Balaji Sadasivan
Singapore
“The issue is, of course, not good publicity for ASEAN. In fact, it is bad publicity for ASEAN. However, the fact that the ASEAN leaders have met and agreed to deal with the issue and ensure that we try and solve the problem at source, and the fact that ASEAN has tasked the Secretary-General to look into the issue and report to the various…”
“Thus far, the authorities here have not encountered any Rohingya refugees seeking to enter Singapore waters. Given our limited land and natural resources, Singapore is not in a position to accept persons seeking political asylum or refugee status. This has been our policy for decades.”
“I would like to conclude by noting that by resolving this dispute through third party adjudication, both countries have demonstrated our respect for international law and our commitment to settle disputes in an amicable manner.”
“Yes, we shall continue with those efforts. In fact, with the Youth Olympics and the F1, it is a great opportunity for all Singaporeans to think about their behaviour and whether they can improve it – whether they can be more polite and more gracious.”
“Sir, currently, the guideline for the Vasantham Channel is that a minimum of 75% of the programming must be in Tamil and 25% can be in other non-Tamil Indian languages. The number of hours is increasing, from 29 hours per week to 65 hours per week. But the guideline will still remain the same.”
“Sir, our branding is what we are and part of our branding is the law and order that we have and the safety that we have in our city and the fact that everybody has to comply with the law. This is part of our reputation and part of our branding, and it is not a bad part of our brand value.”
The complete record
Every one of 434 lines we hold for Balaji Sadasivan, in date order, each linked to its source. Free to read, in full, without an account. Page 7 of 9.
“Sir, with regard to Dr Neo's question on the rescinding of medical benefits scheme (MBS), it was in line with the best international practices and the latest development in blood banking that HSA rescinded the medical benefits scheme for regular blood donors and nominees prospectively for all new blood donors with effect from 1st July 2002. To be fair to donors from the past, this change does not apply to or affect regular blood donors who are already in the MBS by virtue of their previous blood donation. Blood donors are proactively informed of the change in the MBS. HSA has also continued to emphasise to all blood donors and to our public the importance of donating blood voluntarily and in the spirit of altruism without expectation of reward. If we follow Dr Neo's advice and give them something for donating blood, then it will not be altruistic any more. In line with this, HSA and our national blood donor recruiters, the Singapore Red Cross Society, have been taking steps to enhance the blood donor recognition programme in ways that do not involve significant material incentives. This has included upgrading of blood donation facilities to provide donors with a comfortable and pleasant environment and enhancing donor services to make the blood donor experience more positive and enjoyable. The Champion Blood Donor Award programme has also been improved to include special ruby and diamond awards at the 75th and 125th blood donation respectively. Special youth programmes have been introduced to encourage our youths to donate blood regularly as part of the healthy lifestyle and community spirit. Blood donors have, on the whole, responded positively to the message.”
“Sir, with regard to the first question on non-traditional source doctors, during the time they were being assessed when they first came to work, they were under close supervision of the senior doctors. So there was no compromise on patient care. With regard to her second question, she can send in a request and my Ministry will study it.”
“Currently, SNEC is conducting research on myopia and they have a budget for it.”
“This is to allow the woman requesting for termination time to review the situation and decision in the light of information and counselling provided. My Ministry is also working with the Ministry of Community Development and Sports to enhance the counselling process to address the social issues faced by married women seeking abortion, and to encourage them to continue their pregnancies by providing appropriate help. We are also concerned about teenage pregnancies and we are working with the Ministry of Education on this. The Ministry of Education has implemented a sexuality education programme for upper primary and secondary students. The programme which was developed together with the Health Promotion Board aims to provide knowledge about human sexuality and the consequences of sexual activity. It is hoped that through this programme, students would develop healthy attitudes towards sexuality and be able to build responsible relationships.”
