Theme 1: Understanding Governance

Theme 1
Understanding Governance

Chapter 2: Governance in Singapore

·       Principles of governance

·       Consequences/Impact of declining population

·       Solutions to/management of a declining population

·       Consequences/Impact of an ageing population

·      Solutions to/management of an ageing population

Chapter 3: Managing Healthcare: A Case Study of Singapore

·       Solutions to/management of Singapore’s healthcare system

Sec 3 Chapter 2: Governance in Singapore

A) Principles of Governance

‘Leadership is key’ Honest and capable leaders ·         Honest and capable leaders are needed to maintain stability and make the right decisions ·         Honest and capable leaders will make wise decisions and place the interest of the nation first and this will help the nation progress with better policies. ·         These leaders need to have moral courage and integrity to do what is right and not what is popular for the good of Singapore. ·         Honest leaders will do what is good for Singapore rather than for their own benefit. Selection of good leaders ·         Good leadership and governance do not occur by chance, thus potential leaders are selected and groomed. ·         Also, leaders are selected based on good character. ·         Leaders must be incorruptible to win the confidence and respect of the people ·         With good leaders selected, Singapore will always have enough capable and honest leaders at all levels of government making quality decisions for Singapore’s good. ·         E.g. Mr Liu Thai Ker,  former chairman of National Arts Council (NAC) was selected and groomed to head the National Arts Council o   Created more opportunities for local talents o   More Arts events like Singapore Art Festival were organised o   Jobs opportunities created for those in the Arts Industry ·         Good leaders make quality decisions with the country’s interest at heart, helping the country progress and help win the confidence and respect of the people, leading to the stability and success of the country.

‘Anticipate Change and Stay Relevant’ ·         Is being forward-looking ·         Ability to foresee future problems now and comes up with solutions. ·         Ensures that Singapore will not be caught by surprise by unforeseen events that can affect Singapore’s survival. ·         E.g. 1: NEWater o   Government prepare for the future by ensuring self-sufficiency in water supply o   2 water agreements with Malaysia which will end in 2011 and 2061 o   Alternative water supply through NEWater and desalinated water o   The government communicated with the people to assure them that NEWater is safe for drinking through schools, newspapers and Internet o   With these new sources of water, Singapore will not be caught in a situation where we are left without enough water for our needs. ·         A country’s long term success and development depends on the government’s ability to look ahead and make sound decisions to overcome challenges that could affect the country’s development

‘Reward for Work and Work for Reward’ ·         Meritocracy is the main principle ·         A system that rewards hard work and talent ·         People are encouraged to do well ·         E.g. Edusave Scholarship and Merit Bursary schemes o   Rewards top 10% and 25% of students o   Provides all with equal opportunities to achieve their best and be rewarded for their performance regardless of race or religion ·         When every citizen has an equal chance to succeed, it encourages them to work hard and trust the government, thereby contributing to the country’s development and progress willingly

‘A Stake for Everyone, Opportunities for All’ ·         When people have a say in decision-making, it develops a greater sense of belonging ·         More opportunities created to involve people in decision-making ·         E.g. In 2004: Government consulted people on the issue of having casino as part of IR o   People voiced their support and concerns o   The government considered the concerns and decided to proceed with setting up casino as part of IR ·         Develop a sense of belonging and rootedness as people feel valued in the process of decision making, thus promoting social cohesion and making them more receptive to government’s decisions

Why Singapore needed to re-examine the population policy

·         Reasons for declining birth rate

·         Declining Birth Rate from the 1980s

·         Low fertility rate 1.82 children per woman

·         Increasing costs of living

·         People marrying at a later age

B) Impact of a declining population

Unattractive to Multinational Companies ·         Small population unable to produce enough talented people to sustain its development ·         MNCs may find it difficult and expensive to recruit Singaporean compared to other larger and cheaper markets ·         Smaller consumer market ·         Singapore may become less attractive and thus attract less investments ·         Fewer jobs for Singaporeans ·         Weaken Singapore’s economy and slows our economic progress
Ageing Population ·         Fewer young people, larger proportion of older people ·         Singapore would face ageing population ·         More resources needed to take care of senior citizens ·         Greater financial strain on the families and the government.	Weaker Defence Force ·         Fewer men to recruit for National Service ·         Weaken Singapore’s defence force ·         Vulnerable to external threats and attacks
Weighing ·         Inability to attract TNCs is the most serious consequence of a declining population  ·         Leads to economically weaker country and tax collected is lower  ·         Less money to care for an ageing population or meet our defense needs. ·         Even with fewer soldiers, technology can help keep our defense force strong if we can afford the technology. ·         Even with an ageing population, enough public funds through strong economic growth can ensure that the old are cared for adequately. ·         Our strong economic growth can helped by being attractive to TNCs.

