1.

Topic and Government Agency in charge

Healthcare. Government agencies in charge: Health Promotion Board (HPB) and Ministry of
Community Development, Youth and Sports (MCYS).

2. Background information
Singapore is facing an ageing population crisis that will only be more apparent in the coming
years. The dependency ratio continues to decrease from 7.2 in 2010 to 7.0 in 2011
i
. By 2020,
the number of Singaporeans aged 50 and over (Seniors) is projected to reach 1,992,000
ii
.
With healthcare costs expected to increase, there is an urgent need to build a comprehensive
healthcare framework in order to support the growing number of Seniors and manage
healthcare costs.

2.1. Existing Policies in Place: While the existing initiative, People Associations Wellness
Programme, encourages active ageing, there is a lack of incentives for Seniors to take part
in the many activities or interest groups on a consistent basis. Another existing policy,
Community Health Assistance Scheme (CHAS), subsidizes the primary healthcare costs of
the Seniors, but does not encourage Seniors to take ownership of their own health. Therefore,
a two-pronged approach is needed to address each policys gap by not only providing
financial incentives but also encouraging Seniors to proactively take charge of their health
and well-being.

3. Key Objectives and Issues
Our policys key objective is to promote healthy ageing in Seniors by enhancing their
quality of life, helping them cope with rising medical costs and instilling independence.
From this, the key issues that arise are firstly, how to encourage a healthy lifestyle? Secondly,
how to strengthen the social safety net for Seniors in addition to the existing health policies
(i.e., MediShield and MediSave)? Lastly, can Seniors play an active role in propelling the
programme forward, achieving the sustainability goal of By the Seniors, for the Seniors?

4. Recommendations & Rationales - LifeMed
The existing PAs Wellness Programme
iii
(Budget 2009 and 2011
iv
) maintains an emphasis
on active aging by encouraging seniors to participate activities such as volunteerism, lifelong
learning, inter-generational programs, and fitness activities. To improve on this existing
programme and also achieve the above stated key objectives, an overarching health policy
will be introduced. This policy will introduce a fund, LifeMed, that is sustained through Life
Credits given for participation in social activities. In addition, the policy encourages group
participation by granting additional Credits when seniors participate in groups. The credits
accumulated can then be used to subsidize medical expenses.

An increase in involvement in community activity by the Seniors will prevent or delay the
onset of chronic disease and increase healthy life expectancy level, and in turn, manage the
burden of increasing healthcare costs. This policy is therefore centered on promoting a
healthy and active way of life. Succinctly put, our policy aims to bridge the objectives of
MCYS and HPB by amalgamating the benefits of the Wellness Programme and CHAS while
tackling the deficits of each respective policy. All Singaporean or Permanent Resident
Seniors above the age of 50 will be in this policy unless they choose to opt out.

5. Mechanism/ Implementation of LifeMed:
The mechanism behind LifeMed will be illustrated through the following example: Senior A
(A) decides to participate in a cooking class at a community centre (CC). A will need
his/her NRIC and relevant documents upon registration. The administrator will key in his/her
particulars into an integrated LifeMed system which tracks the activities that A has signed up
for. At the end of the cooking class, credits will be added to As account in the system. These
credits can then be used for As medical expenses and other health expenditures namely,
primary care and other illnesses listed under the existing Community Health Assist Scheme
(CHAS). Using the LifeMed System, administrators at medical institutions will know the
amount of Credits balance that A has and can advise A on the option to use them offset his
medical expenses.

The LifeMed System is an integrated information system which links the CCs with HPB and
health institutions, i.e hospitals and polyclinics. The LifeMed System can tap onto the
Electronic Health Record (EHR) system
v
to facilitate the administration of credit transfer and
usage. Thus, in addition to their personal medical information, information on the LifeMeds
activities and the LifeMed Credit can also be tracked in the EHR.

Credits Rates & Limits (Table 1):

Activities:
The activities under consideration have to be from the following institutions including
Peoples Association, Community Centres, Approved Voluntary Welfare Organization (i.e.
SAGE
vi
) and other institutions approved by MCYS and HPB.

