Aline K. Wong
Singapore
“The ENABLE (Encouraging Achievement and Better Learning) programme gives additional support to those who are not achieving their potential. Our curriculum has given more emphasis to critical and creative thinking skills.”
“Can I just take one more second on the waiting list because Mr Ahmad Magad mentioned that the waiting list is long? There are 18 SPED schools now which cater to about 4,000 children. Of the 18 SPED schools, eight have waiting lists.”
“Sir, I am sure the Member in his meet-the-people sessions has also encountered cases where some families pleaded for priority to be admitted on grounds of, say, the child's sickness, or that the mother is working and is unable to bring the child to school, or that the grandparent cannot manage to take care of so many grandchildren.”
“I think he did not hear what I say. For both of these families, someone who lives within one kilometre or next door and someone who lives right on the border of this one kilometre, or of any delineation you choose to draw, my point is that for both of them, this is their nearest school.”
“Principals, as part of their duties, are always alert to what is happening in the school. They have also been given guidelines, in the Principals' Handbook, on discipline and the code of conduct which is expected of the teachers and staff members. But having said that, all these things are not foolproof.”
“It will continue to stagger the rental increase to market levels for assignment of tenancies, subletting cases and for tenants who are renewing their tenancies for the third time. Shop lessees can also apply to convert to shorter leases to reduce the cost of servicing their mortgage loans.”
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“Some Tables have been worked out, again based on the idea of annualised incremental cost versus 1% additional Medisave the Government will pay into these pensioners' Medisave accounts. The PSD has done calculations and found that the 1% Medisave contribution is enough to cover the average yearly incremental medical cost for all officers and their wives in all the Divisions. Together with the salary gain during their service, pensions and their accumulated Medisave and, if necessary, they can draw on MediShield, a pensioner is very well covered, even for exceptionally high bills. If a pensioner wants to have additional psychological assurance, he may want to take up some insurance scheme. In the Ministerial statement, the Minister has already given an indication that PSD has consulted insurance companies and their advice is that for civil servants, because the Government pays 85% and 60%, most civil servants will be adequately covered, especially if they also have MediShield. It would be wasteful for civil servants to have additional insurance coverage. The examples that I have given you show that only for dependants in class A and B1 wards, MediShield may not be enough to cover large hospitalisation bills. For these cases, civil servants with dependants who are eligible for A and B1 wards and who wish to co-pay no more than before, they may wish to buy the Co-pay Assist plan, because that will help them to half the co-payment rate. CPF Board will soon implement the MediShield Plus scheme and I should add that the MediShield Plus scheme is mainly designed for those with no medical benefits. It is for everybody, not just for civil servants. There are some people who work in the private sector with no medical benefits.”
“Of course, the premium varies with the age group, because hospitalisation rates differ between age groups. So there are different outlays. Table 10 - ANNUAL INCREMENTAL MEDICAL COST OF OPTION B WITHOUT AND WITH CO-PAY ASSIST PLAN (Cols. 275 - 276) You can see that for all Division officers, the younger ones are going to be all right if they opt into NTUC Income's Co-pay Assist scheme. They can both pay for the premium plus the outpatient charges and have something left over. It is only among the older age groups (50 and above) that those people who receive only a minimum salary increase may not want to spend that amount on NTUC Income's Co-pay Assist. In fact, only the last row of Division I and the last row of Division II officers show that a male officer in the 50 and above age groups with a wife and two children would probably find that their sums do not break even. But it is very unlikely that at age 50 to 60, or 60 above, an officer will still have two dependent children. So these are not really realistic figures. Finally, let me go to the post-retirement benefits. There is a lot of concern about officers who will be retiring. For those who have retired on pensions, there would be no change to their medical benefits. For serving officers on pensionable services, upon retirement, the Government will continue to bear the bulk of the pensioners' and their wives' medical costs at 85% and 60% respectively. This refers to those who opt for CCS. Upon retirement, the Government will still continue to pay 85% of the hospitalisation cost and 60% for the wife. In addition, the Government will contribute 1% to Medisave based on the last drawn salary for the lifetime of the pensioner. In any case, the incremental cost of post-retirement benefits is relatively low.”
“If people feel that, even with Basic MediShield, the amount they have to co-pay for their dependants is something that they do not want to bear, they can pay a premium and go on the NTUC Income's Co-pay Assist scheme. This scheme will result in the officers and their dependants co-paying at approximately the same level as before. Instead of 40%, they now pay 20%. Instead of 15%, they now pay 7.5%. There are some advantages to NTUC Income's Co-pay Assist insurance scheme. If I can bring you to Table 10 (Cols. 275 - 276) - this is the last of the tables I will refer to - please look at the column on the left-hand side on the "average incremental costs per year". This column is actually transferred from Table 4; it refers to the additional annual medical cost for officers who opt for Option B. And this covers both outpatient and hospital expenses. For Division I (Ward A), female officer pays $65 extra; male officer with no dependant, $55 extra, etc. Compare this column with the last column on the right-hand side, the annual salary gain, you will see that for all officers (Divisions 1, II, III, IV), the minimal annual salary gain of $400 - this is calculated on per month increment times 15 months - is more than sufficient to offset your average incremental cost per year (the first column compared with the minimum annual salary gain in the last column). Many officers have gained much more than the minimum sum, as the median income gain column indicates. They are much, much more comfortably off. If the officer takes up NTUC Income's Co-pay Assist scheme, it only pays for hospitalisation, so he still has to pay something for outpatient treatment. This is what the middle part of the Table is about - NTUC Assist premiums plus your own outpatient outlay.”
“For the same kind of operation and the same length of stay - if you choose to stay in class A, you incur a bill of $14,120 - how does MediShield help you? Here you have to note that because MediShield is pegged at B2 rates, so the room and board claims limit is pegged at B2 rate, which is $100 per day. So the maximum claimable limit for 19 days is $1,900 only, and this principle goes down the line. The maximum claimable amount under MediShield is $2,900 for the whole bill, but for class B2, your deductible is $1,000. After that, you have to co-pay 20% ($380). In the end, MediShield pays $1,520 and you pay $12,600 which represents 89% of the bill. But civil servants are again covered by the Government's 85% subsidy and their dependants by the Government's 60% subsidy. So if you look down the Table, you will see how MediShield also helps Division I and II officers who stay in class A ward. With these examples, it should be quite clear that Basic MediShield helps everybody. Tables 8 & 9 - REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD, RENAL DIALYSIS (Cols. 271 - 274) Table 9 on renal dialysis at Class A/B1 charges shows the same principles at work. I think you can study Table 9 at your own leisure. The above examples show that if the officers are covered by MediShield, they pay either nothing or a very small fraction when they incur large hospital bills. If you look at Table 8 again, with Basic MediShield, a civil servant pays only 4% of the bill because the Government pays 85% already, and MediShield pays 11%. However, for dependants who stay in class A and B1 wards, they are not fully covered by MediShield and the 60% subsidy from the Government. The dependants end up having to pay about 29% of the total bill. So this is where NTUC Income's Co-pay Assist comes in.”
