Singapore faces a 'silver tsunami' By Megawati Wijaya
SINGAPORE - In a departure from the usual state-sponsored message urging
Singaporean couples to have more children, this year's National Day rally
addressed the island state's rapidly graying population. As rising health and
living costs emerge as a threat to social stability and economic growth, a
dramatic demographic shift is driving the government to re-examine its past
anti-welfare stance.
Singapore has one of the fastest aging populations in the world, with over
65-year-olds estimated by 2030 to represent 23% of the population, the second
highest percentage in Asia lagging behind only Japan. If current demographic
trends hold, the island state's median age will rise from 36 presently to 41 by
2030. By 2050, the island state's median age will rise to 54, leaving only
Japan, South Korea and Macau with more elderly populations.
Singapore's demographic shift has been accentuated by the
country's low fertility rate, which fell to a low of 1.24 in 2004 before rising
last year to 1.29. Fewer offspring translates into an increased burden on the
young population to provide for their elderly forebears. Health Minister Khaw
Boon Wan earlier this year described the changing demographics as a "silver
tsunami".
The government has long enforced individual savings through the mandatory
Central Provident Fund (CPF), which mandates that the population saves for old
age. More recently the government announced plans to pass a so-called
Re-employment Act, which will take effect in 2012 and extend the standard
retirement age from 62 to 65.
Nonetheless, a recent survey found that less than 5% of the current elderly
population relies on CPF disbursements for their livelihood. Rather, the
majority of respondents said they depend mainly on their children. That
dependence, however, is straining family ties as average health-care costs
rise.
The government has emphasized the role of the family in caring for the elderly,
including through the passage of the 2005 Maintenance of Parents Act, which
allows parents to sue their children for financial support. Applications at the
Tribunal for Maintenance of Parents hit a nine-year high last year.
Over the past 12 months, some 172 senior citizens have filed applications
against their children, up substantially from the previous annual rate of
around 100. Still, Geylang East Home for the Aged, a shelter for elderly people
abandoned by their family, said that its 37-bed home is always full. Abandoned
parents who can no longer fend for themselves are often recommended by social
workers.
The generational conflict is being driven in part by spiraling health costs. In
1984, Singapore's government covered about three-quarters of national health
costs. That burden shifted when the government introduced medical saving
accounts which required individuals pay their own way.
Health care now accounts for 4.5% of Singapore's gross national expenditure,
one of the lowest such percentages in the world. A research report by Nanyang
Technological University's David Reisman showed that 36% of health-care
expenditure was government financed in Singapore in 2007, comparable to the
percentages of much poorer Indonesia and economic basket case Zimbabwe.
With the growing number of senior citizens and cash-strapped children who are
unwilling or unable to shoulder the burden, the Singapore government will find
it difficult not to bear more of the costs, according to Reisman.
In Organization of Economic Cooperation and Development (OECD) countries,
around 80% of health care expenses are covered by public spending, mostly
through subsidies to public hospitals. That figure stands at 85% in Sweden and
the United Kingdom, 81% in Japan and 45% in the United States, which is now
grappling with a controversial reform plan to provide universal healthcare
coverage.
Member of parliament Paulin Tay-Straughan was quoted in the local media saying
that spiraling healthcare costs could potentially be a major strain on the
Singapore government's resources. "If [individuals] don't have adequate
coverage, there will be a tremendous strain on subsidized care which will drain
revenues from the state," she said.
Singaporeans are hospitalized on average 11 times through their lives, with
eight of those visits occurring after the age of 55. Older persons suffering
from chronic degenerative diseases and non-communicable disabilities are more
likely to be "bed-blockers".
Even when individuals can pay, there is a chronic shortage of beds in
hospitals, with average waiting times of four to eight hours before patients
are admitted, say sources. The government is encouraging more home care, but
there is a shortage of doctors willing and able to do emergency house calls,
industry experts say.
The mounting crisis has spurred some creative - and controversial - thinking.
The government in recent years launched a national elderly long-term care
severe disability insurance (LTCDI) scheme, known as Eldershield, to protect
its citizens against severe disability. Although not overtly referred to as
welfare, new government support measures have quietly been implemented to
assist the elderly, including the Workfare Income Supplement and other
healthcare subsidies.
In February, Health Minister Khaw drew flak when he suggested Singapore
consider moving its elderly residents across the causeway to the neighboring
Malaysian city of Johor Bahru. He estimated that for the cost of establishing a
polyclinic in Singapore a 200-bed full service nursing home could be built in
Johor Bahru.
"Of course many [family members] visit [their parents] daily, but quite a
significant number visit only during the weekends. So what is the difference in
putting them in Johor Bahru?"
Moving patients to Malaysia would also address the island state's acute
shortage of health-care specialists in palliative care and geriatric-related
fields, which in recent years has compelled hospitals to import nurses from
China, the Philippines and even impoverished Myanmar. Some say Singapore's
health-care crisis comes down to culture and changing generational priorities.
In the Philippines and Thailand, children, particularly women, are expected to
care for their parents when they reach old age out of a debt of gratitude.
"We cannot legislate love," Minister of Community Development, Youth and Sports
Vivian Balakrishnan recently told parliament. "But we know that a small
minority will need help and we will ensure that help is available... Those
contemplating abdicating responsibilities will know that the system will catch
up with you."
Megawati Wijaya is a Singapore-based journalist. She may be contacted at
megawati.wijaya@gmail.com.
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