Features of the policy:
1) Credit Limit
As this policy aims to focus more on the low-income Seniors, there will be credit limit put in
place according to the type of housing. The type of housing provides a reasonable gauge of
income level and as well as allow for easy implementation. The Seniors will be segregated
into 3 different groups which correspond to different Credits limits (Table 1). The low-
income Seniors will have the highest Credits limit and thus, provides a greater incentive for
them to participate in the policy and also indirectly relieves their medical expenses burden.
2) Group Incentives
To promote cohesion and foster long-term relationships between Seniors, a group incentive is
introduced to encourage seniors to join activities in groups. Through the network effect, the
group incentive aims to push active Seniors to rope in those inactive Seniors, and therefore
ensure the continuous increase in participation rate of activities. Mechanism: When a group
comprising of 4 or more Seniors participate in an registered activity together, each Senior in
the group will enjoy an additional $10 Credits. However this is not applicable for free
activities.
3) Other features
Firstly, the funds cannot be withdrawn by the Seniors and can only be used to pay for the
Seniors medical treatment or other qualifying expenses. Secondly, the accumulated credits
will be rolled over indefinitely and be available for life. Thirdly, the Life credits are non-
transferable and non-convertible to cash. Also, upon the passing of the Seniors, the credits
will be removed from the fund of the Seniors. Lastly, the fund can be accumulated on an
annual basis, but restricted to annual credit limit.

6. Implementation:
The entire policy will be comprised of three phases which spanning a minimum of 15
months. Firstly, the LifeMed system, will be set up within the next 9 months. The second
phase will be a pilot phase, where the policy is implemented under a few selected CCs where
participation rate is relatively low and where there is high concentration of Seniors. Thirdly,
after a 6 month review of the pilot phase, the credit system will be rolled out to all CCs for all
Seniors in Singapore.

How Our Proposal Fills the Existing Gaps
1) The usage of the Credits incentivizes the Seniors to take the first step to participate in
social activities where they can make friends and after which, continue to participate actively
in social activities. Together with the group incentive feature, active Seniors can rope in the
less active ones through word-of-mouth, facilitating the creation and growth of social units
within the community. Within the social units, Seniors can help to monitor fellow Seniors
lifestyle, provide mutual support and encouragement.
2) By introducing different credit caps according to housing types, our policy will help the
lower-income Seniors while still encouraging other Seniors to participate. Through a higher
credit cap for the lower-income Seniors, the policy aims to boost participation rate among the
lower income Seniors and provide more financial assistance for them.
3) The Credits system will enable Seniors to earn credits through participation in
activities. This encourages senior citizens to take greater responsibility of their lifestyle and
their health.

7. Desired outcome/ Key Performance Indicator (KPI)
Participation Rate: This program will be able to increase the level of participation in
community activities among the Seniors. This also helps the elderly in becoming an integral
part of the society since it creates more opportunities for interaction among the young and
old. The policys KPI is to achieve a participation rate of 70%, engaging over 900,000
participants aged 50 and over by 2017.

Reducing low-income Seniors medical costs: In order to help the low-income Seniors
better cope with rising healthcare costs, this program will provide more assistance towards
the lower income group through a higher credit limit as compared to the middle and higher
income group. Therefore, this policy is able to reduce their burden of rising medical costs.

Cost Savings: With an increase in activity, likelihood of illness falls, and thus alleviates the
problem of rising health costs
vii
. According to an analysis conducted by the U.S. Centers for
Disease Control, it is estimated that a one-dollar investment in measures to encourage
moderate physical activity leads to a cost saving of $3.2 in medical costs. Thus, we estimate
that the government will be able to save a minimum of $1 billion dollars in medical costs
with a $500 million investment into the policy.

