Chia Shi-Lu
Singapore
“Chairman, I wish to thank all Members who have taken part in this debate and, of course, Minister Gan, Senior Ministers of State Amy Khor and Dr Lam Pin Min and Mr Edwin Tong and also Senior Parliamentary Secretary Amrin Amin, together with all the staff at MOH for their replies and the work they have put in for the healthcare system for…”
“Nonetheless, I believe that a united society will be a key piece to this puzzle, and I look forward to the Ministry of Health's stewardship in this regard. May we all live long, live well and grow old together as one people. Thank you, and I beg to move. [(proc text) Question proposed.”
“Mr Chairman, high usage of air-conditioning and refrigerators contributes to global warming, and none more so than in Singapore where we love our climate control and air-conditioning. But as a responsible member of the global community, we should do our best to reduce our carbon footprint.”
“Management of E-waste Last cut. With the introduction of the Resource Sustainability Act last year, the EPR scheme will commence and a PRS operator I alluded to earlier will be appointed to collect and ensure proper disposal of electrical and electronic consumer products.”
“I thank the Minister for the update. I just have two clarifications about the Disease Outbreak Response System Condition (DORSCON) level – the acronym of the year, so far! First, some clarification about how this DORSCON is arrived at. Is it by independent committee that makes this decision and recommends to the Minister?”
“I just want to echo and express my thanks to Minister Gan Kim Yong for his statement of thanks and support for healthcare workers. Two short but slightly technical questions, I apologise. The first, the Minister touched about it earlier.”
The complete record
Every one of 326 lines we hold for Chia Shi-Lu, in date order, each linked to its source. Free to read, in full, without an account. Page 5 of 7.
“So, it is evident that much has been done, and yet it is timely to ask if we should consider other ideas to address nagging concerns among some Singaporeans. One of these is the uncertainty over long-term care costs. Many Singaporeans believe this to be large and required for an extended period. They also worry that nursing homes may be their only option, when they prefer to age at home. Quite a number of families are willing to have grandpa or grandma or their parents at home, if they have access to quality home care services. Another worry they have is being a burden to their families – financially, physically and emotionally – should they lose their independence with severe disability. Naturally, they are apprehensive about long-term suffering if they were bedridden and needs various aids to survive. I have some suggestions for the Ministry's consideration. First, we should have a comprehensive action plan to help our seniors remain healthy and connected. We have to accelerate the development of more alternatives to nursing homes. Our seniors want to be with their families even when they become frail. Family members want to be assured that they can rely on skilled help and nursing support when their parents or grandparents require it. And for seniors without family, or when their families can no longer look after them, new models of care such as assisted living centres should be explored. The level of care delivered by a traditional nursing home may be excessive for some residents. Studies have shown that restoring the autonomy of nursing home residents, while theoretically putting them at higher risk of accidents, may actually have many positive effects on their well-being that more than offsets the potential risks.”
“Moving on to long-term care needs, I think this is one area where we still face many challenges. About 3% of residents aged 55 years and above are non-ambulant and require physical assistance. Long-term care needs can last for several years if disability strikes. This group of elderly require a lot more support from their families to care for them and their daily needs. Many prefer to age-in-place, but strong family support is needed to make this happen. They also need the support from services in the community, for example, like home nursing care. I applaud MOH's efforts in expanding long-term care capacity, including nursing homes as well as home and centre-based senior care services, to ensure that the disabled elderly have access to the care that they need. Since 2011, nursing homes beds has increased by 1,000, home care places by 2,700 and centre-based care by another 1,000 places. I am glad to note that the Government is committed to increasing nursing home beds to 17,000, home care places to 10,000 and centre-based care to 6,200 places, by the year 2020. MOH has also worked on enhancing the quality of aged care services by introducing new licensing standards for nursing homes and new guidelines for home and community care services. The Government has been increasing support for long-term care and more Medifund assistance has been made available. Patients can receive subsidies of up to 100% in some cases, and that eligibility has broadened from half to two-thirds of households by the year 2012. Other measures include the Enhanced Interim Disability Assistance Programme for the Elderly, the Senior Mobility and Enabling Fund, ElderShield and the Pioneer Generation Disability Assistance Scheme.”