“In the end, MediShield pays $885, the patient pays the deductible of $500 and co-insurance of $221, altogether $721. So 55% of the total hospital bill is borne by MediShield and 45% by the officer. This case applies to anyone who comes under MediShield in Class C ward. The civil servant is much better off because the Government pays 85%. So if the civil servant is not covered by MediShield, the Government already pays 85% for him, and he himself pays $241. For the dependant, because Government pays 60% of the total bill, he pays only 40% for the dependant - $642. Under MediShield, it would have paid a total of $885. So it covers entirely his 15% co-payment as well as his dependant's 40% co-payment. I go over these Tables carefully with you because a lot of people say that they have not seen how MediShield works. I think with these Tables, Members of the House may be able to show their constituents how these computations are worked out. The same principle applies to a Class B2 bill, Table 6 (Cols. 267 - 268). For outpatient renal dialysis, Table 7 (Cols. 269 - 270) - a lot of people are very worried about chronic illness and their bills - for class B2 and C, the hospital bill is $480 per month. MediShield pays 80% of the hospital bill, subject to the limit of $600 per month. So it comes to $384. The patient pays $96. For the civil servant, without MediShield, he pays only 15%, which is $72; his dependant pays 40% or $192. With MediShield, the civil servant pays $0, and his dependant also pays $0. So MediShield really helps a lot. Table 6 & 7 - REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD, RENAL DIALYSIS (CLASS B2/C) (Cols. 267 - 270) The next Tables 8 (Cols. 271 - 272) and 9 (Cols. 273 - 274) show that even for Division 1 and II officers, Basic MediShield helps.”
“I want to show you how, even under Basic MediShield, people can receive quite a bit of help. If I may refer you to Table 5 (Cols. 265 - 266). This is a case of a very serious illness, 21 days of hospitalisation in Class C ward. I choose the removal of breast cancer with reconstruction as an example. It is one of those things that women are vulnerable to, and it is a major operation. Actually this kind of bill can be applied to other equally serious conditions, for example, bone cancer, liver cancer, open heart surgery. For Class C ward, 21 days, major operation, the hospital bill comes to $1,607. MediShield, if you remember, has a deductible. For Class C, it is $500. And for each category of expenditure, there is an upper claim limit. For room and board for 19 days, the limit is $100 per day times 19. So $1,900 should be the claimable limit. The actual bill is only $1,235; so it is under the limit, and you can claim for the entire item. Intensive care, two days. For Class C, the limit is $200 a day. So, the upper limit is $400. Your bill is $142, again, you can claim for the entire item. Surgical procedure - this is a Table 7, major operation - the upper claim limit under Class C ward is $600. All the limits to claims are in the Annexes to the Ministerial Statement. So if you want to study further, you can refer to them. Table 5 - REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD (Cols. 265 - 266) For this person, the total claimable amount under MediShield is $1,607. This does not mean that he does not have to pay anything at all at this point. You must minus the deductible of $500. So the actual claimable amount is $1,107. But there is also the feature of 20% co-insurance. So 20% of $1,107 is $221, which the patient has to bear.”
“annualize the incremental cost of a hospital bill for the different divisions of officers (Divisions I, II, III and IV), the annual extra costs are shown in Table 3. To read Table 3 (Cols. 261 - 262), you should just concentrate on the "Average" column because it is very near the 75th percentile already. This Table gives you the figures of the annual incremental cost of the hospital bill under Option B. If you compare this Table with the salary increases the civil servants are receiving, you will see that under Option B, the salary increases for all Division I to IV officers are several times the additional amounts of medical costs they would incur, even though they pay a higher co-payment now. Table 3 - ANNUALISED INCREMENTAL COST OF HOSPITAL BILL UNDER OPTION B (Cols. 261 - 262) Table 4 (Cols. 263 - 264) shows the average incremental cost per year for outpatient plus hospitalisation expenses, ie, everything combined, annualized, and compared to the minimum annual salary gain for officers from Divisions I to IV and their families. There is a clear indication from Table 4 that under Option B, the salary increases are more than sufficient to cover the annual incremental cost of medical expenses, both outpatient and hospitalisation. Table 4 - ANNUALISED INCREMENTAL OUTPATIENT AND HOSPITALISATION EXPENSES UNDER OPTION B COMPARED WITH ANNUAL SALARY GAIN (Cols. 263 - 264) With some more examples, I will show you how, under the existing Basic MediShield, all the officers will benefit and will get some help from this insurance scheme. Members have brought out the point that a lot of people do not understand how MediShield works. In the Ministerial Statement we have worked out examples for MediShield Plus. The same principal structures apply to Basic MediShield.”
“But ward charges only cover the bed and the meals. Total hospital bill covers a lot of other things, such as investigations, X-rays, and sometimes operation fees. This 20% co-payment under the old scheme works out to be around 7% of the total hospital bill. Under Option B, the officer will co-pay 15%. This represents only an additional 8% as compared to the amount he used to have to pay, and the Government pays the rest. Likewise, under the old scheme, the dependant co-pays 50% of the ward charges, but this 50% works out to be only around 17.5% of the total hospital bill. So the incremental cost to the dependant is 22.5% (i.e. 40% - 17.5%). Table 2 (Cols. 259 - 260) gives you an idea of what is the incremental, that is, the additional co-payment on a hospital bill for an officer under Option B, based on what he has to pay as an additional outlay, that is, the extra 8%. This Table gives you not just the average but also the percentiles. Table 2 - INCREMENTAL CO-PAYMENT ON HOSPITAL BILL FOR OFFICER ON OPTION B (Cols. 259 - 260) But Table 2 is on hospital bills. You have to also remember that people are not hospitalised every year. You can work out the probability of hospitalisation in a person's life-time and according to age groups. There is also differentiation by gender. I would not bother you with the details, but a very simple rough guideline is that, on the average, men below 60 are hospitalised once every 10 years. For women, it is slightly higher at 1.5 times in 10 years because this is related to child birth and so on. If we spread out the extra co-payment, that is what is presented in Table 2, over every year, i.e.”