Health Development Index: Singapore is ranked 26th out of 187 countries for the UNs
Health Development Index in 2011, with an index of 0.866. With healthy life expectancy
projected to increase and the delay in the onset of chronic diseases resulting from the policy,
Singapore will be able to ascend up the ranking considerably by 2017.
Annex: Cost Estimates & Financial Feasibility
The total estimated cost for the scheme is $493.5 million. This is computed based on the
multiplying the credit limit by the number of participants for each bracket (refer to Table 1 in
Reference). Thus the total cost represents the maximum cost incurred based on the credit
limits each year. The credit limits were carefully selected through a financial feasibility
analysis (refer to Table 2) in order to ensure financial feasibility and provide an attractive
credit system.
Assumptions:
1. Percentage of the population aged 50 and over in each housing bracket is estimated
based on demographic data from Department of Statistics Singapore (refer to Table 3 & 4).
Based on observations of these data (Table 5 & 6), we have assumed the percentage of
population aged 50 and over living in 1 to 3 room flats to be 30%, those living in 4 to 5 room
flats to be 52% and others to be 18%.
2. Participation rate is expected to reach 45% by year 1 and progressively increase to a peak of
70% by year 5 as promotional campaign and group credit take effect.
3. Usage rate is assumed at 30% of credit balance of the beginning of year 1 with a annual
increase of 5% in each subsequent year.
4. Population growth of Singaporeans above 50 is assumed to be at an average of 3.45%
annually over the next 5 years computed based on forecasted growth rate from 2010 to 2020
from Euromonitor International.
5. Promotional cost is estimated at 7 million in the year 1 with the estimated FY2011
promotional cost of MOHs 5-year IT Blueprint for Health Promotion Board (6,974,100)
serving as a gauge. It is expected to decrease to 2 million in year 5 as participation rate
increases.
6. Information Systems cost which would involve the addition of a module to the existing
National Electronic Health Records (NEHR) to be 5 million in the 1st year and 2 million for
year 2 to 5. The amount is estimated with reference to the amounts spent for similar
programmes like iGov 2010 for Healthcare Clusters ($4,672,500).
7. Miscellaneous costs including labor costs and operating expenses are estimated to be 2
million per year.

