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No country for old men: Can Singapore's aged truly rely on the existing social security savings plan and healthcare system?

Special report

No country for old men: Can Singapore's aged truly rely on the existing social security savings plan and healthcare system?
Despite an improved welfare system, Singapore’s retiring baby boomers still face financial perplexities that are uncommon in the first world. In the medical hub of Asia, are opportunistic medical professionals and would-be welfare abusers wrestling rightful rewards away from our nation’s builders?

Singapore has an increasingly complex safety net for taking care of its elderly. Referred to as the "Pioneer Generation", Singaporeans born just after World War II were spawned in sizeable broods, but had significantly lesser offspring of their own. Lawmakers have spent the past few decades bracing for a greying population that would impact the economy, tax resources, and diminish domestic productivity if not adequately managed.

A portion of Singaporeans' salaries have to be contributed to funds such as the Central Providence Fund (CPF) and Medisave. These funds are bulwarks against the possibility of them not having enough in their old age, and these mandatory savings are gradually released to them when they turn 65.

Singapore also continually improves its welfare policies. The Silver Support Scheme is its latest scheme, which was announced in 2014 and entitles the retirees to varying stipends, the final amount being determined by factors such as one's type of residence and one's total accumulated CPF funds. Beneficiaries of the Silver Support Scheme include the elderly who live apart from their breadwinners or live with low-income grossers — a category that was overlooked by the previous scheme.

However, Singapore's Pioneer Generation is still lamenting that the ability to finance a dignified retirement in Singapore is rare.

Some have even taken their own lives, with the rationale that living on would burden their kin. Janice Tai of local newspaper The Straits Times noted that in 2014, "126 seniors aged 60 and above killed themselves. This is a jump of nearly 60 per cent from the 79 seniors who committed suicide in 2000. There were 95 of them in 2010."

67-year-old Singaporean interviewee Michael Lim puts this into perspective, remarking, "If Singapore asks: 'Why should we take care of you (the older generation)?' Our response is, 'Because during the years when we were young and able-bodied, we took care of Singapore.'"

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Not much, but enough to survive

73-year-old Madam Besah Naman resides in a modest apartment flat in the Bendemeer neighbourhood together with her husband. She has one child who lives elsewhere, but he does not give her money. She reasons that he has three children of his own and she understands that he has to provide for his offspring first. The government's improved welfare system, the Silver Support Scheme, entitles her to $1,500 every month. However, she still struggles to cope.

"I have the three highs," she divulges. "High blood pressure, high cholesterol and diabetes. We have emptied our Medisave. My husband and I see the doctor once every four months, which costs about $400 each time."

Madam Besah discloses that she does not have CPF because she has always been a housewife. "All the money that the government gives us (my husband and I) goes to paying for the house and utilities," she shares. "I recently paid for my husband's hearing aid and that set us back an additional $1,000."

Is it difficult to retire in Singapore? "Yes, but I can't think of a solution. However, even while I am making ends meet, I still approach life with a positive attitude, I still am happy."

"Every government and empire in history has had its shortcomings. When we give our feedback, it is in the hope that it will actuate positive change"Seeking solutions across the Causeway 

A retired logistics manager, formerly with an IT multinational corporation, 67-year-old Jeffrey Jonathan applied for early CPF withdrawal to meet his wife's medical and living expenses. She suffers from dementia and he cares for her daily. Her adult diapers cost a few dollars a day, while the day care centre she visits costs $35 to $70 a day, but costs $9 a day after subsidies. Medication and consultation set him back an average of $100 each month. His daughter lives abroad and he is not entitled to much under the Silver Support Scheme because he lives in a two-storey maisonette apartment.

"I think a problem we face right now is that many old folks are still not aware of the welfare available to them," comments the retiree who makes no bones about the challenges he faces. "I myself am probably not entitled to much under the current scheme, but I have not applied for it as it will probably involve a lot of paperwork."

However, Jeffrey's qualms are not with the welfare plan, but with medical practitioners and the pharmaceutical industry. "The same medication is cheaper in Malaysia and even in nearby Australia. It has to be sold at a higher price in Singapore, because Singapore is recognised as a first-world country. Also, when some medical practitioners find out that you are covered by a certain insurance or welfare policy, they might send you for unnecessary tests or prescribe unnecessary medication. When these physicians took their (Hippocratic) Oath, did they not swear to treat rich and poor indiscriminately?"

