care becomes more established, it also will receive 50% of its operating costs from the government.
Unlike in Japan, most individuals in Singapore do not hold healthcare insurance which pays for the medical care of the nation. Instead, the government operates a compulsory saving scheme called the Central Provident Fund or CPF, where employees are required to put 25% of their salaries into an account under their own names, and employers pay about 20% of their wage bill into the employees' CPF account. This money is allowed to be used for specific purposes only, such as buying housing, and for hospitalisation costs. Since 1994, the government has allowed the portion of the CPF money set aside for medical care to be used for in-patient hospice care. This represents yet another form of recognition that hospice or palliative care has become an integral part of the healthcare system in Singapore. The ability to use the health insurance to pay for in-patient hospice care has the same significance in Japan.
Challenges for the future
What about the future? What are the challenges that face in-patient palliative care units in Japan, in Singapore and in many of the more developed nations in the world?
A fully integrated service
I have already mentioned the diversifying of hospice or palliative care services to include hospice home care and hospice day care. This is the first challenge and trend that I see for the future of in-patient hospice and palliative care.
To provide a seamless, integrated service to patients, many in-patient services are looking to provide home care and day care services to cater for the varying needs of their patients. Depending on the history of the local services, home care may come first, or may follow the setting up of the in-patient service. In Singapore, we have seen both. Assisi Home and Hospice started off as purely an in-patient service, but recently set up its home care service to improve the care it gives to the patients. The Hospice Care Association started off purely as a hospice home care service, but with the setting up of Dover Park Hospice in the adjoining site at the Hospice Centre, it has linked up
