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 9 of 9.
“Sir, Dr Chong Weng Chiew brought up the issue of domiciliary home care. This is something that my Ministry supports. There are now six VWOs providing home medical services. Home medical care is the provision of a doctor's care in the person's own home as the person has difficulty leaving his home because of severe disability. Home nursing services usually involve dressing of wounds, injections, changing of catheters, etc. The availability of home medical and home nursing can help to reduce the need for nursing home beds. MOH is in the process of finalising the norm cost for home medical care and home nursing care after which subsidised home medical and home nursing care will be available to those who pass the means test and will seek such care from the various VWO providers. The availability of Government subvention for home medical and home nursing will also encourage more service providers. This is an expansion of current services which have been limited to the seven approved providers under the Ministry's framework for integrated healthcare for the elderly. With regard to physiotherapy, home medical and home nursing providers will instruct the patients and their relatives on basic physiotherapy exercises. For patients who require more specialised physiotherapy inputs, home physiotherapy is provided by four restructured hospitals. There are eight private physiotherapy providers and they do not have a waiting list. The Ministry is currently reviewing the continuum of rehabilitation services and whether there is a need to expand home physiotherapy, particularly as the previous severe shortage of physiotherapists is being addressed with the local diploma course.”
“In this area, the two clusters have been working with the GPs to try to come out with an efficient system of admitting patients to the hospital. And in fact, the clusters are working by allowing GPs to admit patients directly to the hospital. With regard to the specific case, if he can send the information to my Ministry, we will look into it.”
“I think where a GP refers a patient to a Specialist Clinic ---”
“These companies control the prices of the medication while they are under patent protection, in order to recover their R&D costs. They might price their products differently in different countries, and we do not have direct control over these companies. But there is a great difference in price between a generic and a branded drug. So, it is possible, for example, in calcium supplements, if you buy branded medication, it may cost many, many times more than a generic calcium supplement. So this may explain why there is such a difference in price with regard to the person who has bought it. In Singapore, we do not have a regulatory body to control drug prices, and the market is allowed to set its own price. The Ministry of Health does not intend to set up such a regulatory agency. However, the Ministry of Health does monitor the price trends of pharmaceuticals through the data available from the group purchasing office that buys medicines for the two hospital clusters. However, in response to concerns expressed by the public on the high prices of medicines in Singapore, the Ministry did commission a study by a task force. The task force has made several recommendations. We are studying the recommendations and would decide on some measures maybe later in the year. 6.00 pm”
“These have been set up at a total Government subsidy of $225 million for capital cost and $200 million for recurrent funding. Another $82 million has been provided for the financial year. So my Ministry has a great concern that there are sufficient step-down facilities for patients. With regard to means testing, the Minister has already explained the rationale for means testing, and I will not go into it. Dr Tan also asked about the polyclinics and their cooperation with general practitioners. Our polyclinics try to work with general practitioners in the community to provide effective and efficient service for the community. Among the areas of cooperation between GPs and the polyclinics are that polyclinics allow patients referred by GPs to use their services such as X-rays, mammography and laboratory services. These patients are charged non-subsidised rates. X-rays and mammography services are relatively well utilised by the GPs. Patients referred by GPs constitute half of X-ray workload and a quarter of the mammography workload in some polyclinics. These are clear indications of the level of cooperation between the GPs and polyclinics. In addition, patients referred by GPs can undergo diabetic eye screening at polyclinics. They can also refer patients to purchase drugs from the retail pharmacies in polyclinics. Mdm Ho brought up the question of cost of medication. In Singapore, as a whole, we spend approximately $450 million on prescription drugs annually. Generic products make up just over 10% ($54 million) of the local market. Various branded proprietary drugs account for about 90% ($396 million). Branded drugs are produced by the major R&D based pharmaceutical companies. They are generally higher priced.”
