Health care for older persons in Singapore: integrating state and community provisions with individual support

Health care policy in Singapore is similar to that in the United States and the United Kingdom, where a residualist strategy is used to pass health care costs to individuals and their families, the rationale being that this enables the state to concentrate on devolution of care to the community and ensure efficient and affordable service to all Singaporeans. The services include public restructured hospitals and outpatient poly-clinics as well as community services such as community hospitals and hospitals for the chronically ill, nursing homes, day care centers, and home help services. Availability does not translate into optimum usage because current and potential users and their families are not able to match their financial and social resources with the services. Instead, the state acts as the case manager and places parameters on what individuals can access.     

Contraceptive self-efficacy: does it influence adolescents' contraceptive use?

This research investigates the relationship between contraceptive self-efficacy and contraceptive use, measured one year later, among adolescent boys and girls. Data are obtained from the two waves of the restricted use sample of the National Longitudinal Study of Adolescent Health (n = 3,577). Employing multiple regression and logistic regression strategies, we examine whether demographic and background characteristics influence contraceptive self-efficacy, and whether contraceptive self-efficacy increases the likelihood of contraceptive use. We find that adolescents who are female, older, live with step-parents, and whose mothers approve of contraceptive use report higher contraceptive self-efficacy, while adolescents whose mothers did not complete high school report lower contraceptive self-efficacy. Results partially support the expectation that adolescents with higher contraceptive self-efficacy act accordingly by using contraceptives.     

AIDS: A case management approach. The illinois experience

The Illinois Department of Children and Family Services provides through their Medical Foster Care Program substitute living arrangements for wards of the state with positive antibody tests, ARC, and AIDS. At present there are ten children (eight in Cook County) that fall into one of these categories. Half (5) of these children are infants under the age of one year. Three (3) are adolescents who were exposed through intravenous drug abuse and/or prostitution. Case illustrations and discussion together with case planning and management techniques are presented for two of the cases: an adolescent with a positive antibody test, and a three-year-old with AIDS. Current trends and future issues for investigation are also presented.     

Population planning and change in Singapore

Population planning in Singapore has always been linked to economic planning. Lacking natural resources on an island 536 sq. kms. in size, the physical carrying capacity was not large so that the government had to resort to careful economic planning to overcome this constraint. The “stop at 2” population policy of 1965–87 was designed to support the economic plans to improve the quality of life of the people. Restraint of population growth was promoted as a necessary move serving the common good of Singaporeans as the country struggled in her early years of independence to build a nation. By 1983, however, Singapore switched from being antinatal to being pronatal. The environmental determinism school that influenced population planning gave way to environmental possibilism in which man is the main agent determining his own actions in the population-environment relationship. Technology has allowed the leadership of Singapore to make use of the global economy as its hinterland. By concentrating on the high-end service sector, such as mercantile banking or currency markets, Singapore has used the new information age of computers to take advantage of the changing world market. The “quality” population required to do this job is missing, thus the “have 3 or more if you can afford it” policy.