新加坡的長期護理體系：適應人口老齡化 - 亞洲開發銀行（英文版）（25頁）.pdf

1、Singapore, a multiethnic country with one of the highest median incomes in the world, is undergoing a demographic shift. Twenty- fi ve percent of the population is predicted to be aged 65 and older by 2030, versus 14.4% in 2019. This demographic shift has profound implications on the countrys health

2、 and care needs. In response, Singapore has been moving toward a more holistic view of aging, health, and care, along with policies and systems related to these. AGING ASIA AND THE PACIFIC ASIAN DEVELOPMENT BANK SINGAPORES LONG-TERM CARE SYSTEM ADAPTING TO POPULATION AGING AGING ASIA AND THE PACIFIC

3、 ADB_AgingAsia Follow us: Social Development Thematic Group Sustainable Development and Climate Change Department Asian Development Bank 6 ADB Avenue, Mandaluyong City 1550 Metro Manila, Philippines sdtgadb.org ASIAN DEVELOPMENT BANK Singapore, a multiethnic country with one of the highest median in

4、comes in the world, is undergoing a demographic shift. Twenty-fi ve percent of the population is predicted to be aged 65 and older by 2030, versus 14.4% in 2019. This demographic shift has profound implications on the countrys health and care needs. In response, Singapore has been moving toward a mo

5、re holistic view of aging, health, and care, along with policies and systems related to these. AGING ASIA AND THE PACIFIC ASIAN DEVELOPMENT BANK SINGAPORES LONG-TERM CARE SYSTEM ADAPTING TO POPULATION AGING AGING ASIA AND THE PACIFIC ADB_AgingAsia Follow us: Social Development Thematic Group Sustain

6、able Development and Climate Change Department Asian Development Bank 6 ADB Avenue, Mandaluyong City 1550 Metro Manila, Philippines sdtgadb.org ASIAN DEVELOPMENT BANK LONG-TERM CARE SINGAPORE MULTIFACETED APPROACH TO INTEGRATED A focus on home and community-based care, nested within an overarching A

7、ction Plan for Successful Ageing and a policy shift toward a population health approach CONSOLIDATING AGING, HEALTH, AND CARE The Ministry of Health coordinates interministerial and multistakeholder collaboration on a holistic approach to successful aging and creating an age-friendly environment. 70

8、 initiatives in 12 areas THE ACTION PLAN FOR SUCCESSFUL AGEING Ageing Planning Ofce Responsible for planning and coordination of all aspects of long-term care service delivery by all providers at all levels (home, community, center-based) Executed by Bridges all relevant ministries in the planning a

9、nd implementation of initiatives toward successful aging Agency for Integrated Care under the Ministry of Health PUBLIC HEALTH CARE The management of public health care has been reorganized into three integrated clusters bringing together health promotion, disease prevention, and curative and rehabi

10、litative care to promote efcient and appropriate delivery of health care and support across the life course. Health promotion Disease prevention Curative and rehabilitative care Health and care insurance schemes are being reorganized for increased coverage and risk pooling across the population incl

11、uding for long-term care. HEALTH AND CARE INSURANCE SCHEMES to increase long-term care insurance coverage new schemes2 t0 be launched in 2020 1 23 2019 Population ratio of aged 65 and above 14% 203025% Life expectancy at 60 23.2 years 26.7 years Healthy life expectancy at 60 19.6 years 22.3 years (p

12、opulation: 3.9 million) Launched in 2015 S$3 billion ($2.2 billion) Financing for LTC and support to older adults exists within an overall ecosystem of health-care financing that, in turn, is intertwined with the way in which social care and even pension funding is organized. As such, Singapores hea

13、lth-care financing model is unique and may not be easily replicable in other settings. The reforms and plans are relatively new so smooth implementation will take continued effort to achieve. While the early results are promising, data is needed to ascertain whether all these initiatives translate i

14、nto benefits in medium- and long-term outcomes at the system and population levels. Even though many countries can learn from Singapores current LTC development and population health focus, countries will need to consider the unique context of their health and care systems, including their particula

15、r needs as well as accompanying facilitators and barriers, to redesign health and care delivery to meet the needs of the older population with care needs.16 HealtH Financing ecosystem evidence For impact still required unique context 2 16 J. Woo. 2017. Designing Fit for Purpose Health and Social Ser

16、vices for Ageing Populations. International Journal of Environmental Research and Public Health. 14(5). pp. 457. CONTENTS This case study was developed under the regional technical assistance for Strengthening Developing Member Countries Capacity in Elderly Care, funded by the Japan Fund for Poverty

