is a strong sense of filial piety and the young takes good care of the old. Our elderly are enjoying greater life expectancy – Singapore’s life expectancy of 81.7 years is higher than the average of OECD countries’ 79.7 years in 2010, but a closer inspection reveals troubling news amidst this happy statistic- the years of healthy life lost due to disability has increased by roughly two years from two decades ago. The average man spends 10.7 years while the average woman spends 13.3 years of their lives suffering from poor health. Poor health aside, the elderly are financially vulnerable as a group. 35% of elderly above the age of 75 years are not enrolled in the MediShield scheme. Neither do they enjoy employer benefits since most of them are not working or are working without benefits. The ‘traditional’ model of family support may also be under strain: smaller families, single Singaporeans and children of elderly Singaporeans struggling with high housing prices, inflation and paying for their own children’s expenses all stress the long-assumed family safety net. The occasional Medisave top-up, while helpful, is not definitive; Medisave only commenced in 1983 and Singaporeans in their 70s and 80s would have built the Medisave nest egg for only a decade or two and hence would not have sufficient monies to provide for a lifetime of healthcare needs.

With many years of disability and a financing system not designed for them, many elderly may lack the monetary means to pay for their hefty medical bills. This may lead to foregoing of necessary medical and preventive healthcare, further exacerbating the risks of ill health and disability. Do we need reform? Any revamps of the system needs to address two critical objectives: ‘compression of morbidity’ and ‘financial peace of mind’. What are the options?

Compression of Morbidity

‘Compression of morbidity’ is the shortening of the number of years lived with disability before death by delaying the first onset of chronic diseases and mitigating the lifestyle impact of these chronic conditions. This means two things: remaining healthy as long as possible and timely disease detection and treatment to enable continued functionality. Singapore does reasonably well in the former.

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