“There has also been introduction of vision screening in kindergartens and childcare centres to identify children with early myopia or amblyopia, lazy eye syndrome. For the latter, early treatment can prevent the development of functional blindness in the lazy eye. Pre-school children who are detected to have defective vision through screening are referred to specific refraction clinics in polyclinics for further assessment. In 2002, about half a million students from Primary 1 to Secondary 5 and 43,000 students in kindergarten 2 were screened. In 2003, a similar number of kindergarten 1 students will also be screened for myopia. Since our programme started, three new refraction clinics have been set up in polyclinics to provide refraction and counselling services for pre-school children referred from the screening programmes. Mr Chiam asked about lasik. At the present time, lasik is an accepted treatment for treating myopia in adults. However, it is still not a standard treatment. And the day all eye surgeons give up their glasses and go for lasik, we know it is time to make it a standard treatment! The experience in lasik treatment for children is even less than adults. So, that is why we are not advocating lasik as a standard treatment at this time. Dr Lily Neo was concerned about abortions and abortion numbers in Singapore, and we share her concern. The total number of abortions performed has decreased, from 16,476 in 1993 to 12,749 in 2002. Under the Termination of Pregnancy Act, all healthcare institutions authorised to perform termination of pregnancy, are required to provide pre-abortion counselling to women seeking termination of pregnancy. In addition, 48 hours must elapse after counselling before termination of pregnancy can be performed.”
“Hands-on training and continuing education by international experts are carried out on a continuing basis for all health professionals involved in the programme. Dr Neo noted that the recall rate for assessment of women with abnormal mammograms is about 8%. This recall rate is comparable to the national breast cancer screening programmes in other countries. At present, the average waiting time is three weeks for a mammogram and two weeks for an assessment. My Ministry is prepared to use private sector services in the national breast cancer screening programme, provided they meet our clinical quality standards, and we are looking into this. Mr Chiam noted that many young people in our schools wear glasses. My Ministry recognises that myopia is a major health problem which needs to be addressed. The Health Promotion Board launched a national myopia prevention programme in August 2001. The programme aims to prevent and reduce myopia progression as well as to delay the onset of myopia in children. As the onset and development of myopia occurs mainly during childhood, the programme targets mainly children in schools, kindergartens and childcare centres. The main component of the national myopia prevention programme is public education, particularly in schools, on good eye care habits. The main message is to take vision breaks after every 30-40 minutes of near work, such as reading or using the computer. HPB has also produced updated guidelines for teachers on promotion of vision care in schools, kindergartens and childcare centres. Enhancement of existing vision screening programmes in schools is also emphasised, placing greater emphasis on follow-up of students detected to have myopia and providing more intensive counselling and education for this group.”
“We estimate that a budget of $3.3 million will be adequate to provide training for 90 staff over the three years, comprising 10 medical traineeships in geriatrics, rehabilitation and palliative medicine; 12 nursing traineeships in advance gerontology; and 70 traineeships in other areas identified to be of high priority for step-down care service development. Let me assure Members that the number of traineeships only serves as an estimate to work out the budget. My Ministry is prepared to support more trainees within the budget allocated. We are also prepared to consider more funding support, if required. Our plan is to offer this as part of our overall operating subsidy to step-down care service providers. We have started inviting proposals from the VWOs for these awards for FY 2003. The deadline for submission is 31st March 2003, and the feedback has been positive so far. Dr Lily Neo also asked about standards of breast screening in Singapore. Breast Screen Singapore, the national breast cancer screening programme, was launched in January last year. A stringent quality assurance programme was implemented from the start of the programme to ensure that clinical quality and service standards are met for both mammograms and the assessment of women with abnormal mammograms. The programme has also instituted minimum service standards for waiting times for appointments for mammogram screenings and for assessments. Breast Screen Singapore is available at a total of 11 centres, ie, in 10 polyclinics and the Health Promotion Board building. To ensure that the quality assurance standards are met, the centres are audited and accredited every two years.”
“Compared to our local MOs, they are often more experienced, having worked for at least six years, and many also possess some form of post-graduate qualification. There have been some issues relating to adjustments to a different work environment but, on the whole, the clusters have found many of these doctors to be hardworking and committed. Dr Neo, on behalf of Mr Yeo, had asked about training for step-down care personnel and how much my Ministry has allocated for this training. My Ministry has set aside $3.3 million for the next three years to provide advanced training in elderly and continuing care. Under the programme, doctors, nurses and allied health professionals, such as physiotherapists, occupational therapists, medical social workers, case managers, and others working in step-down care services, can apply for funding support to pursue training or skills attachment at local or overseas healthcare institutions in areas such as geriatric medicine, geriatric rehabilitation, dementia and mental health and palliative care. Trainees must be Singapore citizens or permanent residents. MOH will fund 75% of the approved training expenditure, while the VWOs will fund the remaining expenses of the trainees. They will be required to sign a bond to work with the VWO upon completion of training. The duration of the bond will depend on the length and location of the training. In addition, to ensure that patient care is not disrupted, my Ministry will provide financial assistance of up to 75% of the salary of temporary staff employed to cover the work of the staff who is away on training. To encourage training attachments in local healthcare institutions such as a public hospital for between 1-3 months, MOH will fund 100% of the salary of temporary staff.”
