Tag Archives: Healthcare

Building a New Social Compact

By Nicole Seah

Inequality hurts not just the poor, but ALL segments of society. Research in the field of social science has shown that social indicators such as life expectancy, rates of imprisonment, social mobility show poorer performance across the board when there is greater inequality.

Inequality has many practical implications, the most important one being dissatisfaction and discontentment across different classes.

Economic progress accounts for more than just pure output or growth. Other indicators of well-being include consumption, health and longevity, leisure time and income distribution.

Even though our per capita GDP was 83% of the US, the well-being of Singaporeans was disproportionately a mere 44% in comparison.

With regards to the issue of inequality, we cannot continue to look outward to other countries and assume that there is less for us to do because we are in a much better off situation on the whole.

Singapore is well-poised to take on the challenges of the global economy with the strong growth policies that have been put in place.  I believe that now is the time for us to look inward and draw our focus back to the core of good governance . . . and the core of good governance is the ability of a state to take care of its people.

So a National Conversation is good. It is important. But if we do dig deep into what makes this country tick, what makes people stay or go, then we will only be left with just that – Conversation. Singapore is in a good position to transform its social policies.

Policy biases

For too long there have been several arguments AGAINST giving more to the poor. We do not want to create a welfare state, we do not have the finances to sustain a greater amount of assistance. Our policies have benefitted the population at large, there will always be poor people in society no matter what you do, so the fact that our numbers are less than other countries means that we are in a good position.

There are so many of these arguments.

And this is where I think, the Singapore government needs to re-engineer the way it thinks about the poor.

Think of them, not just in terms of statistics, but as people. People who could be our neighbours. The uncle next door who might have to take up 3 jobs to provide for his family. The karang guni lady, who makes a pittance sourcing for my broken fan and making her rounds every morning and night.

I know these people, because I live right next to them where I stay in Tampines. And that is why it always breaks my heart, when I meet people who have had a much more privileged upbringing, who have all the creature comforts that they could possibly ask for, say that the government has done enough and that there will always be poor people in this society.

It is easier said than done, when these people will never understand what it feels like to live below media wage. They will never understand what it feels like to get paid by the hour, or to spend their last dollar note in their wallet and not know where the next one is going to come from.

And that is why it is time for us to build a new social compact.

Sceptics may argue that we will not be able to get the money, it is not fiscally feasible.  To that I say, if the government sees value in closing up this inequality gap, if they start to place emphasis on doing so, it will be important enough to have a budget. We could have used the same argument against F1, the Youth Olympics or the Integrated Resorts. But the government felt that the benefits would be important to Singaporeans, and so, money was put aside for these projects.

In that same vein, as we reconsider what it takes to close up the income gap, I’d like to remind all of us that we need to be mindful in the way we render assistance to the poor. Drawing back to the old cliché of teaching a person how to fish versus giving him a fish, we need to relook at our social infrastructure rather than merely increasing assistance or doling out more money, which is important and it is good, but it is not sustainable in the longer term. We need to start looking at things with a new approach and perhaps make unorthodox suggestions to orthodox policies.

One area we can consider is that Singapore needs to create more hands and feet for the people who are down and out, and aren’t able to get up on their own two feet. This can extend to employment agencies, childcare centres, the social work sector. Make the pay packages more attractive. Acknowledge social work as a legit profession. Streamline the job scope so that existing social workers do not wade through a mountain of bureaucracy which may further aggravate an emotionally demanding job. Jobs creation of this nature needs to stem from a willingness to change the system. We can’t just rely on creating ad campaigns without changing what is unattractive about the job. It’s not going to solve the problem of expanding the social work talent pool in the long run.

With that, I’d like to end off on one point about our social spending, and a couple of other possible solutions in brief . . .

Singapore spends 16% of its GDP on social programmes. Other developed economies average out at 25%-30%. While we do not need to go as high as 40%, compared to some other developed countries such as Sweden or France, I believe that alot more can and should be done to push for more social spending in Singapore.

With that in line, the increment in social spending can then be considered for some of the following areas:

(1) Worker retraining and income support – Allow the poorer in society to search for better opportunities

(2) Healthcare – Universal Healthcare insurance models in places like Japan, South Korea and Taiwan have seen out of pocket expenses for locals fall significantly. Singapore currently has the highest risk of extremely high personal spending in healthcare compared to other developed Asian economies, which really gave rise to the heartland idea of “Better to die than to fall sick in Singapore.” Currently, the system limits claiming for chronic long term care, which is actually the area that tends to affect low to medium income families the hardest.

(3) More subsidised infrastructure – Void deck or government-owned spaces can be converted into eldercare centres or childcare centres. With subsidies in rent, cost savings can be passed on to Singaporeans who might not be able to afford private facilities.

This article is based on the opening remarks given by Nicole Seah at a panel discussion on “Reducing the Income Gap: Finding Practical Solutions” organised on 12 September 2012 by ONE (SINGAPORE) and the Wee Kim Wee Centre.

18 ways to reduce the income gap

1 Oct 2012

By Leong Sze Hian

With the gap between rich and poor widening, financial advisor and commentator Leong Sze Hian argues that new government policies are needed in several key sectors. But that Singaporeans need to change their mindset as well.