“We are using a variety of strategies to reach out to the target groups. Mass media, talks and forums are carried out to create public awareness of the importance of mental health. To impart skills to healthcare professionals for the early detection of these mental conditions and mental stress problems that patients may have, workshops and training courses are being carried out. I now come to Dr Tan Cheng Bock's concerns about case-mix and step-down facilities. First of all, I want to clarify what case-mix is. Case-mix is a statistical way of reimbursing hospitals. What happens is that an average is taken for a condition, based on the cumulative cost of treating the condition in the population divided by the number of people who have that condition. So the hospitals will make some profit in some cases and losses in other cases. But, overall, the hospitals will not be worse off. It has been found in the United States that the introduction of case-mix or case-mix like systems leads to efficiency in the hospitals. For case-mix to work, it requires doctors to be professional and that doctors would treat patients not using case-mix criteria but treat patients according to what patients need. If administrators do their job and look at the bottomline, and if doctors act professionally and treat patients as they should be treated, what we will end up having is an efficient system that provides healthcare for Singaporeans as well as providing the correct treatment for patients. With regard to step-down facilities, over the last 10 years MOH has been putting in place facilities and programmes to meet the requirements of an aging population. We have five community hospitals, 16 VWOs' nursing homes and 21 day rehabilitation centres.”
“I thank Dr Lily Neo for having good things to say about our preventive healthcare programme. The community health screening programme has indeed been very successful since its implementation two years ago. My Ministry will continue to promote and provide for this community screening programme. Forty districts have already been covered. We intend to cover another 48 by next year, and after that this will be an on-going programme. And those who have gone through once will go through again. So this will be an on-going programme. The national breast cancer screening programme has also been extremely successful and large numbers of people have called to have appointments for the screening. But I think, with time, the demand for the screening will level out and then the waiting time for screening would become much shorter. The Ministry is also increasing the number of polyclinics that will have this facility from eight to 11 by the end of this year. Both Dr Lily Neo and Mr Yeo Guat Kwang have brought up their concerns about mental health. We need a healthy mind to deal with the current problems that Singapore is facing. My Ministry recognises the importance of promoting mental health among Singaporeans. To place greater emphasis on mental health, a mental health education programme, called "Mind your Mind", was implemented in 2001 by the Health Promotion Board and the Institute of Mental Health. The programme aims to promote mental wellness and raise awareness of the importance of early screening, detection and treatment of the common mental conditions such as stress, depression, anxiety disorders and schizophrenia. The programme is targeted at all Singaporeans, children and adolescents, adults and the elderly.”
“I think the Ministry will periodically review the demand for subsidised beds and looking at the trend, if there is a necessity in future where beds have to be converted, that is something that we will have to consider. CENTRAL BUSINESS DISTRICT (Bus lane restrictions on Saturday mornings) 4. Mr Yeo Guat Kwang asked the Minister for Transport whether, in view of the much lower traffic volume on Saturday mornings, his Ministry will lift restriction on or review the bus lane operating hours in the Central Business District on those mornings.”
“Mr Speaker, Sir, we do not want our doctors to discharge any patients who are medically unfit. This is not acceptable. If there is any case that anybody knows, please let me know.”
“Currently, the consultants in charge of the patient are responsible. But this is a suggestion that we can take up, ie, as to whether or not, when an appeal is made, another doctor within the hospital can review the case. This is a suggestion that we will take up in the Ministry.”
“Mr Speaker, Sir, we are fully aware that, in medicine, there are subjective decisions to be made and the guidelines are drawn up by the doctors for themselves. So when the guidelines are drawn up, it is the specialists within a certain area who draw up guidelines to help them make the correct decisions. And most of the guidelines are clauses to ensure that it is not rigid, such that the doctor involved can still use his own discretion to make the final decision.”
“We have left the decision to the doctor in charge because it is not possible to draw a guideline that you can apply across every case. Every sick patient is unique. So we will leave it to the doctor who is looking after the patient to make the decision. As a rule, and in fact all the doctors are very compassionate people, I cannot imagine that they would want to discharge a patient who is not fit to be discharged. What we will make sure is that there is no financial, social or administrative pressure on the doctors to make a decision that is not in the interest of the patient.”
“Mr Speaker, Sir, I do not agree. There is a difference between a step-down unit and an acute hospital. In an acute hospital, the level of medical care is more intensive and the patient is more acutely ill. The patient goes to a step-down unit when his condition is stable and needs medical care or nursing care of a lower intensity, and that is why the cost of providing care in a step-down unit is much lower than in an acute hospital. And, in a step-down unit, they are subsidised too.”