“Non-traditional source (NTS) doctors refer to those who graduated from medical schools that have not traditionally been included in any of the previous versions of the Schedule of Registrable Basic Degrees. Such doctors may be granted temporary registration by the Singapore Medical Council to work under supervision as medical officers within the public sector. A total of 258 NTS doctors were granted temporary registration between 2001 and 2002 to fill the vacant MO positions in our public sector hospitals. These doctors graduated from medical schools in countries such as China, Indonesia, India, Myanmar and the Philippines. Another 19 doctors from medical schools that were in the pre-1993 Schedule were also granted temporary registration during this period. The performance of all temporary registered doctors is closely monitored by their supervisors who are required to submit assessment reports to the SMC in the third month of their appointment, and at six-monthly intervals thereafter, until the doctor leaves. Only doctors with satisfactory performance reports will be allowed to have their registration renewed for up to one year at a time. All doctors with poor or unsatisfactory reports will either have their contract terminated immediately, or after further monitoring, if they fail to show improvement in their performance. Only 6% of the NTS doctors registered between 2001 and 2002 had their contracts terminated. The majority were terminated by the employers for poor performance, including poor command of English. However, none of these NTS doctors have been involved in any complaint or disciplinary case investigated by the SMC. The feedback from our clusters on these NTS doctors has generally been favourable.”
“I will begin first with Dr Neo's question on errant doctors. The Singapore Medical Council places great emphasis on the integrity and honesty of our medical practitioners, as these values are fundamental to a good doctor-patient relationship. It is important for our patients and the public to have confidence and trust in the doctors who look after them. For this reason, the SMC has the authority to look into all cases where a doctor has been convicted in a court, to assess whether there had been professional misconduct. The provision for those who have been convicted for any offence involving fraud, dishonesty or moral turpitude, to have their professional registration suspended is not unique to the medical profession. It also exists in the regulatory legislation for other professionals such as accountants, architects, engineers and lawyers. So what happens with regard to doctors is not unique to the medical profession. The SMC judges each case on its own merits and the penalties may differ according to the specific circumstances in each case. It should be noted that in one of the tax evasion cases, the SMC granted the doctor one month's deferment of his order of suspension so that he could have time to transfer his patients to other specialists for care and management. The range of penalties available to the SMC is prescribed by the Medical Registration Act. The SMC has no authority to require these doctors to perform compulsory community services, as suggested by the Member. Dr Neo was also concerned about the quality of doctors from non-traditional source countries.”
“These include various public health initiatives and community services, such as nursing homes, rehabilitation homes and day rehabilitation centres. Two major initiatives have been implemented in Singapore. They aim to educate the public on prevention strategies, decrease stigmatisation, and increase awareness of mental conditions and availability of treatment. The first initiative is the Mind Your Mind Programme, which is a 10-year prevention programme started by the Health Promotion Board in 2001 as part of the National Mental Programme. The second initiative is the Early Psychosis Intervention Programme, which is a comprehensive and integrated treatment programme that targets the reduction of chronic disability amongst schizophrenic patients. Woodbridge Hospital has also formulated long-term and immediate action plans to achieve a more balanced model of community and institutional psychiatric care. These plans include enhancing the quality of in-patient care and ramping up the development of community psychiatric care services in the next three to five years. But at the end of the day, whether a patient should remain in an institution or whether the patient can be sent home is a clinical decision, which we will have to leave to the competent psychiatrists at our institutions to decide.”
“Under the guidelines for private healthcare institutions providing assisted reproduction services, Regulation 4 of the Private Hospitals and Medical Clinics Regulations, there are guidelines regulating the use of human embryos below 14 days created through in-vitro fertilisation techniques but which are not used in assisted reproduction treatments. This is permissible, provided stringent regulatory stipulations are met. With regard to donation of parts for research, no person is under any compulsion to give, nor is any person under an obligation to accept these donations. These provisions in the Medical (Therapy, Education and Research) Act ensure that patient donors are protected through having to make informed choices and are not under any financial inducement. But to further enhance our regulatory oversight over biomedical R&D areas where there are greater ethical concerns, the Ministry of Health is in the process of drafting a new Bill which will provide for the regulation of human stem cell research and human tissue research and banking, and provisions to extend the regulation to selected new types of biomedical R&D as these evolve. It will have the necessary regulatory and enforcement provisions to enable the Ministry to issue licences for biomedical R&D facilities, and monitor and control selected biomedical R&D activities. MOH intends to enact the new Act sometime this year. Dr Ong Seh Hong was concerned about insane patients being locked up in hospitals. I want to assure Dr Ong that we have come a long way since the day when all insane patients were just locked up in asylums. In fact, we have moved into the area of preventive mental healthcare. We have put in place a comprehensive range of community and institution-based programmes for the mentally disordered.”