“This is the option that I would be talking mainly about. We think that most civil servants will opt eventually for Option B, the Comprehensive Co-payment Scheme. Why? Because for most officers, they will enjoy, first, the full benefits of the 1994 salary revision and future salary revisions. Second, the pay increase will exceed the additional co-payment. Third, they can afford additional insurance coverage if they want to cover the additional co-payment. This is where the Tables would be of help. Under Option B, the officer co-pays 15% for himself and 40% for his eligible dependants. Table 1 is about the amount of outpatient co-payment expenses he has to come up with. How do we arrive at those figures? Based on a PSD survey of 10 departments in 1992, only 70% of civil servants used outpatient services at the polyclinics, specialists' outpatient clinics and private clinics; 30% did not. The average bill for an officer himself for outpatient expenses is $180 per year. So under Option B, the Government will subsidize 85% of the bill. The officer only pays 15% and this 15% comes to $30 per year. Similarly, we found out the figures for the officer's dependants. Average expenditure is $120 per year per dependant. Because the civil service subsidizes 60% under Option B, the dependant pays only 40% of that and this comes to $50 per year. Row 2 of the Table adds up the outpatient co-payment for the officer and his wife. In the third row, it is the officer, his wife and two children. For each dependant, it is $50 per year, so the total for the family adds up to $180. I think most people are not worried about the outpatient expenses. They are more worried about hospitalisation. Under the old scheme, the officer co-pays 20% of the ward charges for in-patient bills.”
“There is a sense of being let down, even a sense of betrayal, to put it very strongly. This is in their own words. But this is not justified. Actually, the Government has every good intention to take care of the medical needs of the civil servants. The salary increases will fully cover any additional outlays they incur. We have made careful calculations on such incremental expenses, ie, additional expenses, and have made sure that the salary increases will more than cover such additional expenses. I think much of the anxiety and confusion can be allayed if the officers can see some actual calculations on what are their additional costs. They can then see how MediShield helps and can also consider whether they need additional insurance under MediShield Plus or under the NTUC Co-pay Assist scheme. With your indulgence, Mr Speaker, Sir, I would like to go over some calculations and examples with Members of the House. Can I ask the Clerk of Parliament to distribute a set of tables (Cols. 259 - 276)? [Copies of tables distributed to Members]. tables - ANNUAL OUTPATIENT CO-PAYMENT UNDER OPTION B, INCREMENTAL CO-PAYMENT ON HOSPITAL BILL FOR OFFICER ON OPTION B, ANNUALISED INCREMENTAL COST OF HOSPITAL BILL UNDER OPTION B, ANNUALISED INCREMENTAL OUTPATIENT AND HOSPITALISATION EXPENSES UNDER OPTION B COMPARED WITH ANNUAL SALARY GAIN, REIMBURSEMENT COMPUTATION FOR BASIC MEDISHIELD, RENAL DIALYSIS, ANNUAL INCREMENTAL MEDICAL COST OF OPTION B WITHOUT AND WITH CO-PAY ASSIST PLAN (Cols. 259 - 276) Just now, we were talking about how civil servants may want to choose between the different options. We think that most civil servants would choose between Option A and Option B. To reiterate, Option A is the old scheme. Option B is the new Comprehensive Co-payment Scheme.”
“Any future salary revisions will be different from those who opt into the other two schemes, because in future the people who stay on the old scheme will receive medical benefits whose value will increase over time. Option B, called the Comprehensive Co-payment Scheme (CCS), is a modification of this. The co-payment level is 15% of the total hospital bill and outpatient bill for the officer himself and 40% for the dependants. If civil servants opt for Option B, they will enjoy the 1994 salary revision. The third option, Option C, is what I have described earlier. It is the Medisave-cum-Subsidised Outpatient Scheme (MSO). I have already gone through the features of this scheme. Officers who opt for MSO will enjoy the 1994 salary revision. Since the announcement of the new medical benefits scheme, we have received quite a lot of feedback about an upsurge of anxiety among the civil servants. Members of this House have brought it up during the last two days' debate also. Many of the civil servants do not understand what are the options open to them. Existing civil servants have three options. Some of them do not even know that. There is also confusion over how each option works for them - methods of payment, what levels of co-payment, how to pay, etc. I think their anxiety is understandable. Health care is a very emotional subject. When you are in good health, you do not worry very much about medical expenses. But once you fall ill, the expenses come in. And if you have a serious illness, your medical bills can come to considerable amounts. Now, under the new medical benefits scheme, the civil servants only hear about having to pay more. Many think that they would be worse off. As I said, they have expressed their sentiments to us.”
“So there is an additional 1% Medisave in place of, partially, whatever they have been giving out as benefits in kind. There are several advantages to this and this explains why we are moving towards the MSO scheme in the civil service. The advantage of giving Medisave instead of medical benefits in kind is that it encourages the employees to use medical services responsibly. The employees would have the maximum freedom to choose and decide how they want to use their Medisave. If they use their Medisave sparingly, then whatever is in excess will go back to their Ordinary Account. This scheme also does not tie the employee to any particular job. So this is why we encourage employers to give the 1% additional Medisave in lieu of what they are providing for. The civil service is leading the way in this transition by instituting a new medical benefits scheme, called the Medisave-cum-Subsidised Outpatient Scheme (MSO), for new officers. Under this scheme, the civil servants receive 1% additional Medisave in lieu of hospitalisation benefits, and also an outpatient subsidy of up to $350 per year. For existing officers, those who are already serving in the civil service, they have three choices. Option A is to stay on the old system, ie, the Co-payment on Ward Charges Scheme. Under the old system, they co-pay 20% of ward charges for themselves, but 50% for their eligible dependants. Outpatient treatments are free. This old medical benefits scheme has been there, I think, for many years, maybe since the 1950s. And we started charging a bit of co-payment back in 1972 or so. If civil servants opt to stay on this old scheme, they have to stick to their old salary scale as at 31st December 1993.”
“Mr Speaker, Sir, since the new MediShield Plus and also NTUC Income's Co-Pay Assist Schemes are going to be intertwined with the medical benefits scheme and since several MPs have already raised questions about the medical benefits scheme and what can be done for the civil servants, I wish to take this opportunity to lead Members through these various schemes. I think this would address the point raised by Mr Loh Meng See that the Government should provide assurances to the civil servants. To understand the new medical benefits scheme, we have to go back a little bit to the first principles in our health care financing policy. We have always said that we uphold the importance of personal responsibility. And this means that we should save for our medical expenses. That is why we have Medisave. Medisave is for that purpose. The person's savings for medical expenses are supplemented by Government subsidies for outpatient treatment as well as for stays in subsidised wards in Government and restructured hospitals. For those who incur serious illness and have to stay in hospital for lengthy periods, there is MediShield. Finally, there is Medifund, if you cannot afford to pay the bill after these resources have been exhausted. There is a safety net. So this is the existing situation. In accordance with the principle of self-responsibility through Medisave, ie, people should save for their medical expenses and build up their Medisave account, the White Paper recommends that employers should make voluntary additional Medisave contributions for their employees over and above the existing statutory contribution rate. And this is in lieu of part of whatever they have been giving out as medical benefits in kind.”
