Demand for healthcare for the elderly in Singapore is set to grow significantly as the population increases and ages. The resident population is anticipated to grow from the current 4.5million to 5.5 million by 2020 while the population of residents aged 65 and above is expected to increase to 900,000 or 20% of the population by 2030. At present, there are approximately 307,000 elderly aged 65 and above representing 8% of the population. As the population ages, demand for healthcare and medical technologies is also expected to grow as the more affluent and discerning aging population would demand, and be able to afford, better quality healthcare and step-down services.
Singapore’s healthcare budget is expected to double to between 8% and 10% of GDP by 2030; the extra expenditure over the next 20 years is meant to cope with a graying population. Correspondingly, this would mean that individuals would spend between 12-15% of their income on healthcare. Based on available statistics, the future cohort of seniors, those aged between 65 and 74 years, will be better educated. The number of seniors is projected to increase dramatically from a mere 19% in 2000, to 29% in 2010 to 62% in 2030.
Singapore’s health administrators are concerned with providing the best care for an aging population while containing costs. As such, U.S. companies that have efficient and cost effective medical technologies that aid health screening, disease prevention and diagnosis, expertise in the long-term care for the elderly and programs that help the caregivers may be interested in Singapore’s healthcare industry.
The national healthcare plan covers almost 100% of the population and for those who do not have adequate finances, the government steps in to provide support. This enables all Singaporeans to have access to medical care and augurs well for the healthcare industry.
Singapore is also recognized as the healthcare hub of the region, delivering excellent and first-class services to both its resident population and international patient market.
According to a report by the Commission on Global Aging, Asia is aging fast. Leading the way is Japan, which will be the first in Asia to be hit by hyper-aging, in which more than 20% of the country’s population will be aged 65 years and above. The more developed Asian economies of Singapore, South Korea, Hong Kong and Taiwan are only a decade or two away. China too, is expected to join its Asian neighbors by 2040. A United Nations report published in 2002 states that the aging of the world’s population is irreversible and by 2050, the number of people aged 60 or more will exceed those below the age of 15 for the first time in history. The world median age would have risen from 26 years to 36 years.
Apart from a rapidly aging population, life expectancies are also higher. World Health Organization (WHO) data indicates that the average life expectancy of a male Singaporean was 78 years in 2006 but his healthy life expectancy was only 69 years (9 years of ill health). For a female Singaporean, it was 83 years with a healthy life expectancy of 71 years (12 years of ill health).
To this end, the Singapore Government set up a Ministerial Committee on Ageing (MCA) in 2007 comprising high level government officials and senior civil servants tasked with coordinating Singapore’s policies on aging. The focus is on four main areas, finances of the elderly and their employability; accessibility issues for older people; active aging and health. The key is providing employment opportunities to older persons and getting more people to become health-conscious at a younger age.
The main recommendations cover health promotion and disease prevention, screening and early detection of illness and disability, better training in geriatric care for medical undergraduates and general practitioners, development of long-term care facilities and services in partnership with voluntary welfare organizations, ensuring standards of healthcare services and measures to finance long-term care. It is hoped that these initiatives will enable Singaporeans to age gracefully.
The elderly are considered disproportionate users of healthcare. At present, the elderly comprise 8% of the population but use 20% of public sector primary care and hospital services. This will translate to a four-fold increase in utilization of healthcare by 2030.
Singapore’s financing of healthcare for the elderly is premised on personal responsibility, planning, anticipating and preparing for the future. The system encourages self-reliance with the Government playing an enabling role to help each person build up his individual assets and savings, through home ownership and the Central Provident Fund (CPF). The following healthcare financing plans help Singaporeans pay for hospitalization expenses.
A compulsory savings plan to help individuals save and pay for their healthcare expenditure. It is designed to help Singaporeans build up sufficient savings, especially for their old age. Medisave is used for hospitalization expenses including surgery fees, certain outpatient expenses, long-term outpatient treatment for chronic illnesses, chemotherapy or kidney dialysis, hospice care and more.
Standard outpatient expenses and elective treatments such as cosmetic surgery are not payable under this plan.
It is a basic, low cost, catastrophic medical insurance plan to complement Medisave to help meet the cost of large medical bills. Premiums are paid through Medisave. Private insurance firms also provide variations to this basic plan and Singaporeans can choose their preferred insurance provider.
To help Singaporeans save for old age, the Central Provident Fund Life Scheme will be in place from 2013 to provide CPF members (Singaporeans who work and have contributed regularly to this central fund) a regular income for the rest of their lives.
A life annuity plan that guarantees residents with CPF funds payouts from early as age 65 for as long as they live. There are 12 options that members can choose from and these are broadly divided into refundable and non-refundable ones. Payouts start at age 65, 70, 75, 80 , 85 or 90.
The less fortunate and elderly poor will have access to Medifund and the Eldercare Fund which have a combined reserve exceeding S$42 billion. This is fourteen times Singapore’s annual operating health expenditure of about S$3 billion.
To help patients pay for services at hospitals, community hospitals, step-down facilities, the Health Ministry will develop what it terms the 3 E’s – ElderSave, ElderShield and Elderfund.
A relatively new concept, was recently introduced to help young people set aside enough of their Central Provident Fund to provide for their healthcare needs when they are old.
helps the elderly poor pay their hospital bills, while ElderShield is insurance for severe disability. The government will inject US$267 million/S$400 million into the Eldercare Fund, bringing it to US$1 million/S$1.5 billion. This is to help seniors who need to live in nursing homes and other long-term care facilities.
In the past, the focus had always been on acute hospitals, however, there is a shift as the health ministry is now looking at combining the medical and social services.
Healthcare charities involved in either preventive care or care of the elderly will receive a US$20 million/S$30 million boost over the next two years. Charities in the preventive care category may get up to 50% of the cost of health education and screening programs. According to the health ministry, those dealing with chronic diseases like diabetes and high blood pressure will be especially targeted.
Another focus is on step-down care services which deal with the impending wave of aging citizens. More funding will be available for home health care, home nursing and therapy services. There will also be funds available for programs that teach patients and caregivers proper care at home and those promoting active aging.
Further Education Trends
In an effort to address the concerns of a rapidly aging population, tertiary educational institution, Temasek Polytechnic, has launched a Gerontology Course and the response from the young has been overwhelming. The course aims to teach students to cater specifically to the ‘active agers’ of today, who are far more demanding that the seniors of previous generations.
According to the school, the silver market in Singapore is estimated to be worth at least US$10.67 million/S$16million a year by 2015. The course will focus on four areas:
- Financial products and services that will help seniors manage their savings
- Assistive technology that will bring or use relevant equipment to help seniors stay independent
- Healthcare and wellness to keep them active for longer
- Leisure and travel so that they can continue to enjoy their preferred lifestyles
The Singapore government will also invest an additional US$1 billion into recruiting and training more healthcare professionals, including doctors, nurses, palliative care specialists and allied professionals such as pharmacists and physiotherapists.
By Luanne Theseira