Singapores

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May 3 (UPI) — Inflation, the cost of living and economic stability concerns propelled Singapore’s conservative People’s Action Party to a landslide election win on Saturday.

The PAP and its leader, Prime Minister Lawrence Wong, secured 65.6% of the vote and a large majority of 97 seats in the Singaporean Parliament, the BBC reported.

The election results “put Singapore in a better position to face this turbulent world,” Wong said in a post-election address to the city-state.

“It’s a clear sign of trust, stability and confidence in your government,” Wong told the TV audience. “Singaporeans, too, can draw strength from this and look ahead to the future.”

Wong became Singapore’s prime minister last year, and the election partly served as a gauge of voter support for his policies and those supported by the PAP.

“Singapore feels particularly vulnerable given its economy’s size and exposure to international forces,” Ian Chong, an associate professor of political science at the National University of Singapore, told the BBC.

Chong said Singapore’s voters are “risk-averse,” which enabled the PAP to maintain its control of Singapore’s government.

The PAP has been the majority party within Singapore’s government since 1959. The center-left Workers’ Party is its primary opposition and held onto its 10 seats in the Singaporean Parliament.

Older voters are especially prone to voting for the PAP after living under its governance for more than six decades.

The WP hoped to gain seats in Saturday’s election due to the PAP receiving its lowest support in years during the prior three elections, while the WP gained support.

The 2020 COVID-19 pandemic led to the PAP’s erosion of voter support during the 2020 election, but Saturday’s election reversed the trend.

Current regional and global issues, including a trade war between China and the United States and the wars in Ukraine and Gaza, have raised concerns of a potential recession in Singapore.

Wong campaigned on a platform offering stability and good governance, which voters embraced.

Singapore – Last year, Charlotte Goh received a call from someone claiming to be an officer with Singapore’s Cyber Security Agency.

The caller told Goh that her number was linked to a scam targeting Malaysians and directed her to the “Malaysian Interpol” to file a report.

As a sales professional who often lists her number in public spaces, Goh, who asked to use a pseudonym, found the story plausible.

Over two hours, Goh shared personal details such as her name and identification number, though she hesitated to disclose her exact bank details.

“I wasn’t sure if it was a scam – it sounded so true – but I was also afraid it might be,” she told Al Jazeera.

When she was asked to photograph herself with her official identity card, Goh realised she was being scammed and hung up. Luckily, Goh, 58, was able to quickly change her passwords and transfer funds into her daughter’s account before any money could be stolen.

Others in her circle of friends have not been so fortunate.

“Some friends lost thousands,” she said.

Singapore, one of the world’s wealthiest and internet-savvy countries, has become a prime target for global scammers.

In the 2023 edition of the Global Anti-Scam Alliance’s annual report, Singapore had the highest average loss per victim of all countries surveyed, at $4,031.

In the first half of 2024, reports of scams hit a record high of 26,587, with losses topping $284m.

To combat this, the government has turned to unprecedented measures.

Earlier this month, Singapore’s parliament passed first-of-its-kind legislation granting authorities new powers to freeze the bank accounts of suspected scam victims.

Under the Protection from Scams Bill, designated officers can order banks to block an individual’s transactions if they have reason to believe they intend to transfer funds, withdraw money, or use credit facilities to benefit a scammer.

Those affected still retain access to funds for daily living expenses.

Singaporean police say that convincing victims they are being scammed is a persistent challenge.

Despite numerous anti-scam initiatives, education efforts, and banks’ introduction of features like kill switches, 86 percent of all reported scams in the city-state between January and September 2024 involved the willing transfer of funds.

Common tactics used by scammers include impersonating government officials and creating the illusion of a romantic relationship.

“This Bill allows the police to act decisively and close a gap in our arsenal against scammers,” Minister of State for Home Affairs and Social and Family Development Sun Xueling told parliament.

While the law has been hailed by its supporters as a critical tool to fight rampant scams, it has also stoked debate about the Singaporean government’s famed tendency to intervene in private matters, a model of governance sometimes described as “benevolent paternalism”.