“About 11,000 foreign nationals come to Singapore specifically to seek medical care and are admitted into hospitals. This is equivalent to approximately 3% of all public and private sector hospital admissions. This figure has not fluctuated much over the past three years. We do not have the data on foreigners who come to seek outpatient care. Foreign nationals spent an average of $4,000 for each hospitalisation, inclusive of both the hospital and doctors' charges. Foreigners who use public sector hospitals are charged at more than the full cost of treatment. Foreign nationals who come to Singapore for medical treatment therefore constitute only a small proportion of total patient load in Singapore. As such, they do not impact significantly on our health care system. All external factors, including projections on foreigners seeking medical treatment in Singapore, are taken into account in the national planning of health services and health manpower. VENTURE CAPITAL SCHEME 4. Mr Low Thia Khiang asked the Minister for Trade and Industry how many local companies have benefitted from the Venture Capital Scheme since the scheme was implemented; and whether there are plans to expand the scheme.”
“I am sorry I do not have the figure for the range. But it depends on the peak hour. I think everybody would observe that, during the peak hours, there is a much heavier patient-load and therefore a longer waiting time. So this median is the average. We have tried to improve the waiting time by giving appointments, especially to chronic cases, so that they can come back during the off-peak hours. CHILDREN OF SCHOOL-GOING AGE (Number who did not attend school) 12. Mr Low Thia Khiang asked the Minister for Education how many children of school-going age did not attend school from 1990 to 1993.”
“The waiting time in Ang Mo Kio Polyclinic is just about the national average. The national average from the time of getting registered to seeing a doctor, that is, consultation, is about half an hour. This is the median, and Ang Mo Kio is just about the same.”
“Mr Speaker, Sir, Ang Mo Kio Polyclinic currently provides a wide range of services which include outpatient medical treatment, maternal and child health services, health education, laboratory and home nursing services. It has a patient-load of about 1,000 attendances a day, which has remained stable in the past 10 years or so. The staff of 13 doctors and 28 nurses are able to comfortably cope with the patient-load. Apart from the polyclinic, there are about 60 GP clinics in Ang Mo Kio. Primary health care is well provided for in the area. In addition, a Senior Citizens' Health Care Centre has opened in August this year in Ang Mo Kio Community Hospital which is only 1 1/2 kilometres away from the polyclinic. Therefore, there is no need to further expand the Government's provision of medical services in Ang Mo Kio.”
“Mr Speaker, Sir, Mr Chia's question is on the general pricing policy. It is not about specific ways in which drugs are priced. I do remember that the last time he spoke on the White Paper, he raised this question about some drugs being more expensive. But I wish he had also checked his facts. Dr Moses Yu also informed me that for all the expensive drugs - and I have checked the prices - the charges at Government and restructured hospitals and SOCs are cheaper than private pharmacies. If you are referring to certain drugs which constitute a very small proportion of our Standard Drugs List which are priced slightly higher than the cost - our practice is to charge $1 per item per week, up to a maximum of $4 per week - out of the nearly 500 items of standard drugs, less than 10% cost less. But you have to add the administrative cost for dispensing and procuring the drugs. So for administrative convenience, less than 10% of the standard drugs dispensed at outpatient clinics can be slightly higher than the cost. But these average out with those drugs charged below cost. CERTIFICATES OF ENTITLEMENT (Increase in tender prices) 7. Mr Chiam See Tong asked the Minister for Communications whether he intends to take any action in regard to the unabated increase in the tender prices of Certificates of Entitlement.”
“The employees feel that the capping of 2% on the total payroll for tax deductible medical expenses for them will result in their employers reducing the provision of medical benefits. On the other hand, the employers feel that the unions may exert pressure on them to increase medical benefits for employees because total medical bill is currently still lower than 2% of the total payroll. Both sides are having mutual doubts and suspicion, and it is certainly not doing any good to our employer-employee relationship. The White Paper's recommendation to incorporate the medical benefits provided by employers into the national Medisave and MediShield systems is indeed a constructive suggestion. On the use of Medisave and the question of balance billing for Medisave patients, some of our colleagues in Parliament had already touched on and, in fact, the Minister for Health had already given his answer yesterday. I do not wish to repeat it. Finally, I would like to raise an observation as a conclusion. The objectives and guiding principles in the White Paper form the basis for MPs and people to discuss. I hope the Ministers concerned would accommodate the different views and perspectives of the various quarters, and consider implementing some of these suggestions which are feasible. This is not a debate in which we want to find a winner. Even if our own reasoning and perspective are correct, we should also try to explain to our people to convince them in order to ensure that our medical and health care system is excellent beyond doubt. 1.38 pm”
“After the publication of Dr Aline Wong's Report, I mentioned in this House, for the benefit of the Ministry of Health, that traditional medicine had reached out to the people and were generally cheaper than western medicine. On the other hand, among the physicians who are practising traditional medicine, the good and bad ones are intermingled. Moreover, the herbs used are not systematically authenticated. I suggest that the Ministry of Health should not neglect the value of traditional medicine, but it should look squarely at the roles that traditional medicine can play in our health care system. The last issue in our dialogue session was on the financing of health care. Generally speaking, most or almost all the participants at the dialogue session accepted the principle that the patients should bear part of the medical expenses. Even the poor people who request for waiver of medical fees or for instalment payments would not talk about their problems openly for fear of "losing face", they too have self-respect. So we must not assume that everyone in the lower-income group would keep on asking for free medical service. Our people are worried that with the ever increasing medical cost, there will come a day in future that they will not be able to afford medical and health care. I agree with the Minister for Trade and Industry that this is not just a question of who is paying the medical expenses, but also a question of how to pay the expenses. Each of the individual methods of financing has its own problems. For example, on the provision of medical benefits by employers, the employees consider it as a benefit over and above their wages, but the employers take it as part of their labour cost.”
“For example, will the Government consider making euthanasia legal, or whether Government accepts "living will" by the individual, permitting the doctors to choose not to extend his life with artificial means in the event of his falling into a coma, or to authorise his next-of-kin to make a decision? Yesterday, the Minister for Health announced that the Government will not accept this practice of euthanasia. However, I think we should look into this matter more carefully. The third issue is the supply of doctors. Several doctors who participated in the dialogue session agree to limit the number of doctors. They felt that the private clinics in HDB estates were competing very fiercely with one another and the clinics have to meet the ever increasing rental and manpower costs. One participant suggested that the HDB should limit the number of neighbourhood clinics in each estate. This is a very natural response by the doctors. But two community leaders who participated in the dialogue session also agreed to limit the number of doctors. They are worried that over-competition would result in a drop in the number of patients per clinic and, thus, prompting the doctors to increase their consultation fees, in order to recover their overhead expenses. When touching on the supply side, the focus of the discussion was diverted to the issue of traditional medicine. Some people felt that the Government should regulate the practice of traditional medicine. But some others felt that the Government had never recognised the legality of traditional medicine and hence it has no moral authority to regulate it.”
