Social Policy in an Ageing Society: Age and Health in Singapore

316 Pages·2009·7.69 MB·English

by  David Reisman

Social Policy in an Ageing Society
Also by David Reisman
Adam Smith’s Sociological Economics
Alfred Marshall: Progress and Politics
Alfred Marshall’s Mission
Anthony Crosland: The Mixed Economy
Conservative Capitalism: The Social Economy
Crosland’s Future: Opportunity and Outcome
Democracy and Exchange: Schumpeter, Galbraith, T.H. Marshall, Titmuss and
Adam Smith
The Economics of Alfred Marshall
Galbraith and Market Capitalism
Health Care and Public Policy
The Institutional Economy: Demand and Supply
Market and Health
The Political Economy of Health Care
The Political Economy of James Buchanan
Richard Titmuss: Welfare and Society
Schumpeter’s Market: Enterprise and Evolution
State and Welfare: Tawney, Galbraith and Adam Smith
Theories of Collective Action: Downs, Olson and Hirsch
Social Policy in an
Ageing Society
Age and Health in Singapore
David Reisman
Edward Elgar
Cheltenham, UK (cid:129) Northampton, MA, USA
© David Reisman 2009
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system or transmitted in any form or by any means, electronic,
mechanical or photocopying, recording, or otherwise without the prior
permission of the publisher.
Published by
Edward Elgar Publishing Limited
The Lypiatts
15 Lansdown Road
Cheltenham
Glos GL50 2JA
UK
Edward Elgar Publishing, Inc.
William Pratt House
9 Dewey Court
Northampton
Massachusetts 01060
USA
A catalogue record for this book
is available from the British Library
Library of Congress Control Number: 2009921532
ISBN 978 1 84844 094 4
Printed and bound by MPG Books Group, UK
Contents
Acknowledgements vii
1. Introduction 1
2. Old and ill 5
2.1 Indicators and inputs 5
2.2 The demographic iceberg 9
2.3 The cost of growing old 22
3. The Provident Fund 34
3.1 The Central Provident Fund 34
3.2 The Ordinary and the Special Account 39
3.3 The Minimum Sum 50
3.4 Income streams and annuities 58
3.5 Modifi cations and extensions 63
3.6 Retirement income above the fl oor 70
4. Aff ordable health care 73
4.1 Promotion and prevention 73
4.2 Personal responsibility 78
4.3 Aff ordable access 78
4.4 Competition 95
4.5 Cost containment 96
5. Payment for health: Medisave 101
5.1 The delivery of care 101
5.2 Subsidies for beds and subsidies for patients 106
5.3 Medisave: rationale and rationality 111
5.4 Medisave: limits and exclusions 118
5.5 A decent minimum? 122
6. Payment for health: MediShield and Medifund 126
6.1 MediShield 126
6.2 Medifund 139
v
vi Social policy in an ageing society
6.3 The preconditions for policy 150
6.4 The best in the world? 160
7. Home and family 162
7.1 The family in Singapore 162
7.2 Old people on their own 171
7.3 Homes and nursing homes 177
7.4 Insurance: the options for care 179
8. Assets: capital and property 188
8.1 Savings 188
8.2 Housing 194
9. Labour in the retirement years 204
9.1 A manpower shortfall 204
9.2 The participation rate 215
9.3 The employment rate 222
9.4 The older worker 226
10. Older workers: the policy options 228
10.1 The retirement age 228
10.2 Retirement age and Minimum Sum 234
10.3 Training and retraining 237
10.4 Pay 244
10.5 A reappraisal of work 250
10.6 Laws 256
10.7 A new consensus 261
11. Conclusion 265
11.1 The three ratios 267
11.2 A share in the future 274
Bibliography 281
Index 295
Acknowledgements
The author would like to express his thanks to Lim Hua Sing, Naohiro
Ogawa, Phua Hong Kiat, Soh Ning En and Wang ShiHui for their encour-
agement and assistance.
vii

1. Introduction
The Republic of Singapore is a city-State. It is situated in tropical South-
East Asia, at the tip of the Malay peninsula. It is 1° 17' (136.8 kilometres)
north of the equator. Singapore’s total landmass is 692.1 square kilo-
metres. It is 12.61 per cent larger than at independence due to the steady
reclamation of coastal land. Singapore is approximately 3.5 times the area
of Washington, DC.
Singapore’s population in 2008 was 4.84 million. There are three main
ethnic groups: 74.8 per cent are Chinese, 13.5 per cent Malay and (the
fastest-growing) 9 per cent Indian. The population density per square
kilometre at 6652 is the third highest (after Monaco and the Special
Administrative Region of Macau) of any country in the world. Cities score
worse than states: in Delhi it is 9294 although for India as a whole it is no
more than 336. In Nigeria the population density is 145. In China it is 137.
For the continent of Asia it is 152. For the world as a whole it is only 45.
Agriculture has given way to high rise. About 53 per cent of the world’s
population lives in rural communities. In Singapore, 100 per cent of the
population is urban. In rural Asia only 31 per cent of the population has
access to safe water and hygienic sanitation. In Singapore everyone does.
Singapore is made up of one large island and 53 smaller ones. Built-up
areas account for 50 per cent of the territory. The rest is given over to
parkland, (15) reservoirs, military areas and (4 per cent of the total) forest,
mainly secondary. Roads take up 12 per cent of the total land area. The
highest peak is Bukit Timah, 164 metres above sea level.
Singapore has virtually no natural resources apart from its human
capital and its strategic location on vital shipping lanes. The port of
Singapore is the world’s busiest in terms of total shipping tonnage. Changi
Airport is the fi fth busiest in Asia and the nineteenth busiest in the world
by passenger traffi c. Exports plus imports as a ratio of GDP were 428 per
cent in 2004. This is believed to be the highest ratio in the world. The fi gure
for Luxemburg is 271 per cent, for the UK 53 per cent, for the USA 25 per
cent (Heston et al., 2006). A small open economy, Singapore is abnormally
exposed to fl uctuations in world demand and in foreign direct investment.
Its macroeconomics are not its own.
The rate of economic growth in Singapore was 6.4 per cent on average
between independence in 1965 and the ‘Asian economic crisis’ in 1997/98.
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