“We need to tweak our labour policies, then automatically wages will rise,” Sze Hian told a packed room at SMU in a panel discussion about income inequality organised by ONE (SINGAPORE) and the Wee Kim Wee Centre.

But the outspoken advocate of poor and disenfranchised families also notes that the government can not do everything.

“We cannot put all the blame on the government. Look at the issue of cleaners. Two years ago, their pay was S$800, now (the amount is) less. Why? Because every time the workers’ levy goes up, (companies) cut workers pay and we accept it. As Singaporeans, we need to be more compassionate.”

In this article, Sze Hian focuses on four key areas where new policies – or in some cases, a return to previous rules – could reduce the income gap, increase purchasing power and ensure that catastrophic illnesses do not also bankrupt families.

Wages and CPF

  1. Peg the interest rate paid on CPF accounts to the GIC’s historical rate of return (minus a one-percentage administrative fee).

Singaporean’s retirement funds are essentially invested by the government in securities chosen by the Government Investment Corporation. While there has been some controversy about how this works, it appears that the Government sells bonds to the CPF Board and then provides the funds raised to GIC.

Currently, ordinary CPF accounts pay 2.5%. There’s a slightly more complicated formula for calculating the return on Special, Medical and Retirement Accounts (SMRA), but they tend to pay 5% on the first S$60,000 and 4% on subsequent funds.

But the GIC has a historical rate of return over the past twenty years of about 6 percent in US dollar terms. So instead of paying Singaporeans a 2.5% rate of return on their CPF accounts, it would be more equitable to pay about 5 percent (providing GIC with a profit for administering the funds).

By the way, Malaysia’s Employees Provident Fund (EPF) paid a dividend of 5.8 and 5.65 percent in 2010 and 2009, respectively, and has historically paid a return of between 4.25 to 8.5 per cent.

  1. Change the rules for self-employed Workfare accounts.

Self-employed individuals currently do not receive any cash payments from Workfare. Instead, Workfare transfers to the self-employed are paid into their CPF Medisave accounts. This discourages older lower-income self-employed Singaporeans from contributing to CPF to qualify for Workfare.

  1. Require employers to pay CPF for foreign employees too.

Current policy exempts employers from having to pay a 16 percent contribution to CPF for foreign employees. This policy puts Singaporeans at a disadvantage as employers save 16 per cent of salary costs when they employ foreigners.

Healthcare

  1. Pay Medishield premiums

Instead of making periodic CPF Medisave top-ups to older Singaporeans, use the funds to pay for their Medishield premiums instead. Otherwise, such top-ups can easily be consumed by rising medical costs.

  1. Provide coverage for all infants

Currently, CPF Medishield does not cover new-born children with congenital illnesses.

  1. Increase public spending

Singapore’s spending on healthcare is one of the lowest in the world. The government currently spends about 1.6 percent of GDP on healthcare. We need to invest more in the health of our citizens.

  1. Stop Privatising Healthcare

Private sector spending on healthcare, as a percentage of total healthcare spending, has risen from 25 percent not long ago to 60 percent now. We need to reverse this trend. Private healthcare costs patients more.

  1. Subsidise out-patient treatments for those in need

Out-patient treatments at polyclinics can be expensive and a large burden on low-income families and individuals. The government Medifund programme should pay for these treatments. Instead, the government has transferred S$86 million of Medifund surpluses to the Protected Reserves over the past decade or so.

  1. Better coverage for workplace injuries – Part 1

An injury at work can be all that it takes to push a family into poverty. The Workmen’s Injury Act was amended a few years ago to reduce employers’ and insurers’ liability for medical expenses arising from workplace accidents to S$25,000. But according to the Ministry of Health, medical fees from five percent of industrial accidents exceed this cap, placing an unfair – and potentially debilitating – financial burden on employees.

  1. Better coverage for workplace injuries – Part 2

Require public hospitals to extend the same subsidies to all patients, whether they are in hospital due to an industrial accident or other matter. Currently, ‘subsidised wards’ are actually not subsidised at all if you are hospitalised due to a workplace injury. This means that patients are paying five times as much to stay in a Class C ward.

  1. Fight higher costs by changing the way hospitals are reimbursed.

Hospital fees have doubled over the past four years. A major reason for this is that the government reimburses public hospitals based on the MOH’s average treatment type subsidy computation. Yet hospitals are still free to charge higher prices and pass the difference on to patients. Instead, the government should reimburse hospitals for the actual subsidy shown in medical bills.

  1. Better means-testing

Review means testing for patients who request for down-grading to lower-class hospital wards. The last time a reply on this was given in Parliament, it was revealed that only one percent of those who applied for downgrading from a higher class ward were successful.

Transparency

Information is a key for effective governance and developing solutions. There are a number of facts though that are not currently public knowledge. For example . . .

  1. If someone can not afford medical treatment, what is the likelihood that s/he will receive government support?

MOH discloses the number of successful applications, but not the total number or number rejected. What is the percentage of Medifund applicants that are accepted because they can not pay their medical bills?