“They would stay in first and think of the consequences later. So under such circumstances, is the Government's plan to reduce Class C beds from the present 26% to 18% by the year 2010 and to reduce the combined Class C, B2 and B2+ beds from 53% to 50% and at the same time to increase private hospital beds from 21% to 30%, a move in the right direction? Will this further encourage the trend of staying in higher class wards? The second issue that was raised at the dialogue session was the question of euthanasia, which is an act to terminate the pain and sufferings of terminally-ill patients by allowing them to pass away painlessly. The objective is to terminate the patient's pain and sufferings, and at the same time to alleviate the burden and hardship of the family members, and of course, the medical expenses. The basic medical package does not include the extension of life by artificial means. According to a report in the Lianhe Zaobao on 9th November, in the United States, approximately 1/3 of a person's total lifelong medical expenses are spent on the last year of his life. On the other hand, some people hold the view that life is a gift from God. It is therefore not for the doctor or, for that matter, any layman to decide when to terminate the life of the patient. Children who are filial would normally urge the doctors to try and extend the life of their terminally-ill parents. This is a sensitive issue. It involves not only medical judgment but also religious, legal and social issues as well. A number of participants in our dialogue session advocated that the matter be discussed publicly. With our aging population, I think we should formulate the proper policy on this matter as soon as possible.”
“However, the degree of freedom to choose must be directly proportional to his willingness to pay for the medical fee. On 3rd November 1993, the Feedback Unit held a dialogue session with some 45 doctors, unionists, community leaders and employers to discuss the White Paper. I have already submitted the minutes of the dialogue session to the Ministers in charge. Here, I would like to sum up some of the main points at the dialogue sessions, and add on my personal views for the Ministers' consideration and response. First issue - demand and expectations. The Cost Review Committee's Report mentioned that in 1980, 80% of the patients were hospitalised in Class C wards. By 1992, the number of C class patients dropped to only 21%. This may be due to rising expectation of our people, but can it also be a reflection of the fact that our Class C beds are being reduced drastically? The Government has been emphasising that the standard of medical treatment in Class C wards is no different from that in the Class B or Class A wards. In a market economy, people's perception of "you get what you pay for" is deep-rooted. Therefore, it is not easy to convince the people that patients in different class wards would receive the same standard of medical treatment. Coupled with the problem of face-saving and the availability of Medisave, it is extremely difficult to ask the people not to opt for higher class wards beyond their means. At the same time, this would also involve some "emotional" and "rational" issues. When a patient is hospitalised, he or members of his family, in order to relieve the patient of his suffering, more often than not, would make some very emotional rather than rational choices. High cost or not, they would not care.”
“I also accept the Government's objectives and principles on health care, as mentioned in the White Paper, particularly two of the principles which I think are the most important. First, the role of the Government. The Government assures all Singaporeans, including the poor, that they will receive medical and health care, and that the Government shall intervene, if necessary, to compensate for any market failure. In so far as medical service is concerned, the Government is not only the regulator but also the provider and, for that matter, the biggest provider. The second important principle is the personal responsibility in health care. Every individual must be responsible for his or her own physical and mental health. Maintaining good health will reduce one's demand for medical services. As it is said, prevention is better than cure. The hon. Member, Mr Cheo Chai Chen, said, "Nobody wants to be sick." The hon. Member, Mr Low Thia Khiang, also said, "The individual should not be held responsible for his sickness." I strongly believe that the Government does not wish any of its citizens to be sick because this will affect our manpower, reduce production and productivity; the Government will also have to pay more medical subsidy. However, growing old, getting sick and dying is a process which is inevitable in life. When a person has unfortunately fallen ill, he or members of his family will have to pay at least part of the medical cost. On the other hand, the individual has, to a large extent, the right of choice. He could choose the hospital, the type of ward that he wants to be admitted to, and the method to pay for his medical fees and even the choice of doctors.”
“Hence, we are developing a whole range of services, including community hospitals, day hospitals, rehabilitative services and community-based care, such as nursing homes, home nursing and home support services as well as hospice care. These are cost-effective methods of providing care for the elderly which will reduce the financial burden of medical care for them. Recently, we have announced the formation of regional networks of services for the elderly. Based on the present catchment zones of the acute hospitals, there will be three regions. In the western region will be the Geriatric Department at Alexandra Hospital; in the central region, the Geriatric Department at Tan Tock Seng Hospital; and in the east, the Geriatric Department at Changi Hospital and the future general hospital in Simei. Each of these Geriatric Departments will act to coordinate its own regional network of services, such as community-based services, community hospitals and so on, in order to provide for the appropriate level of care for the elderly. So we are working closely with the private sector. We are working closely with both the specialists and the GPs, and with the voluntary organisations, in order to provide Singaporeans with a very good and well integrated network of services. The Ministry of Health will work very closely with all the care providers. Thus, I do not see how the Government can be accused of over-emphasising self-responsibility of the individual and not doing its bit. Provision for the health care needs of the population is shared between the public sector, private sector and the voluntary organisations. Dr Ow Chin Hock (Leng Kee)( In Mandarin): Sir, I support the motion standing in the name of the Minister for Trade and Industry.”
“But we must also realise that our resources are limited. We must concentrate resources in areas where we are likely to do well, where there is a bulk of patient load and where there is a concentration of expertise. So we, each and everyone, must not go for excellence in all kinds of areas. This is the strategy that we adopt in developing excellence in certain medical services. We have the national centres such as the Eye Centre, the Skin Centre, and we are going to have a Heart Centre and a Cancer Centre. Tan Tock Seng Hospital is going to develop a neuroscience institute. All these will allow people to develop medical excellence in these areas. It does not necessarily mean that we would adopt the most recent high-tech and most expensive equipment. I think excellence should also be interpreted in terms of excellence in rendering basic medical care which will cure you and which will allow for a better quality of life. I do not see back tracking. In fact, we should interpret excellence in terms of our limited resources and how we strategise to achieve the most cost-effective and the best results for us. Finally, I would like to touch on the very important issue of the care of the elderly. Some Members of the House, including Mr Chin Harn Tong and Mrs Yu-Foo, have mentioned this yesterday. As the proportion of the elderly increases rapidly in the coming two decades, we are making preparations to provide a whole range of health care services for them. But let me emphasise that the care of the elderly is not and should not be confined to the provision of geriatric beds in hospitals. These should be used mainly for acute illness. Hospitalisation is for acute illness. Very often, the elderly patients do not require hospitalisation for their chronic illnesses.”
“For example, they can utilise more of the services provided, such as diabetic eye screening that we have introduced in our polyclinics, the laboratory services, the X-ray services, which the GPs may not have on their premises. They can also work more closely with the specialists in Government hospitals when the patients need to be referred for specialist care. In fact, some of the hospitals are already taking the initiative to reach out to the GPs in their catchment zones, such as offering continuous medical education courses and holding monthly focal discussions on how the specialists in the public sector can work more closely with the private sector GPs in order to better take care of their patients. So we are working with providers of health care in the various sectors. Many countries with huge national expenditures are coming to realise the importance of primary health care doctors acting as gatekeepers to the expensive specialist care. The most effective way that the GPs can serve as gatekeepers is through the practice of family medicine. I think one of our goals in the immediate future is to encourage the population to stick to the family doctor. Do not hop among doctors. Allow doctors to know your medical history and that of your family members, so that they can follow your progress closely and become the gatekeepers for your health. When you need specialist care they can refer you to a specialist with the particular expertise. Are we giving up on excellence when we say that we cap the rate of increase in the number of specialists? Are we back tracking on excellence? I do not think so. Excellence is already a social ethos among Singaporeans. We should continue to nurture the idea of excellence. We reach for excellence in many fields.”
