Lijia Wang is currently a Master student in the Department of Statistics and Applied Probability, National University of Singapore. He is also a research assistant in the Saw Swee Hock School of Public Health, National University of Singapore. His research areas focus on public health problems of ageing and economics of ageing.
Forecasting disability in Singapore using the Future Elderly Model
Singapore is one of the fastest-aging populations in the world with an increasing burden of chronic diseases and disability as lifestyles change. This study focuses on the future elderly of Singapore, using local demographic transition. Singapore will be a “top-heavy” society due to increases in life expectancy, coupled with low, below-replacement fertility rates, which will have important implications for social protection systems, including financing and healthcare. The goal of this paper is to model future disability and healthcare expenditures based on current trends.
To project the health and functional status of future cohorts of the elderly and to understand their cost implications, we have developed a version of the Future Elderly Model (FEM) adapted to the context of Singapore. The FEM is a dynamic Markov micro-simulation model first developed in the US. Our main source of population data is the Singapore Chinese Health Study (SCHS), a cohort study of over 63,000 respondents followed in three waves from 1993-2010. The SCHS linked with a detailed cost database from the Ministry of Health, Singapore that captures all hospitalization episodes and cost for the same period. We employ the FEM model to illustrate projections of disability in Singapore, including disparities in disability prevalence by educational attainment. A strength of the microsimulation models is that they each take account of the evolving educational attainment of future cohorts of older adults and competing risks when projecting disability outcomes and hospitalization cost. All costs are expressed in 2010 Singapore dollars.
Preliminary results indicate that from 2014 to 2050, the educational gradient in health and functional status will steepen, with a wider gap in the prevalence of disability between those who have at least a high school education and those who have less than a high school education. The disparity in disability prevalence defined as having at least one activity of daily living (ADL) starts at 5% in 2014, increases to 12% by 2030, and projected to increase further to 20% by 2050. In 2020, the difference in hospitalization cost for people with disability was S$1131.70 more than those without disability, which will increases to S$1876.85 in 2050. This microsimulation approach will enable us to investigate the effects of disability compound over the lifecycle. Additionally, we aim to expand the analyses targeted on high-risk groups to further research on ways of helping Singaporeans age healthily through prevention. Our study will discuss the policy implications of these findings.