Critics see the law as an extension of the paternalistic governance embodied by Singapore’s founding leader, the late Lee Kuan Yew, who once declared that he was “proud” for the city-state to be known as a nanny state and claimed its economic success was made possible by intervening in personal matters such as “who your neighbour is, how you live, the noise you make, how you spit”.

In his speech to parliament before the bill’s passage, Jamus Lim, an MP with the minor opposition Workers’ Party, expressed concern about the intrusive nature of the law, suggesting individuals be allowed to opt out of its protections or designate trusted family members as administrators of accounts instead.

“One may be uncomfortable specifically with how the bill grants law enforcement an enormous amount of latitude to intervene and restrict what is ultimately a private transaction,” Lim said.

Bertha Henson, a former editor with the Straits Times newspaper, said the legislation was only the latest example of the government intervening in “so many parts of our lives”.

“Can we be adults and not keep running to the State for protection?” Henson said in a Facebook post. “Because we really should think a lot further and ask who is going to protect the individual from the State as well. Or whether we can always be assured that the right hands are on the helm.”

The discussion comes as the government is rolling out a range measures to enhance public security, including plans to double the number of police surveillance cameras to more than 200,000 by the mid-2030s and legal amendments granting police new powers to detain individuals with mental health conditions that are deemed to be a safety risk.

Other recent laws, such as the Protection from Online Falsehoods and Manipulation Act and Manipulation Act and the Foreign Interference (Countermeasures) Act, reflect efforts to address misinformation and external influence.

While cast as measures to protect national security and social stability, they also grant authorities broad discretionary powers.

Walter Theseira, an associate professor of economics at the Singapore University of Social Sciences (SUSS), said the government’s anti-scam legislation reflects the steep economic and social costs of fraud in the city-state.

Theseira noted that many retirees opt to manage significant amounts of money outside Singapore’s mandatory savings scheme used to fund retirement, healthcare and housing needs, putting them “at risk of losing it all”.

“Unfortunately, the right to do what you want with your funds may have to be limited if your decisions end up making you dependent on society or encourage more criminal activity,” Theseira told Al Jazeera.

Eugene Tan, an associate professor at Singapore Management University’s (SMU) School of Law, said the growing losses from scams had spurred a shift towards a “preemptive approach” focused on preventing scams before they occur.

“If not more is done urgently and robustly, then we are not far from an unmitigated disaster,” Tan told Al Jazeera.

“The government is alive to the social cost and it will be remiss in its duties not to deal with the imminent crisis.”

Trust in government

Proponents of the law have argued it is tightly defined in its scope. The legislation specifies that restriction orders will only be issued as a last resort, if all other efforts to convince the individual have failed.

Individuals also have the right to appeal restriction orders, which initially last for 30 days and can be extended up to five times.

While the law could appear intrusive to outsiders, Singaporeans widely expect the government to take an active role in overseeing the welfare and wellbeing of the public, said Tan Ern Ser, an associate professor of sociology at the National University of Singapore (NUS).

“In a sense, Singaporeans want ‘parental support’ but not the ‘control’ aspect of paternalism,” Tan told Al Jazeera, describing the public’s expectation for a “selective, narrower form of paternalism”.

What sets Singapore apart is the public’s high trust in the government, Tan said, citing surveys such as the Asian Barometer and World Values Survey.

Tan pointed out that Singaporeans widely accepted stay-at-home orders, compulsory mask-wearing and contact tracing during the COVID-19 pandemic, which was not “politicised to any significant degree”.

Yip Hon Weng, an MP with the governing People’s Action Party, said that the expanded police powers were a necessary response to the growing problem of scams.

“This ability to act swiftly is a game changer for victims who have been repeatedly targeted, as it prevents further financial losses at critical moments,” Yip told Al Jazeera, sharing the case of an elderly resident in his constituency who had lost his life savings to a scammer posing as a government official.

“Temporarily restricting account access is a drastic step but one that could save individuals from financial ruin. However, such measures must be exercised with care to avoid undermining public trust.”