“Secondly, Singaporeans are generally better off. They can afford the more personalised services of the GPs. And the GPs' charges are affordable. So the Government's role is to complement the role of the private sector, concentrate resources on the lower income groups and indeed among our patients, we have been seeing more lower income patients. Also, we have been seeing more patients with chronic illnesses. With the Government's subsidy, patients with chronic illnesses pay much less as compared to when they see a GP. So patients, especially elderly patients, with chronic illnesses are benefiting from the subsidised services of the Government polyclinics. The GPs, being the main provider of primary health care, have a very important role to play. And I hope to see them playing a greater role in future in patient education, in teaching the patients how to adopt healthy lifestyles, to prevent the onset of disease and also to teach them how to take care of themselves in managing their illnesses. For certain chronic diseases such as hypertension and diabetes which Dr Kanwaljit Soin mentioned, as well as Mr Lau Ping Sum yesterday, they are two very good examples of illnesses where management by GPs and self-care by patients can help to control the illness as well as prevent further complications. In my view, the GPs in the private sector have a very important role to play. They must, as Dr Wan Soon Bee said, not just cure disease, but they must also be teachers. They must have a caring heart and the compassion for the patients' suffering to educate them on how to manage their illness and take care of themselves. I would also like to see GPs work more closely with the polyclinics.”
“When we talk about the proportion of the health budget spent on primary care and how this proportion has not increased over the years, we must look at the quality of the service that we have already got. We must look at the outcome of all the efforts that we have made, in terms of the health and improvements in Singaporeans' quality of life. Do you mean to say that you must spend an increasing percentage of the budget before you say there have been improvements in the status of people's health? I do not think so. Do you mean to say that absolute amounts do not matter? I do not think so. You build a clinic. It costs so many millions of dollars. The absolute amount matters. It is not just a matter of percentage. And we have done very well by all accounts. We should also note that the bulk of primary health care is delivered by the general practitioners in the private sector. We must not always just say that the Government must do this and must do that. We must work together. The private sector and the public sector must complement each other. In this case, in primary health care, we have always had the private GPs who have delivered very good primary care to the greatest majority, three-quarters of the population. The Government's role is to concentrate its resources on the lower income groups who need the subsidies most. Polyclinics offer services with about 50% subsidy. Over the years, and I think Dr Kanwaljit Soin once quoted the number, not on this occasion but previously, the attendances in polyclinics have declined from 3.9 million in 1980 to 2.7 million in 1991, and 2.9 million in 1992. This is mainly due to two reasons. Firstly, there are now more GPs and their clinics are conveniently located near to the patients' homes.”
“We have been educating the teachers who have been educating the food vendors about providing a more balanced and more healthy diet. Some schools and workplace canteens have adopted green labelling of foods - green labelling not in terms of environmental friendliness, but in terms of healthy nutrition, healthy diet, which will promote our health. I think education is a very important part of our health promotion effort and we must continue to pump the message. We must continue to encourage Singaporeans and provide a conducive environment for them to sustain this healthy lifestyle. Singaporeans must take responsibility for maintaining their good health. You have to make some effort to learn about these things because it is good for you. If you keep fit and healthy, you do not need to see doctors. You do not need to be hospitalised. You do not need to draw from your Medisave. Yesterday, some Members mentioned that we should offer incentives for people to keep fit and stay healthy. While we are all out for innovative ideas, lucky draws, incentives, rewards and prizes for doing exercise regularly would not be the things to do. In Medisave there is already an in-built incentive for people to stay healthy. If you do not need hospitalisation, Medisave is your money, you keep it. And then the rewards also come from your enjoying a much better quality of life, apart from the nation having a more productive workforce. The White Paper reiterates the Government's commitment to providing good and affordable basic medical services to all Singaporeans. I think good primary health care services are part and parcel of good basic medical services. By all accounts, we have a good primary health care system, and services are at affordable prices.”
“We cannot deny that all these efforts have been sustained over the last two and a half decades and have resulted in improvements in the health status of our nation. And we must keep up with these efforts. There are no two-ways about it. In fact, the principle of emphasising preventive health care and health promotion was given the most prominence, the greatest priority in the Report of the Review Committee on National Health Policies which Dr Kanwaljit Soin also quoted. We have seen the offshoots of our emphasis. In future years, we are going to sustain the Healthy Lifestyle programme which includes various major thrusts to educate Singaporeans and encourage them to lead a healthy lifestyle, including having a healthy diet, regular exercise, control obesity, avoid smoking, etc. A healthy diet, nutrition. We have in this programme put a great deal of emphasis on educating the Singapore public to eat a healthy diet - less fat, low cholesterol, low calories - and this will help to reduce the risk factors associated with lifestyle diseases. Dr Kanwaljit Soin mentioned the low income families and perhaps generally families where the wives are working, that they have no time, they have no choice, they have to eat at hawker stalls. I question her hypothesis that people have no choice. I think if they are educated enough, they will know how to choose. There is a great variety of food in the hawker centres. In fact, the health promotion effort of the MOH does not say, "Thou shalt not eat in hawker centres." We just say that you should plan your diet in a more balanced manner. You can have a good meal combining vegetables with, say, fish, tahu and other food which is good in nutritional value. You can do that. In the school canteens, we have been promoting healthy food.”
“Thank you, Mr Speaker, Sir, for allowing me to join in this debate. As I was listening to various Members of the House over the last two days, I heard several of them, including Mr Lau Ping Sum, Dr Wan Soon Bee and Mr Sinnakaruppan, and this afternoon, Dr Kanwaljit Soin as well as Mr Umar Abdul Hamid, mention the importance of preventive health care and health promotion in our overall strategy to combat rises in health care costs. Let me stress that I cannot agree with them more. In fact, one of the fundamental objectives of the Government's health care philosophy, which is stated very clearly in the White Paper, is that we aim to nurture a healthy nation by promoting good health. The most cost effective way to achieve good health and contain the rise in health care cost is through health promotion and disease prevention. I think we should look at health promotion and disease prevention not simply from the point of view of the services provided by the Ministry of Health itself. We should include the environmental public health services provided by the Ministry of the Environment. The clean air we enjoy, the clean water that we drink, the excellent sewerage system, even the garbage collection system, all the things that pertain to environmental public health have added to and contributed towards the improvement in our nation's health. Apart from the Ministries of Health and the Environment, we also have to consider the work done by the Ministry of Labour in occupational health services. When we talk about the emphasis on preventive health care and health promotion, particularly in terms of the proportion of the budget spent by MOH itself, I think we have to take this broader perspective of other Ministries being involved in the work concerned.”