Long Term Cost Estimates (in 2020)
The long term cost at year 2020 is estimated based on the future demographics forecast by
Euromonitors Singapore Future Demographic Report 2008. The total population aged 50 and
over is estimated to reach 1.99 million by 2020. Based on the same distribution of the
population by housing types, total cost is estimated to reach $168 million in 2020 (Table 7).
The increase in annual cost incurred is kept in line with the growth in population aged 50 and
over with the use of maximum annual credit limits.
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of populaLlon above 30 30 32 18
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arLlclpaLlon raLe 43 33 60 63 70
usage raLe ( of credlL) 30 33 40 43 30
populaLlon growLh 3.43 3.43 3.43 3.43 3.43
populaLlon over 30 ('000s) 1,129.6 1168.6 1208.9 1230.6 1293.7 1338.4
parLlclpanLs ('000s) 323.9 664.9 730.4 840.9 936.9
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1 - 3 room 22,086.00 $ 27,923.29 $ 31,314.96 $ 33,319.07 $ 39,348.17 $
4 -3 room 32,813.48 $ 41,489.00 $ 46,822.22 $ 32,474.03 $ 38,460.13 $
Condo, rlvaLe, Landed & CLhers 8,318.88 $ 10,771.18 $ 12,133.77 $ 13,623.07 $ 13,177.13 $
1oLal 63,418.36 $ 80,183.47 $ 90,492.93 $ 101,416.20 $ 112,983.43 $
deducLlon/usage of credlL - (22,196.43) (48,362.96) (73,301.82) (93,623.88)
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romoLlon cosL 7,000.00 3,000.00 4,000.00 3,000.00 2,000.00
lnformaLlon sysLems cosL & malnLenance 3,000.00 3,000.00 2,000.00 2,000.00 2,000.00
Mlsc. cosL 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00
1oLal annual cosL 77,418.36 90,183.47 98,492.93 108,416.20 118,983.43
1oLal addlLlon Lo credlL 448,498.42
1oLal promoLlon cosL 21,000.00
1oLal lS cosL 14,000.00
1oLal Mlsc. CosL 10,000.00
1oLal cosL 493,498.42
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CENSUS OF POPULATION 2010
Table 5 Resident Households by Type of Dwelling andAge Groupof Headof Household
Number
Type of Dwelling Tot al
Below25
Years
25 - 29
Years
30 - 34
Years
35 - 39
Years
40 - 44
Years
45 - 49
Years
50 - 54
Years
55 - 59
Years
60 - 64
Years
65 - 69
Years
70 - 74
Years
75 Years
& Over
Tot al 1,145,920 6,579 37,396 86,430 131,447 145,602 165,376 165,699 140,411 106,227 58,122 45,826 56,806
HDB Dwellings* 943,859 4,967 31,957 73,455 107,257 117,206 135,334 136,532 116,159 87,093 48,612 38,606 46,680
1- and 2-Room Flat s 52,275 496 1,443 1,424 2,285 3,657 5,139 6,409 6,529 6,380 4,786 5,276 8,452
3-Room Flat s 229,718 1,328 7,661 15,121 21,155 24,561 30,038 31,722 27,706 24,121 15,782 14,084 16,440
4-Room Flat s 365,423 1,648 13,039 30,476 42,923 46,060 53,521 53,655 46,460 33,027 17,524 12,399 14,692
5-Room and Execut ive Flat s 293,336 1,460 9,622 26,191 40,629 42,667 46,212 44,351 35,082 23,228 10,324 6,735 6,837
Condominiums and Privat e Flat s 128,854 1,252 4,674 10,995 20,094 21,808 21,096 17,870 12,666 9,012 3,913 2,607 2,866
Landed Propert ies 64,908 207 426 1,305 3,211 5,782 7,992 10,232 10,725 9,139 4,968 4,186 6,736
Bungalows 8,319 67 42 97 249 603 795 1,110 1,384 1,311 756 623 1,281
Semi-Det ached Bungalows 19,507 41 101 289 846 1,655 2,278 2,969 3,160 2,949 1,655 1,470 2,094
Terrace Houses 37,082 99 283 918 2,115 3,524 4,920 6,153 6,181 4,879 2,556 2,093 3,360
Ot hers 8,298 152 338 675 885 805 953 1,064 862 983 630 427 524
* 'HDB Dwellings' includes ot her HDB dwellings.
opulaLlon Above 63 of populaLlon
1oLal 344,069
Pu8 uwelllngs* 284,603
1- and 2-8oom llaLs 26,236 7.63
3-8oom llaLs 81,338 23.63 31.28
4-8oom llaLs 103,046 29.93
3-8oom and LxecuLlve llaLs 73,034 21.23 31.18
Condomlnlums and rlvaLe llaLs 22,233 6.46
Landed roperLles 34,432 10.01 17.28
8ungalows 3,473 1.39
Seml-ueLached 8ungalows 11,443 3.33
1errace Pouses 17,313 3.09
CLhers 2,801 0.81
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Age Croup ln '000
30-34 388
33-39 398
60-64 374
63-69 303
70-74 228
73-79 103
80-84 133
80+ 41
1oLal 1992
arLlclpaLlon 8aLe 70
1-3 room 4-3 room oLhers
Pouslng 1ypes ( of opulaLlon above 30) 30 32 18
arLlclpanLs ('000) 418.32 723.088 230.992
Maxlmum credlL cap/year/person 140 $ 120 $ 90 $
1oLal cosL ('000) 168,164.64 $

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i
Population in Brief, 2011. Department of Statistics Singapore. Retrieved from
http://www.singstat.gov.sg/stats/themes/people/popinbrief2011.pdf on 1 February 2012

ii
National statistics, UN, Euromonitor International. Retrieved from
http://www.agentschapnl.nl/sites/default/files/bijlagen/Bijlage%20marktkenmerken%20Singa
pore_1.pdf on the 1 February 2012

iii
Thang, L.L. Singapore Pilots a Two-Year Wellness Program. Human Kinetics. Retrieved
from http://www.humankinetics.com/aaccprograms/aacc-programs/singapore-pilots-a-two-
year-wellness-program on 28 January 2012

iv
Ministry of Community Development, Youth and Sports (MCYS). 18 March 2011.
Retrieved from http://www.mof.gov.sg/budget_2011/expenditure_overview/mcys.html on 1
February 2012

v
Infoimation anu Communication Technologies in Singapoie's Bealthcaie. uene Wiieu.
Su }une 2u11. Retiieveu fiom http://genewired.com/en/blogs/1-blog-articles/117-
information-and-communication-technologies-in-singapores-healthcare.html on 27 January
2012

vi
Singapore Action Group of Elders. Retrieved from http://www.sage.org.sg/index.htm on 3
February 2012

vii
James F. Fries et al. Reducing Health Care Costs by Reducing the Need and Demand for
Medical Services. 29 July 1993. Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJM199307293290506 on 2 February 2012