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Measure outcomes not effort

~ By Leon Perera ~

The current national moment of urgency in solving social problems is welcome and long-overdue. In Budget 2012 and the 2011 General Elections, no question loomed larger.

But whether it is about retirement adequacy, healthcare affordability or helping the poor, the same questions tend to be asked: “Is the government doing enough?” followed by “What more can be done?”.

Framing the debate in this way is unhelpful because it begs the question - how much is enough? A response along the following lines is all too common - many schemes are already in place to address the problem, please do your homework.

A more helpful approach is to focus on the goals of these schemes – the targeted social or public policy outcomes. Instead of how many schemes exist, we should look at how many needy people have actually been helped by these schemes. Instead of how much has been invested in government funds targeting social issues, we should look at how much money has actually been disbursed.

Most importantly, why not focus first and foremost on a statistical indicator that shows the extent of the problem the schemes were meant to address? And if such an indicator does not exist or is not widely known, create it, ensure it is measured accurately, publish the results, set targets and focus parliamentary and public debates on how the needle is moving.

Debating good measures of actual social outcomes focuses our minds on whether current policies are working by defining what would constitute success.  

Deputy Prime Minister Tharman Shanmugaratnam’s stated goal in 2010 of 30% real median income growth by 2020 is a good example of setting a measurable target. Debate should focus on similar outcome measures and targets in other areas of public policy.

  • Healthcare affordability: The 3Ms framework is meant to provide multiple layers of support for healthcare costs. But rather than debating how much is enough, we should ask questions like: how many cases have there been where victims of catastrophic illness earning say less than $5,000 per month have had to pay more than say $100,000 out of pocket? Surely the Ministry of Health has the necessary data to put a number to this.  We can debate what sort of income and out-of-pocket quantums are acceptable to us as a society. There will never be a universal consensus on this. But the data to support this debate should be publicly highlighted so that we can track cases of healthcare-related economic distress and hopefully set targets for minimizing them.
  • Poverty: Debates about poverty often end up discussing whether the many schemes set up to help poor Singaporeans are enough. These include Comcare, Workfare, Rental and Utility Assistance (RUAS), Personal Assistance (PA), subsidies at GP clinics and so on – a bewildering array of schemes. Rather than debating whether these schemes go far enough or are accessible enough, we should settle on a simple measure of poverty in terms of disposable income for living expenses per person after taking in the cash and benefits from anti-poverty schemes that they have actually received – a national Poverty Line – and track how many people are falling under this line year after year. Once again, the data surely exists to quantify this. Surveys can be used to plug any data gaps. If it turns out that we are losing the battle against poverty, it would be clear that we need to go back to the drawing board.
  • Public transport passenger loading:  Wouldn’t the debate be vastly improved by the regular publication of the number of average peak hour passengers per carriage in our trains and buses, as measured through observational surveys? If this number had received enough attention over the last five years, when it must have increased considerably, wouldn’t corrective measures have been taken much sooner?
  • Public housing affordability: HDB BTO prices per square foot (and the HDB re-sale prices to which they are pegged) have almost certainly outstripped real median income growth in the past 10 years. Even government ministers now admit this. How much assistance is enough? Too much attention goes to the viability of monthly mortgage repayments - which are “invisible” as they come from CPF, but extract a price in retirement adequacy.  Why not focus instead on the ratio between median income and the median housing cost per square foot over the repayment period (up-front cash plus instalments including interest). There is a legitimate debate to be had about what an acceptable ratio would be, given our land scarcity and the comparable situation in other global cities. But surely the ratio itself – and how it changes - is key. By some international measures, housing in Singapore is already classified as severely unaffordable.  Had the debate been focused on such a ratio, would HDB prices have risen vis-à-vis real incomes in the way they did over the past 10 years so that we now need to furiously play catch-up?

SMART* Targets

Measuring and publishing outcomes is the best way to ensure that parliamentary and public debate focuses on ground realities, not just effort put in. It is never sufficient to say that many schemes and programs exist to address the issues, without going into whether they are actually working.

A Public Policy Outcomes Scorecard should be released prior to each Budget debate in Parliament – or at the very least at the convening of each new Parliament every five years. MPs, civil society groups, analysts and citizens should not have to dig out the relevant data from the fine print of government publications – or, worse still, find that the crucial data set is not publicly available. It will then be plain to see whether the measures adopted previously actually worked.

If the government does not broadcast such measures, then our think tanks, civil society groups and alternative parties should step up to fill the gap by publicizing key measures of public policy success or failure.

Once we have clarity on outcomes, we will know whether Singapore is getting better or worse in different areas of public life. And where it is getting worse, we can then focus not on tweaking existing schemes but on departing from the old paradigm and adopting bolder, simpler solutions.

Clarity about outcomes will not only benefit public policy effectiveness. The debate about what outcomes should be targeted will help draw more Singaporeans into the conversation about what kind of society we want Singapore to be. Nothing could be better for strengthening societal bonds. And that in itself will be a big part of the solution to the problems we face.


*SMART is an acronym used to guide target-setting, denoting the terms Specific, Measurable, Accurate, Realistic & Timely

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