Jeffrey also accounts that he has been downgraded from professors to junior doctors in instances when he chose to invoke his entitled medical subsidies.

Simultaneously, he sides with the government's current policy, disclosing, "I understand why this scheme is strict and calculative — because the government doesn't want people to abuse it. Individuals in other countries who prove that they are not yielding any income can receive up to thousands in welfare each month."

no country for old men, andre frois, amanda soon

A more generous welfare system is prevented by potential abusers

Jeffrey's primary school friend Michael is enjoying life in his 60s but nonetheless feels for his less fortunate peers. "The word 'subsidy' has been abused." The self-employed building and renovation specialist elaborates, "The money was your contribution from your salary, so one should not be asking 'am I subsidised?' The money was yours to begin with."

Michael argues that while the direct and indirect taxes imposed in Singapore is no different from those in other nations, relief offered to the poor, old and sick is comparatively scant.

"In many other countries, I can retire like a king, but how many of us are willing to give up our friends, food and culture of Singapore to spend our retirement years in a foreign country?" Michael adds, "When individuals make constructive criticisms about policies in Singapore, others are quick to label us as 'anti-government', but I am not anti-government. Every government and empire in history has had its shortcomings. When we give our feedback, it is in the hope that it will actuate positive change."

Is the segregation of healthcare entitlements the reason why poor people have shorter life spans in Singapore? "There might be some statistics that can vouch for this," Michael chimes in. "I am most upset when I see medical professionals bullying the illiterate and convincing them to agree to unnecessary medication, scans and surgery. Rich or poor, we all contributed to the nation's economy when we were young and able-bodied."

"Whoever pays more, will get it first. Thus, there is a need for government intervention, to provide healthcare to the masses as a public good, which in turn, benefits the whole population"Are we children who always require supervision? 

Perhaps Big Brother's intervention might be the solution to our society's faltering integrity. "In Australia, public healthcare is free and abuse is common" describes Singaporean Dr. Tan Ker Fern, who now practices medicine in Australia. He gives an account of how this predicament necessitated Australia to reciprocate with a complex yet still blemished system that addresses these imperfections, while managing the constraints set by potential abusers and the already burdened economy.

"There have been attempts at focusing efforts on preventing social waste of resources through governmental organisations just to curb drug and alcohol issues. Criteria for social welfare like pensions for the disabled are slowly getting stricter so as to ensure that it is not abused. Singapore has means-testing for subsidy and also further subsidy for the elderly. They're also some exceptions, I believe, where the social worker can help with extreme cases of inability to afford for healthcare provided."

Born and raised in Singapore, Australian émigré Dr. Tan lends insight into Australia's government steps in (eg. prices of medication) and when it doesn't (eg. subsidies for treatments), describing, "The Australian government has a pharmaceutical benefit scheme where they identify medications that have a significant impact. There is then a process of negotiating with suppliers as a nation. They then subsidise the medications for people according to different tiers. Pensioners, for example, get the most subsidy. Procedural treatment is, however, subjected to the provider or surgeon. Much of the public treatment in Singapore is subsidised according to means-testing. While in Australia it is free on the public system. That welfare system is a worry in terms of its sustainability."

no country for old men, andre frois, amanda soon

A problem that cannot be completely solved through auditing

"The cases of less informed people being cheated are of course unfortunate, but I feel these are a minority rather than a common occurrence," adds Dr. Mark Lim, a local general practitioner who is an ardent opponent of such practices. However, he does not feel that more stringent auditing of doctors' actions is a perfect solution, explaining, "The medical profession has a duty of care to the patient, to provide a reasonable standard of care at an affordable pricing. Overcharging or ordering unnecessary tests can be subjective, but of course, there will be examples of it occurring blatantly. The main reason this can happen is because the divide in knowledge between patient and doctor can be vast. Without being privy to this knowledge, it's going to be difficult to make an informed choice as to whether to conduct this expensive test or to undergo this expensive procedure. There is no easy solution to this and you might end up punishing everyone just to weed out a few bad apples. The CHAS (Community Health Assist Scheme) situation is a good example of a good idea that got twisted. People were making excessive claims for procedures not done. Its solution would be more paperwork and auditing which might deter clinics from joining the scheme. In the end, if fewer clinics are providing the CHAS scheme subsidy, the patient suffers financially."