17、 Reduction and the Republic of Koreas e-Asia and Knowledge Partnership Fund. The document was peer-reviewed by the Tsao Foundation, a center of excellence on aging and long-term care in Singapore, and a knowledge partner of the Asian Development Bank. Aging in Singapore 2 Singapores Approach to Heal

18、th and Care for Older People Governance and Programs for Aging, Health, and Care 4 7 Financing Health and Care for an Aging Population 16 Key Takeaways from the Singapore System of Long-Term Care 20 Creative Commons Attribution 3.0 IGO license (CC BY 3.0 IGO) 2020 ADB. The CC license does not apply

19、to non-ADB copyright materials in this publication. https:/www.adb.org/terms-use#openaccess http:/www.adb.org/publications/corrigenda Publication Stock No. ARM200243-2 pubsmarketingadb.org Photo by ADB. 2 Asia is undergoing one of the most profound demographic shifts in the world. By 2050, the numbe

20、r of people over the age of 65 is expected to exceed 1 billion. The Asian Development Bank is supporting its developing member countries to prepare for this in a variety of ways, including helping them to learn from the examples of countries who are leading the way. One such example is Singapore. Si

21、ngapore is a multiethnic country located at the southern tip of the Malay Peninsula in Southeast Asia, with one of the highest median incomes in the world. In 2019, 14.4% of its population of 3.9 million people was aged 65 years or older, and by 2030, this figure is expected to rise to 25%, because

22、of rising life expectancy and lower fertility rates (Figure 1).1 This demographic shift has profound implications for the countrys health and care needs. Aging in singapore Introduction While the country currently has one of the lowest age-related disease burden rates in the world, at 108.3 disabili

23、ty- adjusted life-years per 1,000 adults aged 25 and older, in the coming 2 decades, demand for long-term care (LTC) is expected to accelerate with increasing age and a growing number of single households.2 Singapore has recognized population aging as a key issue shaping the future of the country, a

24、nd to address this, it has taken a multifaceted, integrated, and holistic approach based on minimizing adverse effects and maximizing opportunities. This recognizes the varying needs of individuals across multiple domains as they age. Moreover, it has developed robust policy, governance, financing,

25、and service delivery, including expansion of and integration of health and social care, to meet the holistic needs of older people. 1 Department of Statistics Singapore. https:/www.singstat.gov.sg/find-data/search-by-theme/ population/elderly-youth-and-gender-profile/latest-data. 2 A. Y. Chang, V. F

26、. Skirbekk, S. Tyrovolas, N. J. Kassebaum, and J. L. Dieleman. 2017. Measuring Population Ageing: An Analysis of the Global Burden of Disease Study 2017. The Lancet Public Health. 4(3). pp. 159167. https:/doi.org/10.1016/S2468-2667(19)30019-2. 3 3.9 million Population Aged 65 and above 14% 2019 2030

27、 25% Life expectancy at 60 26.7 years 23.2 years Healthy life expectancy at 60 22.3 years 19.6 years Sources: World Health Organization. 2016. Global Health Observatory Data. https:/www.who.int/gho/mortality_burden_disease/life_tables/en/; and International Longevity Centre, Singapore. 2011. A Profi

28、 le of Older Men and Women in Singapore 2011. https:/tsaofounda- tion.org/doc/Profi le_Of_Older_Men_-_Singapore.pdf. 87% healthy and independent 8% need walking aid 3% need assistive devices 1% need assistance for mobility 1% bedridden Figure 1: Singapores Aging Population Men Women Men Women 4 sing

29、apores approach to health and care for older people Approach Singapores approach to long-term care (LTC) focuses on home and community-based care, nested within an overarching Action Plan for Successful Ageing and a policy shift toward a population health approach (explained on the next page). Singa

30、pores aged care begins with the individual and family, and the service delivery system emphasizes aging in place and home and community- based care. The approach is seen by the government as consistent with the preferences of many older persons, aligned with Confucian values, and a means to optimize

31、 resources.3 By aiming to deliver value at lower cost by reducing unnecessary utilization of institutional care, Singapores LTC policies are in line with the Many Helping Hands Approach, a long- established principle in the country that calls for individuals, families, communities, civil society, th

32、e private sector, and government to all play a role in ensuring the well-being of older people. It affirms the primacy of the family, but also encourages the participation of community-based voluntary welfare organizations and grassroots organizations to help in delivering services.4 Singapores LTC

