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Singapore represents an instructive case study in responding to rapid ageing, growing inequalities, and significant relative poverty. Unlike other high-income Asian countries, it has relied on single-tier mandatory savings to finance retirement, housing, and to a lesser extent, healthcare. To address the low fertility rates, it has permitted the share of the non-citizen population to triple between 1990 and 2005 to nearly 30 per cent. This is subtly altering Singapore's socio-political dynamics, while assisting in sustaining growth and competitiveness. The paper argues that Singapore has the fiscal, institutional, and organizational capacities for a modern multi-tier social security system. Singapore is, however, determined to continue with current inadequate and inequitable arrangements, requiring individuals and their families to bear disproportionate risks in financing retirement, healthcare, and short-term income support. This reflects conscious policy choices arising from a Darwinist vision of society, and the need for socio-political control. [ABSTRACT FROM AUTHOR]

This paper assesses Singapore's healthcare financing arrangements in terms of their efficiency, fairness, and adequacy. Singapore represents an interesting case study because it is perhaps the only high-income, rapidly ageing country to rely on mandatory savings to finance healthcare, thus eschewing extensive risk-pooling arrangements, generally regarded as efficient and equitable. The paper argues that parametric reforms, i.e. relatively minor changes in the parameters of current schemes which preserve the existing philosophy and system design, will not be sufficient to meet healthcare financing objectives. Systemic reforms, which will bring Singapore into the mainstream of health financing arrangements found in the OECD countries, are urgently needed. Their design and timing should be based on good quality, timely and relevant data, and an environment conducive to vigorous debate. [ABSTRACT FROM AUTHOR]