Yip said the law’s “intrusiveness – temporarily restricting access to accounts – requires a delicate balance” between safeguarding personal agency and robust implementation.

While the law is suited to Singapore’s political context, such measures may not be so easily adopted in the global context, some analysts say.

“Countries will have to decide what will work for them and whether there is buy-in for the legislative regime to deal with the scams,” the SMU’s Tan said, suggesting that there is a limit to how much state can intervene, and that “the political cost of such measures cannot be overlooked”.

Already, the law has attracted negative online chatter and cost the government some political capital, said Theseira of SUSS, adding that it “created a talking point that may be used against them in the upcoming elections”.

Singapore’s general elections, which are scheduled to take place by November, come amid growing discontent over housing affordability, rising living costs, income inequality, increasing polarisation and perceived restrictions on dissent in civil society.

The NUS’s Tan said it was unlikely the anti-scam law would set a global precedent in an era of growing distrust in politicians and government.

“All in all, my view is that a high degree of trust in government/institutions, social cohesion and consensus is necessary when an intervention is designed to restrict or restrain for a good, legitimate cause, but with society becoming more fractured and polarised, and entering a post-truth era, ‘fair and foul, and foul is fair’,” Tan said, quoting Macbeth.

Singapore’s rapidly aging population presents a critical challenge for its healthcare system. By 2026, more than one-fifth of Singapore’s residents will be 65 or older, placing significant pressure on both primary and specialist care.

To ensure high-quality, accessible healthcare in the face of these demographic shifts, it is timely to consider innovative approaches—one of which is the introduction of Physician Associates (PAs), also known as physician assistants, into the healthcare workforce.

The PA role has been successfully integrated into healthcare systems across at least eighteen countries, including the United Kingdom (UK), the United States (US), the Netherlands, India, and Australia. Each country’s experience underscores PAs’ ability to fill clinical gaps, enhance patient access, and alleviate burden on physicians.

PAs have demonstrated their value in various healthcare systems worldwide. In the United Kingdom, studies have shown that PAs, also known as Physician Associates, can handle a significant portion of routine primary care consultations, with one study indicating they manage up to 70% of such cases.

This has led to a substantial reduction in doctors’ workloads and improved patient throughput. Additionally, research has found that PAs safely support the workloads of clinical teams, provide team continuity, and positively contribute to patient experience and patient journey, benefiting medical and surgical teams and their patients across a wide range of specialties.

This is backed by a 2021 review of the literature on physician assistant/associate (PA) cost-effectiveness compared to physicians found that PAs delivered similar or better care outcomes at the same or lower cost. The review assessed cost-effectiveness in terms of quality, accessibility, and cost of care.

Key findings include:

• PAs provided comparable or superior care outcomes to physicians.
• PAs often achieved these outcomes at the same or lower cost.
• The efficiency of PAs was attributed to two main factors:
  • Greater effectiveness in producing care and activity.

Overall, the review suggests that the employment of PAs can contribute to more efficient healthcare, addressing the growing demands of demographic changes, new developments in healthcare, and physician shortages.

The PA model has been successfully implemented in various countries, demonstrating its scalability and adaptability. In the US, over 150,000 PAs are employed across multiple specialties, showcasing the model’s potential for broader responsibilities. Additionally, PAs are often employed in the private healthcare alongside nurse practitioners to manage higher workloads.

Other countries have also recognized the value of PAs, granting them increased autonomy and responsibilities. For example, the Netherlands has granted PAs prescriptive authority, highlighting confidence in their training and the model’s adaptability.

In Australia, physician assistants (PAs) have been successfully integrated into rural healthcare systems, enhancing accessibility and showcasing the model’s flexibility. However, the experience highlights the importance of clear regulatory frameworks. Pilot programs have demonstrated PAs’ effectiveness in managing post-operative care and chronic disease follow-ups, improving clinic efficiency and continuity of care.

Despite initial successes in the states of Queensland and South Australia, where pilot programs improved patient access and reduced wait times, nationwide implementation faced challenges in professional integration. This experience underscores the need for early stakeholder engagement and well-defined PA roles to ensure a smooth transition.

