Social Policy in an Ageing Society
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Social Policy in an Ageing Society

Age and Health in Singapore

David Reisman

Around half the world’s population live in countries where the fertility rate is far below the replacement rate and where life expectancy is increasing dramatically. Using Singapore as a case study, Social Policy in an Ageing Society explores what might happen in a dynamic and prosperous society when falling births, longer life expectancy and rising expectations put disproportionate pressure on scarce resources that have alternative uses.
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Chapter 5: Payment for Health: Medisave

David Reisman


The third CPF account is Medisave. About 18.8 per cent of total CPF claims are held in this account. Medical savings accounts (MSAs) in Singapore are expected to become universal. Compulsion makes the system work: Voluntary enrolment may result in healthier people choosing MSAs program while leaving traditional comprehensive health insurance plans to face higher average risk and subsequently higher average premiums. Also, when catastrophic health insurance protection is voluntary instead of mandatory, as in the case of voluntary MediShield enrollment in Singapore, enrollees are exposed to greater risk of catastrophic spending. In this case, adverse selection in the voluntary catastrophic insurance program can also emerge. (Hanvoravongchai, 2002: 34) The self-employed are allowed to opt out of the superannuation component. As for Medisave, however, they have no choice but to remain on board. Medisave is one part of Singapore’s ‘Three Ms’. The second M is MediShield. The third M is Medifund. The three Ms are discussed in this chapter and the next. The first section of this chapter explains the delivery of health care in Singapore. The second section discusses the subsidies and the means-test. The third section, returning from provision to prepayment, says what Medisave is and what it is not. The fourth section examines the limits and the exclusions. The fifth and last section is entitled ‘A decent minimum?’. It asks how much medical attention the representative Singaporean will need. It asks how much Medisave the members will have in store to put things right. 5.1 THE...

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