“From 1st January 2004, the test reports issued by accredited laboratories will be recognised and accepted by HSA. The existing product and quality surveillance programme carried out by HSA has been enhanced and strengthened. Also, all local and overseas CPM manufacturers will be subjected to periodic good manufacturing practice audits, in accordance with international standards. The CPM regulatory framework in Singapore has already been enhanced to a considerable extent and we now have one of the strictest framework in the world. In spite of this, no system, short of complete prohibition of products, can absolutely guarantee the prevention of deliberate adulteration, as occurred in the Slim 10 incident, and which can potentially occur in even the strictest of systems. Dr Lily Neo's next question was with regard to regulation of clinical trials. For clinical drug trials, a clinical trial certificate is required from the Health Sciences Authority by law before research can proceed. Issuance of a trial certificate is conditional on the research meeting the requirements stipulated in the Singapore Guidelines on Good Clinical Practice, which include specific requirements for proper informed consent. For other forms of clinical research involving patients or human subjects, there are ethical guidelines on research involving human subjects issued by the National Medical Ethics Committee. Under these guidelines, hospitals and institutions, where such research is carried out, have Ethics Committees to review the ethics of research projects and approval is necessary before such research can proceed. 5.15 pm Dr Neo was also concerned about human embryos.”
“Sir, I want to thank Dr Lily Neo and Dr Ong Seh Hong for their questions. I begin, first, with Dr Lily Neo's question on bulk purchasing and Slim 10. With regard to bulk purchasing, the Group Purchasing Office of the two hospital clusters already bulk purchase standard drugs and commonly used non-standard drugs for the polyclinics and health institutions. As Dr Lily Neo noted, this has resulted in a lot of savings. But the institutions have also carried out some of their own purchases for non-standard drugs where smaller quantities are needed because it is more efficient and flexible in meeting their needs. The Ministry of Health has also requested that clusters should explore the extension of these services with willing partners in the private sector. With regard to Chinese proprietary medicines (CPM) and the Slim 10 incident, the regulatory controls for Chinese proprietary medicines were introduced in phases from September 1999 and were fully implemented by September 2001. All CPM importers, wholesalers, local manufacturers and repackers must be licensed by the Health Sciences Authority. Among the things that the Health Sciences Authority looks at include an assessment of the safety and quality of these medications. There are also full labelling requirements before they are allowed for local sale. But since the Slim 10 incident in 2002, MOH has further enhanced the control of CPM through additional measures. Since January 2003, all CPMs must carry an additional label on the outer sealed packs in both English and Chinese. This label says "Allowed for sale as a Chinese Proprietary Medicine". This helps consumers to better differentiate CPM from western drugs.”
“Hence, the Government has imposed a quota on the intake of female medical students wishing to study medicine in NUS as, comparatively, more female doctors tend to leave the workforce prematurely or switch to part-time work. We do not regard this policy a violation of our obligations under the CEDAW, within the overall context of our health care and education systems in Singapore, as: (i) There is no quota on the number of female doctors allowed to practise medicine in Singapore; (ii) There are no discriminatory practices against female doctors in our health care organisations. Women doctors have equal opportunities to take up training opportunities and assume responsibilities for which they have the necessary qualifications and experience; and (iii) We have to address a real and practical problem, ie, of ensuring Singaporeans have sufficient doctors to attend to their health care needs, bearing in mind the cost of medical education. Nevertheless, Sir, the Remaking Singapore Committee has recommended that the quota on the female intake at NUS Medical School be lifted, and will be submitting its report to the Government early next year. The Ministry of Health would study and respond to its recommendations.”