“Mr Speaker, Sir, I do not have the figures with me at this point in time on the details of the step-down facilities and when they will be available. But I will make this information available to Mr Steve Chia.”
“If an appropriate step-down facility is available for the patient and the arrangements have been made and there is a step-down facility that is available for the patient, it would make sense to move the patient to the step-down facility, because the cost of looking after the patient in an acute hospital is much higher than in a step-down facility. And that is the purpose why step-down facilities are built. So where a patient has an appropriate facility available for him and the family does not want the patient to move to that facility or the patient does not want that to happen, then the full charge will come in.”
“The decision on when a comatose patient is fit to leave an acute hospital will be a decision to be made by the doctor in charge. But there are comatose patients who leave the acute hospital to be transferred to a nursing home where they may remain for several months until they recover.”
“Mr Speaker, Sir, I said close to 100% because the occupancy rate fluctuates from day to day. Any patient who requires treatment will not be delayed. The patient will be admitted, put into a bed in another class, but the charges would remain, depending on what class the patient is admitted. So the various hospitals have contingency plans to deal with the situation when at one point in time there are not enough beds in that particular class.”
“Mr Speaker, Sir, I think we need to make a distinction between medical problems and social problems caused as a result of medical illness. When a patient comes to the hospital, the patient is ill, he is treated and medical care will be provided for him. But as a result of the medical illness, there are real social problems that may occur in that the person may be left disabled, without work and may have to make alternative financial arrangements to look after themselves. These are the social problems as a result of a medical illness. Where the social problems arise, they are referred to the medical social worker, who will then liaise with the various bodies responsible for taking care of providing support for people with financial problems, to help these people.”
“Mr Speaker, Sir, the first premise that we have when a patient is discharged from the hospital is that the patient is medically fit to leave the hospital. So the question of the patient not receiving medical care does not come in. As long as a patient is in the acute hospital requiring medical care, Medifund will be available for the patient.”
“Mr Speaker, Sir, yes, there are plans for more step-down facilities, there are plans for new nursing homes and new step-down facilities to be built.”
“Mr Speaker, Sir, currently there is a great demand for C class beds. We are reviewing the matter and, at this point, we have not made any decision on that.”
“Mr Speaker, Sir, the policy has been implemented for only a month and only one patient so far has been charged. In her case she had financial counselling and, for convenience, she wanted to stay in hospital. We will monitor the effects of this policy over the next few months. If there are any cases that have been discharged and it has caused undue suffering to the family or to the patient, they can bring it up with my Ministry or they can bring it up with me and we will look at it. But as this is a new policy that has been implemented for only one month, I cannot at this time tell the Member whether or not there will be anybody affected in such a manner. But we will monitor this.”
“Currently, it is the policy in many hospitals that looking at discharge of the patients and placement of the patient starts very early, sometimes even soon after admission, particularly with stroke patients. So the medical social workers may be involved very early in the management of the patients.”
“Mr Speaker, Sir, this policy has nothing to do with case mix. At this point in time, case mix has not been introduced for purposes of reimbursement of the hospital. So they have no reason to take case mix into consideration when discharging patients. And should case mix be introduced at some point, we will ensure and insist that decisions on whether patients are discharged home or whether they are medically fit must be decided purely on medical criteria, and not on financial or case mix criteria.”
“Mr Speaker, Sir, the doctors will only certify on the medical grounds whether the patient is fit to be discharged. There are social problems involved in many of these cases and the social problems will be handled by the medical social worker. Where the medical social worker cannot solve the problem, meaning that the home nursing or home medical services cannot be arranged, then the patient will not be discharged. It is only when all arrangements can be made, and there have been seven days since the time the doctor has certified that the patient was medically fit to leave, it is only at that point will the patient be charged full rates.”
“Mr Speaker, Sir, the occupancy rate depends on whether the patients are in the subsidised or the paying class wards. Currently, in the subsidised wards, particularly in the C class wards, the occupancy rate is close to 100%.”
“Mr Speaker, Sir, where step-down facilities cannot be found for the patient, or where the home nursing arrangement has not been arranged, the patient will not be discharged from the hospital, even if they are medically fit and even if the seven days have been exceeded.”