C) Solutions/Policies to promote population growth

The Graduate Mothers Scheme ·         More graduates were marrying later ·         The scheme was introduced to encourage marriages between graduates and encourage graduates to have more children ·         Female graduates should have more children in order to have a higher chance of new generation being educated ·         Several debate and unhappiness among the people ·         Scheme withdrawn in 1985

Three or More if you can afford it ·         Parents were encouraged to have 3 or more children if they can afford it ·         Government introduced measure that allowed people to use Medisave to pay for delivery charges of 1st 3 children ·         Publicity campaigns of the joys of parenthood ·         The measure that were introduced had limited success as not all married couples wanted so many children ·         Fertility of 1.24 in 2004

Other Pro-family Measures Measures that help parents decide that they want to have more children because the policies support the family. ·         Equalised Medical Benefits o   Both parents are able to make medical claims from their employers for their children o   Previously only 1 parent can make claims. o   More medical benefits available for children. o   Medical expenses for children is more affordable o   Encourage families to have more children. ·         Grandparent Caregiver Relief o   Income tax relief $3000 if a grandparent helps a couple to take care of their child o   Helps to encourage family members to help care for children. o   Parents may feel that with such incentives, it may be worthwhile having another child. ·         5-day Work Week for civil service o   To allow better work-life balance o   Parents will be able to spend their weekends with their families o   Couples are willing to have more children as they will have enough time to take care of their children. ·         Extended Maternity Leave o   from 8 to 12 weeks o   Mothers have enough paid maternity leave to recover from the strain of child birth while getting their salary.   o   Mothers may be more willing to have another child as they receive adequate rest without any loss in income.

Attracting Foreign Talent ·         A need to bring in talent from other countries to enhance competitiveness ·         In 1989: government relaxed immigration policy ·         Target to attract foreign talent with skills ·         Foreign talent were offered: (1)    Easier entry into Singapore (2)    Subsidised housing (3)    Attractive education package for children ·         Hope is that some of these immigrants will choose to settle permanently in Singapore and become citizens. ·         Some foreigners will marry Singaporeans, settle down and start their families in Singapore. ·         Both of the above will help to boost our population

D) Impact/consequences of ageing population

Demand for more healthcare & social services ·         Older people tends to have more health related problems ·         Need more medical attention and care ·         More national resources channeled to healthcare and social services ·         Less tax money available for other needs e.g. infrastructure, education, housing and defence	Smaller security forces ·         Insufficient able-bodied men to defend the country ·         Older people are less physically fit to serve in the military  ·         Smaller defence force means less deterrence  ·         Potential aggressors may invade Singapore ·         Singapore can lose our independence
Reduction in competitiveness ·         Inability to maintain competiveness ·         Insufficient young workers as population gets older ·         Local and foreign companies have insufficient manpower to hire  ·         These companies may leave Singapore if they cannot find enough manpower in Singapore ·         If TNCs leave, local SMEs that depend on TNCs for business will close down  ·         Economic Recession ·         Unemployment rises ·         Standard of living falls	Strain on working population At National Level ·         Ratio of working adults supporting each aged person would increase ·         Increase the burden on the younger tax payers ·         Less tax collected as fewer are working ·         Nation is unable to fund its public projects e.g. recreational facilities, infrastructure , schools, hospitals  ·         Standard of living drops  At the family level  ·         Fewer young people per family supporting more elderly family members ·         Medical cost high since elderly fall ill more often ·         Financial strain on the working adults  ·         Family will have more unmet needs as insufficient money ·         Quality of life drops
Weighing ·         Reduction in economic competitiveness is the most serious consequence  ·         Economic recession & Unemployment high ·         Less tax collected means more strain on the working population ·         Government and citizens have less money to care for elderly ·         Less money to meet other national needs e.g.  defence, healthcare and social services. ·         Unable to purchase high tech military equipment to support our defence or spend more on healthcare and social services for the elderly