In India, PAs play critical roles in high-pressure environments, particularly in cardiology, emergency medicine, and surgical assistance. They provide critical care and support in cardiology, assist in emergency departments, and support surgeons and anesthesiologists in operating rooms. By effectively filling healthcare gaps in corporate hospitals and specialty care, PAs contribute to efficient and high-quality care.

In Singapore’s context, PAs can also make a significant impact. In polyclinics, they can manage routine cases, allowing doctors to focus on complex conditions, reducing wait times, and enhancing patient satisfaction. In specialist clinics, they can conduct follow-up consultations, coordinate care, and perform routine procedures, improving clinic efficiency and ensuring continuity of care.

Furthermore, as Singapore’s ageing demographics reconfigure its growing healthcare infrastructure stresses, PAs can play a key role in community-based care, managing chronic conditions and coordinating with specialists as needed, delivering consistent, quality care through their comprehensive training and detailed patient interactions.

To meet the intensifying demand for healthcare services in Singapore, the country’s healthcare system must expand its capacity. This requires building a robust workforce capable of delivering quality care efficiently. By leveraging the skills and expertise of PAs, Singapore can enhance its healthcare infrastructure and provide better care for its ageing population. Integrating PAs can:

1. Bolster Primary Care: In polyclinics, PAs can manage routine consultations and stable chronic diseases, reserving physicians’ time for complex conditions.
2. Enhance Specialist Clinics: By overseeing regular follow-ups, conducting procedures, and coordinating care, PAs can increase productivity and reduce wait times.
3. Strengthen Community Care: PAs, working alongside Advanced Practice Nurses (APNs) and physicians, can expand chronic disease management and elderly care coordination in community settings.

Singapore already has Advanced Practice Nurses (APNs). However, these roles complement each other. APNs bring advanced nursing expertise, patient education, and specialised care. Meanwhile PAs, trained under a medical model, focus on diagnostic, treatment, and procedural responsibilities.

Factoring the compelling economic case to optimise healthcare outcomes with appropriate financial allocations, when deployed together, these professionals can optimise clinical workflows and improve patient outcomes—especially critical for managing complex geriatric cases.

PA training is a cost-effective way to deliver competent routine medical care, requiring fewer resources than physician education. PAs can substitute for doctors in approximately 85% of primary care tasks; generate significant revenue; and are at least as productive as doctors in outpatient visits.

The opportunity cost of producing a PA is also lower, at around 20% of the cost of producing a doctor. Additionally, PAs can provide six years of healthcare services to society before a doctor is fully trained and functioning independently, making them a valuable addition to the healthcare workforce.

Implementing a PA profession in Singapore requires careful planning, appraisal, and deployment. Establishing regulatory frameworks, developing training programs, and ensuring smooth integration into the healthcare system are essential steps. However, the potential benefits of improved access to care, reduced wait times, better care coordination, and efficient resource use justify this investment.

A measured approach to introducing PAs in Singapore could involve:

1. Pilot programs in high-need areas like primary care and geriatrics to evaluate impact on waiting times, care coordination, and cost-effectiveness.
2. Developing accredited PA programs through partnerships with medical schools, ensuring rigorous, Singapore-specific competencies.
3. Establishing clear guidelines that define PAs’ scope of practice and supervision, maintaining public trust and integrating seamlessly into existing teams.
4. Ongoing evaluation using pilot data to refine regulations, training, and deployment, ultimately allowing for broader expansion if results prove favorable.

By adopting a phased and evidence-based approach, Singapore can successfully adapt and localise the PA model to meet its unique needs, ultimately leading to more accessible, efficient, and comprehensive healthcare delivery.

As the city-state grapples with the challenges of caring for an ageing population, expanding its healthcare workforce is crucial to maintaining its high standard of care. The global success of PAs offers a promising solution for improving patient access, optimizing physician workloads, and sustaining cost-effective service delivery. With careful implementation, the PA model can become a vital component of Singapore’s healthcare system, ensuring its resilience, innovation, and readiness to meet the challenges of the future.