“Sir, I am not an expert on insurance. The insurance companies are quite satisfied with the numbers as being viable. UN CHARTER ON THE COMPLETE ELIMINATION OF ALL FORMS OF DISCRIMINATION AGAINST WOMEN (CEDAW) (Compliance with Article 10) 11. Mr Charles Chong asked the Acting Minister for Community Development and Sports (a) whether Singapore had registered any reservation to Article 10 of the UN Charter on the Complete Elimination of All Forms of Discrimination Against Women (CEDAW) when it ratified the convention in October 1995; and (b) if not, is Singapore in compliance with Article 10 of CEDAW which provides women with equal rights as men in the field of education, including the study of medicine. Assoc. Prof. Dr Yaacob Ibrahim: Sir, Singapore did not tender any reservation to Article 10 of UN CEDAW, as equal access to education is one of the cardinal principles in the Singapore education system. Women made up 52.5% of the local university population in the 2001 intake. But equal access to education does not mean that every student has a free choice as to the type of course he or she may pursue. It depends on the number of places available for each course, which depends on national needs and the cost of providing different courses. The cost of training a medical student is five times higher than that for other disciplines in the university. It costs over $400,000 over five years to train a medical student, 80% of which is subsidised by the Government. This means a relatively higher investment by taxpayers in medical education compared to other disciplines.”
“Sir, we realise that in the older population group, there may be people who cannot afford the premiums. But under our current system, should they become disabled, they still can get assistance when they enter into nursing homes with disabilities. And in the event that they cannot afford to pay their bills, there is still MediFund assistance through the nursing homes.”
“I have spoken to Singaporeans who have opted out. Some of the reasons given are that they feel the pay out should be more. Others felt that the premium should be less. This is quite natural. Most people want to pay the least premium and expect the highest pay out. But for an insurance scheme to be viable, there has to be a balance between the two. That is why we tendered out the scheme and selected the two insurers who offered the best deal for the public.”
“Sir, we have not surveyed the people who have opted out. There is still time for people to opt in, and this is something that we can look into when the scheme closes. However, this is an insurance scheme. In an insurance scheme, the premium is related to the pay out and benefits. This is a scheme that we have just started and, obviously, it covers what is the minimum requirement and the premiums are as low as they can be.”
“Sir, with regard to the reduction in numbers, there is a tendency across all countries and also in Singapore for patients to seek psychiatric help at outpatient clinics and in private clinics, because there is still a certain amount of unease about going to a mental hospital to follow up on their outpatient psychiatric treatment. So we can expect that over the next 10 years, numbers will continue to decrease, and more and more outpatient care will be in settings that are not special psychiatric clinics, but you can see a psychiatrist who sees patients in an outpatient clinic. DOING BUSINESS IN CHINA 17. Mdm Ho Geok Choo asked the Minister for Trade and Industry (a) how can Singaporeans embrace the Prime Minister's and Senior Minister's visions on the need to focus on booming China in the context of engaging and doing business in China; and (b) as the window of opportunity can run out fast, what programmes or plans are there to realise these visions and help derive the maximum advantage for Singapore.”
“They can write to the Ministry of Health and we will investigate the case.”
“Sir, there are three levels of caregivers. First, we have the doctors. The consultants are all psychiatrists. This is a medical sub-speciality. The nurses are given training in psychiatric nursing before they can work in IMH. And then we have the non-nursing medical staff like cleaners, etc, and they also have to be orientated to work in the hospital. Mr Steve Chia Kiah Hong: What recourse do the ex-patients of a mental hospital have if they feel that they have been unduly treated by the nurses? If they try to complain, they are told that they are crazy, and so they are given a medical jab, etc.”
“There are no significant differences in the rate of mental illness in Singapore versus other countries.”
“The inpatient admissions are: Year Admissions 1997 6,827 1998 6,687 1999 6,646 2000 6,607 2001 Not available, as we are still collating the data. The SOC attendances are: Year Attendances 1997 146,485 1998 146,987 1999 144,982 2000 142,667 2001 134,131”
“I wish to reassure the Member that flexibility is given to the Medical Social Workers to extend Medifund assistance to Singaporeans who cannot afford to pay their bills.”