“If we can create a pattern where people within seven hours flying time come to Singapore for services in education, health, insurance, banking, law, research, entertainment, the arts, shopping and other services, these patterns will self-perpetuate and get fully established. Then, even if we are a high cost centre, the economics of QWERTY will work in our favour because we will have a competitive edge as established patterns tend to persist. Mr Speaker, Sir, we are at the crossroads. The people of Singapore are pragmatic. They know there are no easy solutions to difficult problems. They do not pine for a lost past that will not come back. We, Singaporeans, are the children of tough and hardy immigrants. Survival is in our genes. If we, people and Parliament, see the future not as one full of problems but as one full of opportunities, opportunities for us to seize for our benefit, we can make Singapore one of the greatest cities of the 21st century.”
“If you look at your keyboard, the keys at the upper left corner are Q, W, E, R, T, Y. When the typewriter was first invented, the machine would often jam when the operator typed too fast. So the keyboard was designed to be as inefficient as possible. Today keyboards do not jam, but we continue to use the same format for the keyboard, even though it is inefficient. Economists like Paul David call this, the law of positive returns or the economics of QWERTY after the keyboard. We can see examples of QWERTY all around. The IT industry began in the Silicon Valley through the foresight of Stanford University. Today, all those interested in the IT industry still continue to converge to the Silicon Valley, even though it is one of the most expensive places in the United States. Likewise, the entertainment industry gravitates to Hollywood. Even Chinese films like Crouching Tiger, Hidden Dragon and Indian films like Lagaan look to Hollywood for approval at the Oscars as this translates into millions of dollars in the global film market. Patients from around the world travel to a small town in the middle of wheat fields in Minnesota to see the doctors of the Mayo Clinic. These are examples of QWERTY where an established practice gives a place a competitive advantage. About a month ago, I was introduced to a former Indian Minister who is now a top lawyer. He came to Singapore because an Indian company had a dispute with an Indian State government. The arbitration was being conducted in Singapore because it is becoming an established practice in many contracts in India to choose Singapore as a location for arbitration for disputes. I was greatly encouraged by this. Singapore has a brand name.”
“But as the computer industry plateaus, we need to look for a new niche where advances in the application of science will fuel growth. The life sciences is an area that Singapore should consider. Although the Government cannot control the three forces I described, the Government must play an active role to complement and manage these forces for the benefit of Singapore. I believe there are three areas where the Government has a major role. The first area is with regard to the civil service and the statutory boards. Our civil servants and statutory board employees are men and women of integrity working diligently in the service of the nation. But these institutions are shielded from the forces of the free market. Yet, they too must restructure and become more efficient or they may gradually become what Bertrand Russell called "a collection of officials, different for different purposes, drawing comfortable incomes", happy "so long as the status quo is preserved." It is Parliament's duty, those on the Frontbench and those on the Backbench, who must ensure that the civil service and statutory boards remain efficient and give the people the maximum at the minimum cost. The second area where the Government must act is to reduce the real difficulties faced by our citizens as a result of the recession and restructuring. We must do our best to help people through this period. However, we must be careful not to create a welfare state and avoid creating a dependency culture in our citizens. We should consider Abraham Lincoln's advice: "In all that people can individually do as well for themselves, government ought not to interfere." The third area where the Government should act is to see how we can utilise the economics of QWERTY, spelt Capital Q, W, E, R, T, Y, to help us.”
“On September 11th, I was watching CNN. The first plane had hit the towers. The instant I saw the second plane hit the building, I knew it was a terrorist attack. So did millions of others across the world who viewed CNN. This is the speed at which information moves across the globe today. When Enron collapsed, dragging Arthur Andersen into the controversy, within days, our honest Singapore accountants working under the Arthur Andersen umbrella had to consider merging with other firms. Globalisation brought the electronics industry to Singapore because it was efficient to locate the industry here. Globalisation is taking many of these factories to China and elsewhere because it is more efficient to be located there. We cannot fight globalisation. What we can do is to find a new niche in the global market where we are efficient and where we have an edge in competitiveness. The third force is the progress in the application of science. Discoveries in science by themselves may have no impact. But when they are applied, they can change the course of history. The Chinese discovered gunpowder but the application of gunpowder to cannons by the Ottomans brought the collapse of Constantinople and changed world history. Although the transistor was invented in the United States, it was Sony and other Japanese companies that were able to exploit its applications and have dominated consumer electronics ever since. The last two decades have seen a revolution in applied science due to the mass introduction of computers in the workplace and in the home. We must be thankful to the Economic Development Board for seeing the potential in the computer industry and bringing the computer industry to Singapore.”
