亚开行-新加坡的长期护理系统：适应人口老龄化（英文）-2020.9-25页_3mb

Summary of Singapore's Long-Term Care System

Core Content

Singapore is a multiethnic country with one of the highest median incomes globally, and it is experiencing a significant demographic shift due to increasing life expectancy and declining fertility rates. By 2030, the population aged 65 and older is expected to rise from 14.4% (2019) to 25%, presenting a major challenge in health and care systems. In response, Singapore has adopted a multifaceted, integrated, and holistic approach to long-term care (LTC), aiming to support aging in place and ensure sustainable, cost-effective care for its aging population.

Main Views and Key Information

1. Holistic and Integrated Approach to Aging, Health, and Care

Singapore emphasizes a population health approach, which integrates health promotion, disease prevention, and curative care across the life course. This approach recognizes the interplay of health, social, and environmental factors in aging and aims to create an age-friendly environment that supports seniors' well-being and autonomy.

• Home and Community-Based Care is the preferred model, aligning with the values of Confucianism and the principle of "Many Helping Hands".
• The government encourages individual and family responsibility, community involvement, and collaboration with the private sector to ensure sustainable and effective care delivery.

2. Action Plan for Successful Ageing

Launched in 2015, the Action Plan for Successful Ageing is a S$3 billion initiative with over 70 projects across 12 areas, including health, education, employment, and social inclusion. It is implemented by the Ageing Planning Office (APO), which serves as the secretariat for the Ministerial Committee on Ageing.

• Opportunities for All Ages (individual level): Focuses on employability, lifelong learning, volunteerism, and retirement adequacy.
• Kampong for All Ages (community level): Promotes Communities of Care, intergenerational harmony, and protection from abuse.
• City for All Ages (national level): Addresses health-care systems, housing, transport, public spaces, and research in aging.

3. Agency for Integrated Care (AIC)

The AIC plays a central role in integrating health and care services, coordinating patient referrals, and managing complex care cases. It also focuses on capacity building, care assessment, and quality improvement in LTC.

• AIC provides Community Care Management Services and Community Care Assessment Teams.
• It supports home-based care, day rehabilitation, dementia care, and palliative care.
• The AIC is responsible for implementing the national care assessment framework and monitoring LTC outcomes.

4. Integrated Clusters for Public Health System

In 2009, Singapore reorganized its public health system into regional health systems (RHSs), and in 2018, further restructured into integrated cluster systems to improve seamless care delivery and cost efficiency.

• The integrated cluster approach combines health promotion, disease prevention, and curative care.
• It ensures person-centered care and better coordination between public, private, and community providers.
• It supports aging in place by enabling shared electronic health records and multidisciplinary care teams.

5. Social, Community, and Caregiver Programs

Singapore has developed a range of community-based programs to support seniors, including:

• Senior Activity Centres (SACs): Provide social and community space, information and referral, and emergency alert response.
• Community Networks for Seniors: Coordinate efforts between government, voluntary welfare organizations, and grassroots groups.
• Silver Generation Office: Mobilizes 3,000 volunteers to assist seniors in accessing services and understanding policies.

These programs focus on active aging, befriending, and care and support for vulnerable seniors, including those with frailty, isolation, and disabilities.

6. Caregiver Support Action Plan

To support informal caregivers, Singapore has introduced a five-domain support plan:

1. Improved care navigation: One-stop information platform, online end-of-life services, and e-platforms.
2. Extended financial support: Grants, subsidies, and flexibility in payment for caregiving.
3. Workplace support: Encourages flexible work arrangements, unpaid care leave, and employment facilitation.
4. Caregiver respite services: Expands respite options, including home-based respite and specialized care for dementia.
5. Caregiver empowerment and training: Includes support networks, community outreach, and elder care training.

7. Health and Care Insurance Schemes

Singapore has a comprehensive insurance system to cover LTC costs, including:

• MediSave: A mandatory personal medical savings account contributing 8%-10.5% of salary.
• MediShield Life: A compulsory basic health insurance for universal lifelong coverage.
• MediFund: A government endowment fund for those who cannot afford care costs despite MediSave and MediShield Life.
• ElderShield and CareShield Life: New schemes launched in 2020 to provide long-term care insurance for severely disabled seniors.
• ElderFund: Financial support for low-income, severely disabled individuals over 30 years old.

These schemes aim to increase insurance coverage, enhance risk pooling, and reduce financial burden on families and individuals.

8. Financing Health and Care for an Aging Population

Singapore's approach to financing prioritizes cost containment and efficiency. The country has achieved modest health expenditure relative to outcomes through a combination of public and private insurance, subsidies, and safety nets.

• Public health expenditure was 4.9% of total government spending in 2014.
• The health budget increased from S$13 billion in 2012 to S$22 billion in 2017, driven by aging population trends.
• The government has focused on preventing unnecessary hospitalizations, harnessing volunteers, and expanding home-based care to reduce costs and improve outcomes.

Conclusion

Singapore's long-term care system is built on a holistic, integrated, and sustainable model that emphasizes aging in place, community support, and cost efficiency. Through the Action Plan for Successful Ageing, the Agency for Integrated Care, and comprehensive insurance schemes, Singapore is preparing for the challenges of population aging by creating an age-friendly environment and ensuring accessible, affordable, and quality care for its elderly population. The system is continuously evolving to meet the changing needs of an aging society, leveraging interministerial collaboration, multi-stakeholder engagement, and innovative financing mechanisms.