“In this medical centre, there will be 14 clinical suites which may house GP clinics, specialist clinics and dental clinics, five retail suites which will be for health related retail services, one pharmacy, one X-ray suite and one clinical laboratory. EDUCATION FOR CHILDREN OF SINGAPOREANS WORKING OR DOING BUSINESS OVERSEAS The following Question stood in the name of Mrs Yu-Foo Yee Shoon - 7. To ask the Minister for Education, in view of the Government's policy of encouraging more Singaporeans to work or do business overseas, what are his plans for the education of the children of these Singaporeans and whether the plans will include having more boarding schools for these children who stay behind in Singapore.”
“Sir, at present, there are NUS staff in Alexandra Hospital, including in the Department of Paediatrics. In fact, NUS has taken complete responsibility for this department where they do teaching as well as servicing of patients. At the moment, because NUS is not having the full complement of medical staff so some of the Ministry of Health's staff at Alexandra Hospital are helping out in the NUS departments. GOODS AND SERVICES TAX (On goods purchased at Johore Bahru) 3. Mr Chiam See Tong asked the Minister for Finance whether, from 1st April, 1994, Singaporeans who purchase goods at Johore Bahru will have to pay Goods and Services Tax or other form of tax on those goods when they bring them into Singapore. Mr Chiam See Tong (Potong Pasir): Mr Speaker, Sir, before I ask Question No. 3, I would like to declare my pecuniary interest in respect of Question No. 4 (Cols. 123 - 124) for Written Answer. Question No. 3, Sir.”
“There are no plans to restructure Alexandra Hospital. This is in accordance with the Review Committee's recommendation that there should be a full range of Government and restructured hospitals and hospitals with participation from the community as well as the privately-run hospitals. The fees at Alexandra Hospital, as in other Government and restructured hospitals, will remain affordable to Singaporeans. But fees will be increased gradually and incrementally in keeping with the rise in health costs.”
“I am afraid this is a rather legal matter on whether immunity can be granted. Among the members in the medical profession they have the responsibility to provide peer review of each other's performance and they do tend to raise their standard through this peer review process. NEW POSTCODE (Introduction) 2. Mr Heng Chiang Meng asked the Minister for Communications whether and when a new 6- or 8-digit postcode will be introduced and why.”
“The Ministry is working with the NUH to provide C class beds so that NUH consultants can in fact give treatment to subsidised C class patients at Alexandra Hospital.”
“There are B2 subsidised beds in NUH. These provide subsidised care for patients who require treatment at a tertiary level hospital like NUH. Dr Tan Cheng Bock: Can I ask the Ministry to ask NUH to reconsider having more C class beds since they are given a grant? An hon. Member: They do not have C class beds.”
“The answer, Sir, is NUH does not have C class beds.”
“Mr Chia Shi Teck spoke about giving incentives to workers and companies to maintain the workforce healthy, particularly through healthy lifestyle programmes. There is no question that companies which provide healthy lifestyle programmes reap the benefits of a lower absenteeism rate, higher productivity and higher morale. The benefits are mutual. The workers feel better, are fitter and can work better. The employers also reap the benefits. As to whether this specific incentive provided within the medical benefits scheme of the companies could be given to their own workers, I think this is best left to the company to decide and discuss with the unions themselves. Finally, Dr Michael Lim talked about the Institute of Health (IOH) which we are building and how it would raise the quality of services for the care of children. The Institute of Health not only relocates the present School Health Service and the Child Psychiatric Clinic, but also the Maternal and Child Health Clinic and the Dental Health Service, all under one roof. So it would be much more convenient for the public, especially for families with young children, to visit. It is located right next to an MRT station. We also have new programmes catering to the health care needs of not only the young people, but also of family members. Of particular note is that there would be a model family medicine clinic inside the IOH where doctors would be trained in family medicine and where the public would be able to receive extensive health education. So with this upgrading of services as well as more training of the staff and the streamlining of the work procedures, the services will be offered in a one-stop health centre manner. With that, I think the services to the children will be greatly improved.”
“One of the big improvements that we made last year was the transport services to transport the elderly to and fro the Senior Citizens' Health Care Centres. Partly because of the improvement in transport service and partly because we now pay the home visiting nurses taxi fare, instead of asking them to take buses, we have been able to increase the number of home visits very drastically. Over the last two years, the number increased from 29,000 to 40,000. As for HDB provision, I think part of the Upgrading Programme would include the possibility of increasing the number of lifts so that it is easier for elderly people to come down either for recreation or to visit other places. The HDB has, over the recent years, been providing ramps so that people who are wheelchair bound can be brought to the lift landings. So HDB is trying to do its part to make it easier for the elderly to lead normal lives in the HDB flats. As for the question on what kind of respite care we are giving to the care givers, it is true that care givers of the elderly can get fatigue, either emotional or physical or both, because it is not easy to take care of the elderly sick at home. So community hospitals will have a number of beds reserved for respite care of the care givers. I understand that even now some nursing homes have some beds for respite care where the family can put their elderly relatives there for a couple of weeks while they take a break, so to speak. So these are the things that we have been doing. We will try to do more for the elderly. In fact, we have formed a Department of Continuing Care in the Ministry of Health since April last year in order to coordinate the whole range of services for the elderly.”
“Mr Loh Meng See would like some information on what we are doing to provide for the health care needs of the elderly. Sir, the problem of the elderly is not yet upon us, but we must be making preparations for the eventual day. Whether it will arrive towards the year 2020 or year 2030 is a matter of different population projections. On geriatric care services, since 1987, we have already opened a geriatric unit in Tan Tock Seng Hospital and very soon we will have two other units: one in Changi Hospital and the other at Alexandra Hospital. When the Eastern General Hospital opens in 1996, we will also have another geriatric department. We have over the years been training specialist geriatricians to take care of the health care needs of the elderly who need acute hospital care. At the moment, we have about five. But each year we are training new ones. By the year 1995, in two years' time, we will be increasing to 13 specialist geriatricians altogether. We are also training nurses and social workers in gerontology. I would like to stress that health care services for the elderly need not and should not be concentrated only in acute hospitals. In fact, we need a full range of health care programmes, many of which are community-based. So we are building community hospitals and day- care centres that will provide for the continuous treatment and rehabilitation of the elderly. We are helping the voluntary welfare organisations (VWOs) to build more nursing homes. Mr Loh asked about the home care and home support services. One of the prominent VWOs which has been working very closely with the Ministry of Health is the Home Nursing Foundation.”
“So they obtain quite a bit of help for the management of diabetes in our polyclinics. When our family medicine course is producing enough family doctors, the whole procedure and the way we treat patients in polyclinics will very much resemble a true family clinic. The first one we are going to try out is in Woodlands which has already been completed and will be opened this year. The next one which will serve as a model would be at the Institute of Health. The ground-breaking has just been carried out, and we can look forward to a very good Institute of Health plus a new set of programmes in the year 1996.”