“The auto industry was forced to make better cars more efficiently and by the 1990s, the American auto industry was again the strongest in the world. Today, it is the Japanese auto industry that is in trouble. Nissan required a foreigner to restructure and save the company. Japan's reluctance to allow restructuring of its economy after its bubble economy burst has hindered its recovery. We must avoid the mistakes that Japan has made. To recover from this recession, we must further deregulate and allow market forces to make us more efficient. The second factor that we have no control over is globalisation. The search for profits has made globalisation a powerful force. It was the desire of Europeans to make huge profits from the spice trade that drove them to explore the world, discover America and circumnavigate the world. Since then, the world has become inter-linked and we cannot escape globalisation. Consider the fate of the African living in his village in the 17th century. European taste for sugar fuelled a triangular trade whereby trinkets from Europe were sold in Africa for African slaves who were then transported to the Caribbean to be worked to death to grow sugar, which would be sold in Europe for huge profits. Whether globalisation is morally good or bad is for philosophers to decide, but like the African in the 17th century, we cannot escape globalisation. What is new, however, is the degree to which the political and economic fates of countries are becoming inter-linked and the speed at which globalisation affects countries. Just imagine, Osama sitting in his office in Afghanistan reviewing the videos of Yishun MRT and the World Trade Center in New York. Because he chose to strike in New York, we were spared death and destruction.”
“The first approach is to try and ringfence our economy and preserve the status quo. Our economy will remain preserved, frozen in time, but the world will move on. Twenty years from now, foreigners will find us quaint. Just as we often remark when we are in less developed countries - this is how Singapore used to be in the 60s - they will say this is how their country used to be in the 90s. Or we take the second approach and look at the recession as an opportunity to allow the free market to reorganise our economy so that we will be more efficient and will enter a period of growth in the 21st century. We must not expect that when we come out of this recession, things will be like they used to be in the mid-90s. Our economy will change. Like the mature economies of the world, there will be a shift from a manufacturing-based economy to a more service-oriented economy. Like the mature economies, our dependence on construction must decrease. Mr Speaker, Sir, in the 1980s, I lived in the United States for five years in the State of Michigan, about a minute's drive from the World Headquarters of General Motors and about 15 minutes' drive from the World Headquarters of Ford Motors. The output of these two companies is greater than the GDP of Singapore. The 1980s were a period of anguish for many Americans. The Japanese economy appeared strong and many contemplated a future where Japan would be the premier country of the world. A Japanese corporation had purchased that icon of New York - the Rockefeller Center. Many thought the American auto industry would perish. Instead of protecting the auto industry, the US allowed market forces to restructure the industry.”
“Mr Speaker, Sir, I speak in support of the Motion of Thanks to the President. Singapore is at the crossroads in its history. The crisis we face is in part the result of forces that we have no control over. These forces were responsible for our past success. They are responsible for our present recession; and if managed correctly, they will bring us future prosperity. The first force is the force of the free market. In historical terms, the force of the free market is a relatively new force. When kings and queens controlled all the factors of production, there was no free market. Only when individuals had the right to private ownership of wealth, no matter how little or how much the wealth was, did the free market emerge as a force. Industrialisation and the division of labour greatly amplified its power. The last century has shown us that the free market is the most efficient way of organising the factors of production and producing wealth. The collapse of the Soviet Union is proof of the inefficiency of centrally controlled economies. The recent rapid prosperity of China is proof of the effectiveness of free market principles in generating wealth. When people of a common culture are divided by an accident of history, and one half follows a free market economy and the other half a centrally controlled economy, the free market economy has always performed better. West Germany was more prosperous than East Germany and South Korea is more prosperous than North Korea. Singapore by embracing the free market system and by having one of the most open economies in the world has become an affluent nation. However, the free market system is also responsible for our current recession. We can react in two ways.”