33、policy recognizes maintaining health is a holistic and multifaceted process. An age-friendly and enabling environment integrates domains of income, environment, health, and social issues in support of successful aging. 3 T. H. E. Pacific. 2015. Long-term Care of Older Persons in Singapore. Bangkok;

34、and K.Y. Gan. 2019. Futurescape: Home HealthcareLocal and International Perspectives. https:/www.moh.gov.sg/content/moh_web/home/pressRoom/speeches_d/2016/speech-by-mr- gan-kim-yong-minister-for-health-at-home-nursing-.html 4 M. Subramaniam, E. Abdin, J. A. Vaingankar, and R. Sambasivam. 2019. Succe

35、ssful Ageing in Singapore: Prevalence and Correlates from a National Survey of Older Adults. Singapore Medical Journal. 60(1). pp. 2230. 5 Population health is an interdisciplinary and multistakeholder approach targeting improved health outcomes across a population. It is based on two foundational c

36、oncepts: a holistic understanding of health, its behavioral and social determinants, and a life-course perspective; and a recognition that medical interventions alone are not sufficient to ensure good health and that much wider engagement is needed. Therefore, a population health approach aims for b

37、etter physical and mental health outcomes, improved well-being, and reduced health inequalities. It engages individuals, communities, and other actors to facilitate good health.a To achieve this, health departments need to connect practice to policy, and utilize partnerships across different sectors

38、 of the community.b Further, this comprehensive approach aims to balance four different pillars: Wider determinants of health Health behaviors and lifestyles Integrated care and health system Places and communities we live in Population health takes an integrated approach to improving outcomes, incl

39、uding coordinating health-care services and social services. It goes further than public health by working on the broader challenge of improving health outcomes for the whole community, not only the ones in need of care. Population health uses a triple aim approach to simultaneously improve the over

40、all health of the population, enhance the experience and outcome of the patients, and reduce per capita cost of care for the benefit of communities.c a The Kings Fund. 2018. A Vision for Population Health: Towards a Healthier Future. https:/www.kingsfund.org.uk/publications/vision-population-health.

41、 b Centers for Disease Control and Prevention. https:/www.cdc.gov/pophealthtraining/whatis.html. c D. M. Berwick, T. W. Nolan, and J. Whittington. 2000. The Triple Aim: Care, Health, and Cost. Health Affairs, 27(3). pp. 759-769. https:/doi.org/10.1377/hlthaff.27.3.759. What Is Population Health? 6 P

42、opulation aging and the related epidemiological transition is viewed as something that an acute-care, doctor- based system would not be able to handle and would lead to extremely high costs for individuals, families, and the state. Thus, cost efficiency is a key tenet of Singapores aging policy: car

43、e and health are integrated as part of a Singapore recognizes maintaining health is a holistic and multifaceted process. Care and health are integrated as part of a wider process of increasing integration of public health, primary care, acute care, rehabilitation, and long-term and palliative care.

44、wider process of increasing integration of public health, primary care, acute care, rehabilitation, and long-term and palliative care; and the design of the services, governance, and financing are done in such a way as to maximize prevention, promote individual and family responsibility, and reduce

45、inefficiencies. 7 Governance and programs for aging, health, and care Master plan The Healthcare Masterplan 20122020 aims to expand accessibility, enhance affordability, and improve quality of health care. Focus areas in the 20122020 master plan are improving seamless health care and primary care, i

46、ncreasing the intermediate and LTC sector including home-based care services, and expanding financial protections. To facilitate integrated delivery of support and services, Singapore has consolidated aging, health, and LTC under the Ministry of Health (MOH) with interministerial remits, where relev

47、ant. Under the governance of the MOH, there is a multipronged approach to aging, health, and care (Figure 2). In 2017, the MOH identified three key policy priorities: 1. From Health Care to Health: Emphasizing health, inclusive of an aging population, requires investments in promotion of healthy and

48、 active aging, social connections, age-friendly homes and communities, prevention of chronic disease and illness, disease control, rehabilitation, and quality health care. 2. From Quality to Value: This priority seeks to deliver quality care in the most efficient way possible, ensuring value for mon

49、ey. 3. From Hospital to Community Hospital: Singapore plans to strengthen primary health care and improve integration of health and care. Health and care services will increasingly be provided in the community for a lower cost with better quality outcomes. To facilitate integrated delivery of support and services, Singapore has consolidated aging, health, and long-term care under the Ministry of Health. 8 Figure 2: A Multipronged Approach to Aging, Health, and Care The Ministr