system capable of allowing early detection of potential infectious disease threats. This, combined with close links with the World Health Organization, allows the Ministry of Health to detect and track outbreaks worldwide, allowing for a quick response to infectious disease outbreaks. Health care institutions and medical workers are also kept informed of potential threats in a bid to ensure that they are prepared. NCDs, particularly cancer and heart disease, remain the leading causes of mortality – in contrast to the 1950s, when infectious diseases like TB were among the leading causes. Cancer incidence rates, which accounted for 30 per cent of all deaths in 2012, have been declining slowly since the early 1980s for men. However, incidence rates for women have increased, due mainly to increases in breast and colorectal cancers. The prevalence of chronic diseases in Singapore, such as diabetes and hypertension, declined between 1992 and 2010, as well as risk factors including smoking, physical inactivity, obesity and high cholesterol. In February 2014 the Singapore Cancer Society celebrated its 50th anniversary on World Cancer Day. In a speech at the beginning of the ceremony, Minister for Health Gan Kim Yong spoke of the society’s mission to ‘minimise cancer, maximise life’ in a country where cancer remains the leading cause of death. The speech focused on the importance of regular screening for breast, cervical and colorectal cancers. In order to promote regular screening, the Ministry of Health continues to put in place measures to ensure access to good quality and affordable health screening. For definitions and sources see page 314. Universal health coverage Just over a third of health care in Singapore (38 per cent) was government funded in 2012. The remaining 62 per cent was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 4.2 per cent of GDP in 2012. Expenditure by government amounts to US$912 per capita. Singapore finances health care using government subsidies, insurance and a mandatory saving system called Medisave, into which employers and employees contribute a percentage of their salary each month. There are still out-of-pocket payments to be made, however, that can be difficult for low-income families to afford. In the early days of independence, the government established a network of satellite outpatient dispensaries, and maternal and child health clinics to bring primary care services closer to people and take pressure off hospitals. The so-called polyclinics offer a onestop shop for immunisation, health screening, family planning services, nutritional advice, psychiatric counselling, dental care, pharmaceutical dispensary, x-rays, clinical laboratory and even home visits. Those living in Singapore who are not citizens or permanent residents generally have to pay the full cost of their health care. Having a baby, for example, costs in the region of S$9,000 (US$6,650). S i n g a p o r e At the end of 2015 a new compulsory medical insurance scheme will be brought in, called MediShield Life. This will address some concerns about out-of-pocket costs and accessibility, promising to provide better benefits and protection, and universal, lifelong coverage and improved protection against large hospital bills. Singapore is not a signatory to the International Covenant on Economic, Social and Cultural Rights, the covenant that commits signees to the ensuring ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. Care of the elderly: Approximately 552,000 people in Singapore are over the age of 65 – ten per cent of the total population (2013). At the age of 60 a person living in Singapore can be expected to live for an additional 24 years, on average (2013). Singapore, like most developed countries, is facing emerging problems from an ageing population. In Singapore the issue is particularly acute thanks to a low birth rate, increased life expectancy and the fact that the post-war baby boomer generation has just started to reach retirement age. The government has projected that by 2030 there will only be 2.1 working-age citizens for each citizen aged 65 and above. Currently, there are 4.8 people of working age for every person over 65. Population over 65 The government has set up the Ministerial Committee on Ageing (MCA) to spearhead a whole-of-government response to the opportunities and challenges presented by this changing demographic. The main role of the MCA is to promote ‘ageing in place’, whereby seniors are given support and assistance within a close community. This is done in part through building an inclusive environment, thereby making the city age-friendly, and providing good care, including health care, within the inclusive environment. The MCA also promotes ‘active ageing’, whereby members of the ageing community are encouraged, and supported, in keeping their minds active and their bodies healthy. Particular attention is paid to ensuring health screening and follow-up care is available to seniors. The country has no tradition of social welfare, which has led to high costs for families that are paying for the care of elderly people. In 2012 the Ministry of Health increased subsidies both for residential care of the elderly and for support provided in people’s own homes. The MediShield Life reforms also promise more subsidies for older people. Further information Ministry of Health: www.moh.gov.sg Commonwealth Health Online: www.commonwealthhealth.org/health/asia/singapore Commonwealth Health Partnerships 2015 263 10%
Commonwealth Health Partnerships 2015
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