“But I should like to thank Dr Michael Lim for his suggestion that for the continuity of care and to put family medicine into real practice in our polyclinics, we should be looking into how we can ask the polyclinic doctors to give a full medical examination, a detailed one, at least at the very beginning when a patient seeks treatment, or is referred to the polyclinic upon discharge from the hospital. We are looking into that. In fact, we have plans to train our polyclinic doctors into real family doctors. The ideal situation may not be possible. But we will try to do as much as we can. We will try to follow up the patients by the same doctor, say, on certain days of the week earmarked for this type of repeat consultations for chronic cases. Dr Michael Lim also asked what we are doing for some chronic cases, like diabetes. I am glad to inform him that, in fact, we have improved our services for diabetic management. Every year, about 30 of our polyclinic doctors are sent for training courses to upgrade their skills in the management of diabetes. This started in 1991, so we have had two years of this programme already. And our community health service continues to run courses three times a year for our nurses also. As Dr Michael Lim knows, one of the health hazards of diabetes is the damage to the eye. So we have been using up-to-date retinal cameras in our polyclinics. We do not have enough of them, not one in each polyclinic as yet, but they are being rotated among six polyclinics. And this service is open to the GPs as well. In fact, about 20% of the case load are referrals from the general practitioners. To help diabetic patients, we sell glaucometers as well as test strips and lancets at cost to the patients.”
“Many of our doctors and nurses receive continuous medical education and they are also attached to the hospitals for postings which are relevant to their particular areas. We also have plans to build more of these modern polyclinics in our HDB population centres. So far, we have already built four. Over the next few years, we will be building five more. As you can see from the Budget document, the development expenditure shows a whole list of new polyclinics coming into being. As the population expands into newer areas, we will also look into the need for more. There is no doubt that the polyclinics, given the large patient load, cannot provide the kind of ideal personalised service that we all hope to have. For example, at the moment, our doctors are seeing, on the average, about 70 patients per day. This already represents an improvement over the 100-plus patients back in the 1980s. So we have been able to reduce the number of patients seen by each doctor at the polyclinic. As I said, there is no question that we cannot provide the type of highly personalised service in polyclinics. But we should note that the health services provided by polyclinics are not given just by the doctors. Patients are also seen, treated and being followed up by trained nurses. A lot of our assessment programmes, minor changing of dressing, continuous care of some chronic cases, etc. are done by trained nurses. So you should not just look at the number of patients seen by doctors alone.”
“The new Woodbridge Hospital will be opened some time next month. It is already there, it is a very impressive, very nicely designed building. And there would be new programmes there too, including an Alcohol Treatment Centre as well as an Institute of Mental Health, which will focus on education, training and research. At the other end, the community-based mental health services will include more day care centres. We will expand from the present three to five by the year 1997, and we will also open more outpatient psychiatric clinics from the present six to ten. So you can see that we have been giving due attention to the mental health programme. And, as I said, I would discuss more details about the health care services for the elderly later. Primary health, in particular, our polyclinics have been mentioned by Dr Michael Lim as well as Dr Vasoo. Both of them are concerned that we may be spending money in building these new generation polyclinics, but has this helped to improve the quality of patient care. Back in 1984, the Ministry decided to consolidate the 40-odd old-style outpatient clinics into 15 or 16 modern polyclinics which are one-stop health centres. So these modern polyclinics offer not just the traditional type of curative service, immunisation and maternal and child health services, but we have expanded into health screening for adults and developmental screening for children, and so on. We have also expanded into health care services for the elderly. In fact, five of the Senior Citizens' Health Care Centres are located in these modern polyclinics. So we have expanded the range of services. We have upgraded our staff.”
“But I agree completely with him that we should pay attention to primary health care, mental health care and also health care services for the elderly. And, indeed, the Review Committee has singled out these three programmes as among its six areas of priority. Since a number of Members of this House will be speaking on the health services for the elderly later on, I would not talk about the details of these programmes. But let me just give Members some idea of what we have been doing for the mental health programme, particularly during the last few years. In a recent speech I made at the opening of the Public Education on Mental Health in February, I announced the eight-pronged approach to the mental health programme adopted by the Ministry so that, over the next three years or so, Singapore will see a comprehensive range of mental health services in place. We have to wait until now to set this whole range of programmes in place because, first of all, we must have the trained personnel to do it. Since seven or eight years back, we have been training more psychiatrists, psychiatric nurses, psychiatric social workers, an00d so on, before we can man and expand the programmes. So over the next three years, we can expect to see a much more expanded mental health programme. Over the last two years, we have, in fact, opened three new psychiatric clinics which are very conveniently located in polyclinics. We have also introduced a community psychiatric nursing service. The number of nurses now is seven but we hope to increase that number to about 20 by 1995. We have also introduced family support group programmes, therapy programmes and also pre-discharge education programmes for patients and relatives. Over the next few years, you would also see very much upgraded facilities.”
“Sir, Dr Tan Cheng Bock, Dr Michael Lim and Dr Vasoo spoke about primary health care and the importance of primary health care programmes, including health promotion, disease prevention as well as mental health and health services for the elderly. First of all, I would like to clarify on the level of expenditure we have been giving to our primary health care, mental health care and health care services for the elderly. While it is true that the primary health care budget has remained at about 11% to 13% of the Ministry's recurrent expenditure over the last few years, the absolute amount we have spent on primary health care has increased quite a lot. In 1992, we spent $70 million on primary health care which represents an increase of 67% over what we spent, say, in the middle of the 1980s. This increase is more than the increase of 42% for the entire Ministry of Health's budget. For mental health care, in 1992, the amount we spent was $35 million which represents an increase of about 45% as compared to 1985, again higher than the increase for the total Health budget. By comparison, the Ministry of Health's expenditure on acute hospital services, including the subvention to restructured hospitals, amounted to $398 million last year and this is an increase of only 27% over 1985. So if we speak about the actual amount of money that we spent on primary health care, mental health care and also health care services for the elderly, which now includes a subvention to the voluntary welfare organisations, because we have taken over the supervision and assistance to voluntary welfare organisations running community hospitals and nursing homes, the increase is not insignificant.”
“In my answer just now, I have stated that Government's subsidy should be reserved to those people who need financial help most. With our present system of subsidised medicine as well as our system of remission, we find that the present policy is adequate to meet the needs of the senior citizens. But we would not be averse to considering the Member's suggestion and we will look into the policy. Mr Chiam See Tong: Sir, I am not satisfied with the Minister's answer. Since the subsidy is a very big issue, and the Government has been playing up on this issue, I am surprised that the Minister does not know how the subsidy is arrived at. I am asking for the number of years for amortisation.”
“Mr Speaker, Sir, I do not have the data on the specific years for amortisation on hospitals or polyclinics. If the Member would like to have the information, could he please submit a question for the next sitting.”