"The pioneer generation, unfortunately, falls through the cracks whenever individuals experience a lack of CPF provisions"Our world-class healthcare is accessible, but mentalities need to change

"From a free-market perspective, private companies are geared towards providing a good or service that has high profit margins," observes local practitioner Dr. Kevin Kok, who respects that healthcare — despite its necessity and compassionate circumstances — needs to be analysed not unlike any other commodity that is subject to economic factors. "Healthcare is also a service that follows this principle. Whoever pays more, will get it first. Thus, there is a need for government intervention, to provide healthcare to the masses as a public good, which in turn, benefits the whole population. Unfortunately, with the provision of subsidised healthcare as a public good, long waiting queues are expected, due to low profitability and less incentive to innovate." This reality in countries with universal healthcare has unfortunately led to numerous fatalities that resulted from delays and subpar treatment.

Nonetheless, he notes that the government has rallied against these obstacles in the name of welfare and gratitude toward its seniors, continuing, "Fortunately, the Singapore government does deliver public healthcare in a fairly efficient way, such that compared to other countries in the region, there is a high percentage of allocated funds going to the intended recipient. As such, Singapore can boast to have world-class healthcare even in the public healthcare ecosystem."

"The pioneer generation, unfortunately, falls through the cracks whenever individuals experience a lack of CPF provisions." He keenly observes a peculiar scenario that is specific to modern Singapore, noting, "In addition, the absence of primary health prevention in former Third World Singapore, means that they suffer from multiple chronic diseases that require polypharmacy intake on a daily basis. This increases the life expectancy of the population, which in turns increases the healthcare burden of society. For their contributions to the success of the Singapore economy, every citizen deserves to have healthcare provided for."

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Specialist syndrome

While others might lament Singapore's public healthcare scenario, Dr. Kok finds it to have excelled, as opposed to the systems of other nations. "Singapore's model of healthcare is, in my opinion, very efficient, as institutes are run in a mixed private/public model, whereby, revenues from the private patients are used to subsidise the fees of the subsidised class, in addition to government grants. Thus, encouraging institutes to be financially lean in terms of costs, to innovate, and in turn to boost productivity. As such, waiting time of three months to see the specialists in a reputable public institution, from the time they see their polyclinic doctor, is very commendable, as compared to a fully subsidised healthcare system like in the UK, where a prior appointment to a specialist can stretch for more than six months, and an appointment to see a GP can stretch for up to two weeks."

Besides keen insight into how fully subsidised systems have resulted in a lackadaisical healthcare system, he also notes that dissatisfied Singaporeans can be viewed as individuals disenfranchised with the already above-average healthcare available to them. "I feel that this efficiency in the public system, ended up being its Achilles heel. People are accustomed to this efficiency such that they develop a nuance of complacency, taking it for granted, demanding waiting times to be shorter. In addition, they develop a 'specialist syndrome', whereby they expect specialist care, even for minor ailments, thus further increasing the load in the public specialist sector or tertiary healthcare institutes."

"Singapore's model of healthcare is, in my opinion, very efficient. People are accustomed to this efficiency and develop a nuance of complacency, taking it for granted, demanding shorter waiting times"Money is the root

Dr. Kok's proposed solution is intrepid, but has been tested and proven in Nordic countries: "My suggestion is to reduce the complacency amongst the general population and specialist syndrome is actually contrary to the popular vote — to increase the individual burden of healthcare for the top 80% of the population. This would reduce the complacency and specialist syndrome mentality, as they will start to hurt more from their demands, whilst diverting the additional savings to the bottom 20% who have less of a safety net."

As medical science advances rapidly, Singapore is one of many countries trying to straddle the disparity between funds available, and how much new treatments cost to heal the aged sick.

About Andre Frois
Andre is a freelance journalist who posts his articles on andrefrois.com and an independent publisher whose books can be viewed on afstorytellers.com.

Andre Frois

  • Image: Amanda Soon
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