E) Meeting the Challenges of/Solution for an Ageing Population

Our nation views seniors as assets to society. ·         With this opinion, Singapore uses the Many Helping Hands Approach comprising of ·         Individual, Family, community and Government to meet the challenges posed by an ageing population.
Factor 1: Senior citizens as assets to society ·         By 2030, 19% of senior citizens. ·         Senior citizens: (1) must strive to remain useful contributing members to society (2) have valuable skills, knowledge, talent and work experience (3) are able to boast family life ·         When senior citizens continue to feel valued and continue to contribute positively to the society, the impact of an ageing population would lessen
Factor 2: ‘Many Helping Hands’ Approach ·         The individual, family and community will complement the government’s effort in providing help to the elderly ·         Everyone shares the responsibility of taking care of the senior citizens ·         Government need not increase taxes ·         Tax collected and resources can be saved to meet other needs of the nation ·         The challenge of the strain from an ageing population is lessened.
Factor 2a: Government Support ·         Government made laws and introduced measures to protect interests of the senior citizens and help them have a better retirement ·         Eg. Tribunal for the Maintenance of Parents o   Parents are able to get the court’s help to obtain financial support from their children o   Ensures that all families will care for their elderly members o   Reduces the dependency on government help, which has finite resources. ·         Eg. Tax Relief given to adult children if (1)    they take care of elderly parents / grandparents /great grandparents This is aimed at incentivising families to take care of the elderly in their family and also to build closer ties between the elderly and the rest of the family. (2)    Adult children contribute to their own or elderly dependent’s CPF retirement accounts This will ensure that the elderly have or when people grow old, they will have more money to care for themselves. (3)    Grandparents take care of children while both parents work Helps elderly play a useful role in the family and for the family to remain close so that the elderly continues to be part of the family in old age. ·         Central Provident Fund (CPF) o   Special Account(4% pa) and Ordinary Account (2.5% pa) for retirement/emergency/investment purposes o   Medisave Account(4% pa) use for medical expenses o   Age 55: CPF can be withdrawn with minimum sum o   Age 62: Monthly withdrawal from retirement account o   Part of each working person’s salary goes into the CPF account each month. o   Money accumulates over time in CPF account to become a substantial amount o   The money on the CPF will help provide the monthly withdrawal payments in old age so that the elderly will have enough money in old age. o   The money in the Medisave account is only for medical expenses and the elderly will have enough money to meet medical needs in old age. o   CPF ensures that all elderly will have enough money for their old age. ·         Public Housing Schemes o   1st-time buyers of government flats can receive housing grant if they buy a flat in the same area as their parents o   Encourages children to live near their aged parents so that it is more convenient for the adult children to care for their elderly parents should the need arise.
Factor 2b: Individual Responsibility Healthy lifestyle ·         Maintain Healthy lifestyle by eating well and exercising regularly ·         Less likely to fall ill ·         Medical costs of caring for elderly will not rise ·         Reduce burden on self, family and government Personal financial planning ·         Plan personal finances ·         Acquire knowledge on managing money (Save and invest)  ·         Will have enough money in old age ·         More independent and self-sufficient, reduce burden on family and government	Factor 2c: Family Support ·         Strong & stable families bring about social stability & harmony ·         Examples of measures: o   Senior Citizens’ Week: Encourages elderly to stay active o   Grandparents’ Day: Show appreciation to elderly ·         Family is the main source of emotional, social and financial support for the individuals, helping the elderly to stay positive and cared for ·         When elderly feel cared for they are less likely to fall prey to mental illness e.g. depression
Factor 2d: Community Help ·         The community provides social & emotional support: Offer free health checks, organize recreational activities for senior citizens e.g. Senior Citizens Corners ·         Healthcare & social services: Government provides subsidies to voluntary welfare organizations to run services for senior citizens E.g. Home Nursing Foundation for Elders ·         Such services help senior citizens remain physically, mentally and socially active(Elderly can be make friends) ·         Elderly will feel loved and cared for.