“Mr Speaker, Sir, the Member for Sembawang GRC asked about the incidence of mental illness among Singaporeans over the last five years. The 1995 NUS Study on Mental Health estimates that about 10% of Singaporeans aged 21 to 55 years old have some form of mental ill health. Of this figure, about 5% have mild disorders, while 5% have moderate to severe disorders. Major mental disorders are relatively uncommon. For example, the prevalence of schizophrenia in Singapore is estimated to be about 0.75%, comparable to world-wide figures which are in the region of 0.5% to 1%. The prevalence of certain common mental disorders will be updated when IMH and NUS conduct a National Mental Health Survey later this year. The Member also raised his concern that Singaporeans who wish to seek help for mental illness may not do so because of the increase in charges at IMH. I would like to highlight that the fee charges for IMH are still very affordable, even after the fee revisions. For inpatient care, the average C Class bill size per day is only $13 while the average B2 Class bill size per day is $30. This works out to an average increase of only $1 for a C Class bill and $4 for a B2 Class bill, which is minimal. Patients can also use Medisave and MediShield to pay for these charges. For outpatient consultation, the average bill size after the fee revision is $25, an increase of only $2. Therefore, the increase in fees should not deter Singaporeans from seeking help for mental conditions if they need to. Nonetheless, should patients be unable to afford the highly subsidised bills even after they have used Medisave and MediShield, Medifund is available to help them.”
“Mr Speaker, Sir, I have already said that we will consider it. We are waiting for the Report to come in. When the Report comes in, we will study it. MENTAL ILLNESS AMONG SINGAPOREANS 16. Dr Mohamad Maliki bin Osman asked the Minister for Health (a) what is the incidence of mental illness among Singaporeans over the last five years; (b) given the stigma related to mental illness, will the recent increase in charges by the Institute of Mental Health prevent Singaporeans, who are not eligible for Medifund, from seeking help for their illness; and (c) what measures are being taken to ensure that those who need help will continue to seek them and not be hindered by fee increases.”
“Mr Speaker, Sir, the Remaking Singapore Committee has recommended that the quota on the female intake at the NUS medical school be lifted. The Remaking Singapore Committee will be submitting its report to the Government early next year. The Government will study and respond to its recommendations.”
“Mr Speaker, Sir, with your permission, I would answer Question Nos. 14 and 15 together.”
“My Ministry fully supports preventive care as one means of keeping healthcare costs under control. Our Health Promotion Board's budget is $100 million and it supports many programmes, such as the mammography programme. QURAN-READING CLASSES RUN BY JEMAAH ISLAMIYAH (Counselling of attendees and family members) 10. Dr Amy Khor Lean Suan asked the Minister for Home Affairs whether his Ministry has (i) identified those children who attended Quran-reading classes run by the Jemaah Islamiyah (JI) to talent-spot and recruit future members; and (ii) made arrangements for these children and their family members to be counselled and helped from being led astray by the JI.”
“Our hospitals review their costs every year. So, next year, they will review their costs and look to see if they need to make any adjustments.”
“First of all, the cost of the hospital is not included in the cost recovery for the hospital. So the depreciation of the hospital building is not one of the costs included. With regard to demand for health services, if we look across the world, as a country gets more affluent, the demand for health services increases. This is because the people have more disposable income, a larger proportion of which they are willing to pay for health services. Take the United States, for example. 14.99% of their GDP is spent on healthcare services, and the more affluent states, eg, California, spend almost 20% of their state GDP on healthcare. So, as Singapore becomes more affluent, a larger proportion of disposable income may be spent on healthcare expenditure. To try to curtail this, we need to make people responsible for their healthcare expenditure, because then they will decide how much of their dollar they want to spend on healthcare and how much of it to spend on education. Where healthcare is provided free, there is usually a buffet-syndrome and there is no control over the demand for healthcare services. But because in our system people are paying for their healthcare with their own money - Medisave is, in effect, money that they have saved - Singaporeans have been very sensible. And Singaporeans are not over-spending on healthcare. That is why we have managed to have a very high standard of healthcare, equivalent to Australia and Europe, and yet our total healthcare spending is only 3% of our GDP, while in Europe and Australia, it is between 6-9%.”
“We do not micro-manage our hospitals from the Ministry of Health. However, if there are any innovative management ideas that the hon. Member has, she can send these innovative ideas on management to the hospital management and they will consider introducing them in the hospital, if these innovative ideas are workable.”
“The clusters are run as not-for-profit organisations, meaning that profits are not their motive. If in a year they have a surplus, the surplus is ploughed back into the hospital for the benefit of the public. If in a given year they have a deficit, then, from their reserves, they would try to cover that.”
