ABSTRACT
This paper examines how healthcare fragmentation produces institutional displacement for Singapore’s aging population, a phenomenon we conceptualise as ‘aging out of place’. It examines how older adults become systematically disconnected from care coordination while remaining physically in place. Analysis of Singapore’s healthcare system reveals that institutional displacement operates through three reinforcing mechanisms: structural fragmentation across independent providers; financing arrangements in which insurance covers less than a quarter of long-term care costs, and administrative complexity that systematically excludes those with limited literacy, digital skills or family support. Current reforms like Healthier SG are constrained by voluntary participation and parallel financing mechanisms which limit their potential to address systemic fragmentation. The study recommends three parallel changes: unified governance cutting across ministry boundaries, a shift from fee-for-service to population-based payment, and operational infrastructure built around interoperable records and simplified administrative processes. Theoretically, the analysis extends aging-in-place concepts to encompass institutional dimensions of displacement. Practically, it shows that coordination must be built into system architecture for the aged. The study’s findings have implications for aging societies worldwide confronting similar fragmentation challenges.