  1. Make public the criteria for approving Medifund applications.
  1. Disclose the “Standard Drug List”.

Patients should be able to know in advance which drugs are subsidised and which are not.

  1. How many people discharged from hospital are unable to pay their medical bills?

We know that 21 percent of Singaporeans who seek assistance from Credit Counselling Singapore are requesting help because of medical fees. But we do not know how many patients are left with financial problems due to medical expenses.

Housing

  1. Remove the income ceiling of S$2,000 for two-room flats.

This limit is based on a simplistic assumption that every household earning more than $2,000 can afford a three-room flat, regardless of family size or financial circumstances.

  1. Do not increase rents for households earning more than S$800.

Families earning between S$800 and S$1,500 may already be finding it heard to make ends meet. The state does not need to add to their burden by increasing their rent. It’s time to reverse this relatively recent policy change.

Singapore’s Budget: Towards an Inclusive Society?

By ShuQi Liu

Following a watershed election last year that signalled public resentment towards a paternalistic state, the AWARE roundtable discussion conducted on 24 March 2012 sustained the political momentum with an honest discussion about this year’s Singapore Budget.

“We have not witnessed inclusive growth in the Singapore budget for a very long time,” says Yeoh Lam Keong, an economic and social policy commentator affiliated with the Institute of Policy Studies (IPS) at the Lee Kuan Yew School of Public Policy.

Despite additional funding for a number of social programmes, panelists at the forum generally agreed that the government’s budget does not do enough to assist the most vulnerable elements of our society — children, elderly, the disabled and low-income families — particularly when it comes to education and health care.

8 Apr 2012 (1)

Health Care

The 2012 Budget signals an increase in healthcare spending from S$ 4 billion to S$ 8 billion over the next 5 years, an increase from 0.7 to 2.2 percent of GDP. But Yeoh notes that Singapore still lags behind other Asian Tigers – Hong Kong, Taiwan and South Korea — which commit approximately four percent of public spending to healthcare.

In fact, overall spending on social programmes is lower now than it was in the 1980s. While GDP has increased four times since the 1990s, public spending on social programmes has dropped from 20 to 16 percent of GDP.

These issues are particularly particularly pertinent as Singapore’s society ages. Medical expenses, especially for common long-term chronic ailments like hypertension, diabetes and high cholesterol, can overwhelm individuals and families.

Increased spending on hospital beds alone will not produce better health outcomes adds Vivienne Wee, a founding member of AWARE. Singapore’s health care system needs to be reorganised, she argues, to better meet the needs of patients and the general population, rather than the demands of healthcare organisations.

Education

Rising inequality meanwhile is giving children from wealthy families a leg up at school, as early as Primary 1. P1 students are expected to be able to read and write upon enrollment, but students from low-income families generally score worse than their classmates. The problem: these children lack access to pre-school education.

NTU sociology professor Teoh You Yenn argues that the government should level the playing field by providing more funding for low-income families to send their children to preschool.

A government’s budget reflects a society’s understanding and value systems, argues Teoh, adding that people’s actions have the power to shape imaginations of the present and future. “What is pragmatically possible is not fixed independently of our imaginations, but is itself shaped by our visions,” Teoh says, quoting from “The Real Utopias Project“.

8 Apr 2012 (2)

Disabilities

“Maximising Potential, Embracing Differences” – that’s the theme of Singapore’s four-year “Enabling Masterplan” for integrating people with disabilities into mainstream society. But until activist Judy Wee stepped forward, the recommendation committee didn’t have any disabled representatives.

Wee argues that if Singapore is to be a truly inclusive society, we need to do a better job of providing people with disabilities with full access to public facilities, starting with our nation’s schools. Currently, only a select few educational institutions are equipped to teach disabled students.

“This would be an important step towards helping Singaporeans with disabilities realise their potential, while respecting the differences of all persons with disabilities,” Wee says, who also notes that data on the number of people with disabilities needs to be better documented and made publicly available.

Contributing to the discussion, hearing-impaired attendees from the Singapore Association for the Deaf, with the help of sign language interpreters from ExtraOrdinary Horizons, called on the government to provide more ‘resource teachers’ for deaf students in mainstream schools.

“We – like any other healthy human beings – have dreams and aspirations to fulfill,” says one SADeaf member.  “It is very hard to tell our children that you cannot be a doctor, lawyer or engineer, because you are deaf.  Unlike Singapore, the United States has deaf societies filled with hearing impaired professionals. This is a strong limiting factor.  And it’s very stifling for the members of the Singapore Association for the Deaf.”

Welfare and Social Services

Better implementation and less duplication is needed in the provision of social services, according to another member of the public participating in the discussion. The “Many Helping Hands” programme can result in cases where several social workers approach the same person with the intention to help. But they end up overwhelming the person instead.

Reflections

In my humble opinion, an inclusive society begins when the government has open dialogues with its citizens. When drafting the budget, our government should actively engage Singaporeans from all levels of society. It’s too late to make changes once the budget is announce in Parliament. A more consultative process, rather than the top-down approach, will be more effective in meeting the needs of all Singaporeans.

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