Sec 3 SS Chapter 3: Singapore Healthcare

Challenges of managing Singapore healthcare:

·         Government has limited resources

·         There are competing needs in society e.g. Education, defence

·         A well-managed healthcare system has High-Quality + Affordability

A)     Best Way to manage/Solutions to manage Singapore’s healthcare system

Encourage self-reliance Singaporeans are encouraged to look after themselves by saving for their medical expenses and buying medical insurance ·         Medisave o   Medisave is a savings scheme that encourages Singaporeans to be responsible for their own healthcare needs o   Percentage of monthly CPF is channelled into Medisave account o   Medisave can be used to pay hospital bills & certain medical treatments o   Money accumulates untouched in the Medisave account at 4% pa and grows o   Government does not have to increase taxes to fund healthcare as CPF Medisave will ensure that Singaporeans will have enough money for their healthcare needs.  ·         MediShield o   A national healthcare insurance scheme paid using Medisave or cash o   Payment for the insurance is from one’s own savings and so it is considered self-reliance. o   Patients can make claims from MediShield to pay for large medical bills (serious or prolonged illness and for long-term hospitalization/ treatment of serious illness such as kidney dialysis) o   Medishield pays only for very large medical bills as smaller bills are paid for with Medisave or cash. o   Medishield ensures that Singaporeans will not be financially crippled by a major illness or prolonged medical treatment cost o   Also, since payment for Medishield is by the individual, it will not burden the government with more costs. How Medishield works. o   Singaporeans must first pay for the deductible (An amount from $1000 to $3000) and then the co-insurance of the first 20% of the bill. The large part of the bill (Balance of 80%) will be paid for by Medishield. o   Expanded use of MediShield to meet the specific needs of people E.g. Eldershield: people > 40 years old would be able to for healthcare in case of disability

Government: Keeping healthcare affordable with government help ·         Government Subsidies o   Direct subsidies given to government hospitals, polyclinics & nursing homes for elderly o   A subsidy means the government pays for part or most of the cost of healthcare o   Less money spent by Singaporeans on healthcare. o   Subsidies made up ¼ of government expenditure on healthcare o   Different rates of subsidies to different classes of wards in hospitals e.g. Class C receive highest amount of subsidies (80%) o   Ensure that basic healthcare services are affordable for all Singaporeans, especially the lower-income group o   With govt. subsidies, healthcare is more affordable for Singaporeans.  ·         Medifund o   Set up to help people who are unable to pay for healthcare ( No cash, no Medisave, no insurance, no family who can help) o   Government started with $200 million and the interest earned given to public hospitals to help pay for needy patients o   Medifund is the final safety net to ensure that even the poorest Singaporeans have access to medical care. o   Ensure that basic healthcare services are affordable for all Singaporeans. ·         Restructuring of Hospitals o   Hospitals have more freedom to reorganize to cater for the needs of Singaporeans o   Government able to reduce the amount of subsidies to hospitals as a restructured hospital will be run more efficiently. o   Savings from this can be channelled to other areas of need in healthcare e.g. hire more doctors and nurses without need to increase the healthcare budget o   Quality of healthcare will improve without the need to spend more. ·         Means-Testing o   Means Testing is a way of checking how much subsidy should be provided to those staying in hospital. o   Main purpose: fairer distribution of finite government subsidies with more subsidies going to less well-off Singaporeans  o   Singaporeans who earn more will receive fewer subsidies while those who earn less will receive more subsidies. o   Ensure that the subsidies are given to patients who need the subsidy more, thus helping the less well-off to cope with the healthcare cost effectively. o   Savings from the reduced subsidies to Singaporeans, who earn more, are channelled to other uses in healthcare e.g. building more hospitals.   o   This will improve the overall quality of healthcare in Singapore.

Promoting a Healthy Lifestyle (Govt + Individual) ·         1 method used to cope with rising cost of healthcare ·         Schools and workplaces has programmes to emphasise the need to maintain good health ·         E.g. regular physical exercises & well-balanced diet are encouraged ·         Activities organised by Health Promotion Board (E.g. Towards a Healthy School Tuckshop, Singapore Workout, ACES Day) ·         Preventive action by keeping the nation fit thus resulting in fewer life-style related illnesses. Consequently causes healthcare expenditure to fall as there is less need for medical care.  ·         Fewer Singaporeans fall ill easily and so their personal healthcare expenses are lowered.

Working with Organizations ·         Community provides healthcare support services ·         It is not possible for the government to run all healthcare services ·         Voluntary welfare organizations & private organizations given grants to run community hospitals, nursing homes & day rehabilitation centres e.g. Ren Ci Hospital, NKF, Ang Mo Kio Community Hospital help provide such support health services ·         These organizations can then provide such healthcare support services at more affordable prices ·         Healthcare services like nursing homes and kidney dialysis which are costly, is more affordable for poorer Singaporeans.