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 6: Payment for Health: MediShield and Medifund

David Reisman


The previous chapter was about compulsory saving. The present chapter is about risk-pooling and discretionary relief. Section 1, MediShield, shows how health-specific savings can be invested voluntarily in medical insurance. Section 2, Medifund, reasserts that there is a public-sector safety net when savings dry up and the family is not enough. Section 3 returns from the parts to the whole. Examining the ‘Three Ms’ as a unified system, it lists the economic and social preconditions that make the Singapore system work. It asks if the tripartite attack is uniquely tied to Singaporean conditions or if, like the rubber tree, it can be transplanted elsewhere and flourish. A failure to copy international best practice means shortfall and neglect. Unthinking mimicry, however, is just as bad. The chapter ends with the template. Section 4 lists the criteria by which a good health care system can be evaluated. It says that the mix of savings, insurance and relief in Singapore can usefully be assessed in terms of that check-list as well as in the context of the five goals that the system has explicitly set itself. 6.1 MEDISHIELD Medisave may be enough for the hospitalisation of the median patient. The balances are not, however, adequate for the extraordinary cases where the patient falls victim to a high-ticket calamity such as a motorway pile-up or a chronic complaint such as renal failure. A heart patient in 2006 whose treatment was costed ex ante at S$15,225 ended up with a bill for S...

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