“With regard to the first part of Mr Tan's comment on KK Hospital, the reason why the specific questions he has asked have not been answered is because he did not table a question on KK Hospital in Parliament and has added it on as a supplementary question. He can table such a question on KK Hospital for the next parliamentary sitting. With regard to the second comment, what we have done is not against the spirit of what was debated in Parliament earlier. What we are doing is ensuring that our healthcare system continues to run as efficiently as possible in providing its services effectively to the Singaporean public. We recognise the difficulties that Singaporeans may face in paying their hospital bills and we have, as a result, increased the amount of money that we are giving out through Medifund to help people meet that difficulty. So it is not against the spirit of what we debated at the last parliamentary sitting. Dr Tan Cheng Bock: Is the Minister aware that his answer to Mr Tan Soo Khoon's question and also with regard to my question was not good, and that it was obvious that the Ministry of Health did not take heed of this House's motion on this price increase? I must say that it is very, very disappointing. I want to ask another supplementary question. How are these clusters run?”
“With regard to Medifund, more than 99.7% of the applications have been approved even though the number of applications has gone up from 55,000 to 157,000-plus. So we are assisting many more people today than we were six years ago. With regard to any over-capacity that the hospitals have, we will work with the hospitals to see whether, wherever possible, they can let others make use of that over-capacity so that their running cost would be down.”
“In the recent relaxation of Medisave, we have allowed Medisave to be used for IV antibiotics because, in the past, the patient stayed in the hospital for maybe three weeks for the IV antibiotics. Now, they can go home with the drip connected to their hand and they come in as an outpatient and get the IV antibiotics.”
“With regard to the first question on public and private cooperation in utilising limited resources, my Ministry is fully supportive of it and I have earlier given an example of how the SNEC had allowed its facilities to be used by private doctors. Likewise, with regard to MRI and other expensive diagnostic equipment, they are open to both private and public doctors to send their patients for testing. The Singapore Gamma Knife Centre is another example whereby there is a machine that is used by both private and public sector doctors. The formation of the clusters has led to competition between the hospitals in the two groups. One of the effects of this competition has been increased efficiency by both clusters. This also allows us in the Ministry to compare the hospitals across the clusters and see if there are any inefficiencies that need to be corrected and any systems that are extremely efficient that the other can copy. We also believe that if you can move inpatient surgery to day surgery, you can provide healthcare more effectively and efficiently. So the hospitals have increased their day surgery capacity and are encouraging day surgery. On our part, we have allowed Medisave, which is meant for inpatient care, to be used for day surgery. In the same way, if a patient can be looked after at home through home nursing, rather than being looked after in the hospital, that is a more efficient way of looking after the person. So we have relaxed our Medisave rules on payment for home nursing. The trend will be, over the next five years, more and more surgeries will be moving from inpatient to day surgery and more and more treatments, like chemotherapy which used to be done inpatient, will become outpatient treatment.”
“About 97% of the patients should be covered by Medisave or MediShield system without out-of-pocket payment.”
“With regard to the second point that we are spending 3% of our GDP, this 3% of our GDP on healthcare is not what the Government is spending. This is what we, as a society, are spending on healthcare. So if we enjoy a standard of healthcare that is comparable to Australia and Europe, and we can get this level of healthcare at 3% of our GDP, while others are paying 6%, 8% or 9% in Europe, it means that our system is much more efficient than the system in Europe. And that is what we mean by 3% of our GDP. So we ask why are we able to do this at 3%, when to get a comparable healthcare system, people have to pay 6% of their GDP, this is for the whole country, both the Government as well as what the individuals pay. The reason we are able to do this is because we run our hospitals on a cost recovery system. Is there a second part to your question?”
“My Ministry is aware that the unemployment rate is around 5% and there will be more Singaporeans who may have difficulties paying their hospital bills. That is why our Medifund approval rate has more than tripled and the funds disbursed, through Medifund, has more than doubled.”
“Mr Speaker, Sir, the new KK Hospital was built to replace the old KK Hospital, and the birth rate had declined more significantly than was anticipated and, so, utilisation had dropped. But with regard to the specific figures that the Member has asked, I would have to go back and check with my Ministry officials on those figures because that was not tabled as a Question.”
“Mr Speaker, Sir, this is a new specific question and I have to check with the Ministry on these figures.”
“The majority of Singaporeans should have enough in Medisave to pay for their health bills. Where they have to fork out from pocket expenses and where they cannot afford it, Medifund will assist them.”
“With regard to the first question, I have answered it. It is more efficient and effective to help people who need assistance in paying their healthcare bills by targeting the funds through Medifund. Because through Medifund, we are identifying those who do not have enough in Medisave to pay for their healthcare. Whereas if you give the same money directly to the hospitals, then the amount, or the proportion of that, which would go to the most needy would be much less. So dollar for dollar, this is a more effective way of helping those who need help most. With regard to Medifund, over the last eight years, Medifund applications that have been approved have increased three-fold, and we are still approving Medifund applications at more than 99% rate. We are quite happy to open the Medifund process for inspection by our Members of Parliament. At the press conference earlier in September, the Minister had invited the press to visit the hospitals to ascertain for themselves that our Medifund process is transparent and is helping those who need the help. And I am not sure how many members of the press took up the invitation but, so far, the press has not reported on any case that has been unfairly rejected. With regard to the third issue on public education, we will take up Dr Lily Neo's suggestion and distribute our brochures to more people and to all Members of Parliament so that they can distribute them to their grassroots leaders and to their constituents.”
“With regard to price rises of paying-class patients, the hospitals are free to raise their charges for paying-class patients. And that is not a major concern for the Ministry of Health because patients have a choice between the private hospitals and the private class of public hospitals, and the market can decide whether the price is too high or too low. It is only where there are price rises in C and B2 class wards that we monitor it, because this impacts most Singaporeans.”
“On the first question on financial advice in the hospitals, we have made it mandatory that every patient receives such counselling. If Dr Michael Lim has a specific case where such counselling was not given to the patient, in writing to the Ministry, my Ministry will investigate the hospital as to why such counselling was not given. But we have made it mandatory and directed our hospitals that they should give such financial counselling. The second issue is about cost going up. Why do costs go up? The single biggest factor for costs going up is manpower cost, not drug cost. Manpower cost in our hospitals amounts to $1.217 billion, or 56% of the total hospital expenditure. This cost has gone up because the wages have gone up. Wages of doctors went up between 4% and 5% in 2001, and for nurses it went up 5% to 8%. In order to retain staff, the hospitals have to pay competitive wages. It is a global market for skilled medical and nursing manpower. In nursing, there are 126,000 vacant positions in the United States. There are 10,000 vacancies in UK, and over 100,000 vacancies in Europe. There is also a shortage of medical consultants in UK and they are trying to recruit surgeons from Southeast Asia. In Australia, they are short of doctors in rural hospitals. All these countries have made attempts to recruit staff from Singapore. Some of the strategies that they have used are distributing brochures in hospitals, advertising in local newspapers and using recruitment agencies. Because of our competitive wages, the impact of these foreign recruitment drives has been minimal. If we do not pay competitive wages and retain our staff, the quality of healthcare will drop.”
“About 70% of Singaporeans use B2 and C class wards. For the majority of these patients, their Medisave should be able to cover the cost even with the 3% increase in charges. Through Medifund, what we are doing is we are using that money to target those people who cannot afford to pay their healthcare bills with their Medisave, whose Medisave has run out, who do not have the money to pay. Whereas if you were to give the money directly, then those who need the money most may not get it.”
“Mr Speaker, Sir, we would like to target our assistance to those who most need it. By targeting our assistance through Medifund, we are targeting these additional funds to help those who cannot afford healthcare.”
“Mr Speaker, Sir, running hospitals efficiently and ensuring that all Singaporeans can afford their healthcare are two related but separate issues. Hospitals are most efficiently run if they follow cost recovery principle, that all aspects of health services are costed correctly and resources are allocated appropriately. As demand shifts due to advances in medicine, due to shifts in demography, hospitals reallocate their resources to meet these demands. If you have a system that does not respond to these changes continuously, then you will find demand will build up, queues will form, and people have to wait long periods before they get their services. This is what happened in UK with the NHS. The NHS in UK does not follow this principle of cost recovery. And as a result, over the years, the development of services and facilities has suffered, and now patients sometimes have to wait over a year before they can get their surgery. It has reached a crisis level that in the UK, they are sending patients down to France, Germany and neighbouring countries for their treatment, while they are trying to upgrade their services. If we do not follow the cost recovery principle, we will be going down this road and, one day, may end up having to send our patients to neighbouring countries too. On the second issue of ensuring that all Singaporeans can afford to pay for their medical care, we have the safety net. In 1996, the number of applications for Medifund assistance was 55,859. In 2001, it was 157,190. Despite the almost three-fold increase, the approval rate was 99.7%, and 156,780 applications were approved in 2001. A total of $27.23 million was disbursed. This is more than twice the amount disbursed in 1996. So, I think we need to separate the two issues.”