“We want to see as many Singaporeans grow old with dignity within the community where they have spent the better part of their lives. Second, support for the elderly. I believe that this is one area in which this Government has done a lot, and I am sure that our seniors can be assured that the Government has invested significantly in building up capacity across the healthcare system. In addition, medical bills have become more affordable through higher subsidies for Specialist Outpatient Care (SOC) and outpatient drugs, Flexi-Medisave, the Pioneer Generation Package, MediShield Life and Medifund has also been strengthened. Our elderly will get the care that they need, without unduly worrying about healthcare costs. Outside of healthcare, our elderly will get help with their daily living expenses through a variety of programmes such as CPF LIFE, the Silver Support Scheme, Enhanced and Additional GST Vouchers. And they also receive assistance with housing matters through, for example, the Enhancement for Active Seniors (EASE) scheme which helps to put age-friendly improvements in the homes of seniors, studio apartments, the Lease Buyback Scheme, the Silver Housing Bonus, priority schemes and/or additional grants for children and parents to live close to one another, such as the recently announced Proximity Housing Grant. Housing estates are also undergoing continuous improvements to make them as senior-friendly as possible, and even our traffic system and road networks are making the transition, for instance, outdoor lifts in housing estates and for overhead bridges, and the Silver Zone programme which has a suite of age-friendly traffic safety enhancements, the latest example of which was inaugurated in Lengkok Bahru just last weekend.”
“For example, some 3,000 taxi drivers have had health screening and follow-up consultations and since last June, about 400 bus drivers had gone through a customised programme that includes chronic disease management, eyesight monitoring, ergonomics and hydration. Keeping healthy is not just a matter of exercise but feeling involved and connected. Many elderly want to continue to lead active lives. I know of examples of many nurses and other healthcare workers whom I work with, who continue employment way past the official retirement age and still continue to contribute significantly to the care of our sick and elderly. The role of family and friends is very important. Our seniors should be able to live in a familiar environment surrounded by loved ones, friends and neighbours, not segregated from the rest of the community. Ageing-in-place is a principle that should be robustly defended. In a recent survey by the Ministry of Social and Family Development (MSF), about 80% of household heads aged 65 or above prefer to age-in-place at their existing flats. Many of the elderly I spoke to speak of the joys of remaining part of the community, living in their own homes. For those living with family members, they benefit from the inter-generational bonds. For those who are living on their own, ties with long-time neighbours and even shopkeepers keep them integrated within their communities. I was delighted when the Ministry for National Development (MND) supported a programme to allow up to six neighbours to select their replacement flats together, as part of the en-bloc redevelopment of the historic precinct of Tanglin Halt. This social glue is important.”
“Second, in the event that one falls ill, I am glad to note that help for our elders has been significantly expanded. Third, when the elderly need to be looked after, they should have a range of options to choose from. Keeping healthy and connected. Health is the foundation for positive ageing. This does not mean taking more medicine or going to see the doctor more often. In fact, over-medication or treatments could do more harm than good and is costly for both the patient and the country. Recent studies suggest that reducing medication, a process that has been termed "de-intensification", has significant benefits in terms of both morbidity and mortality. The other day, I wished a sprightly octogenarian lady the best of health, and she brightly replied that she was indeed in the pink of health, and whereupon to emphasise this point, she proceeded to show me a fistful of pills that she takes every day. This led me to ask her, "Since you are so healthy, why is there a need to take so many pills?" She just smiled wistfully but did not have a reply. Singaporeans should take preventive measures, such as eating healthy and exercising regularly to slow biological ageing. I am very happy to see the many efforts in our community for our elderly to keep healthy. There are wellness programmes in all 87 constituencies in Singapore. In addition, we are embarking on community-wide longitudinal health screening in some parts of Singapore, more recently in the Mei Ling and Stirling estates in Queenstown. Workplace health has also not been neglected. We have health programmes that are customised for mature workers in workplaces.”
“Mdm Speaker, I thank you for the opportunity to join the Members of this House in expressing my support for the motion of thanks to the President for his Address. The President had spoken passionately about the importance of building a caring society. And as the hon Member Dr Amy Khor had mentioned earlier, a key characteristic of this society of ours is that an increasing proportion of it will comprise the elderly. So, for this speech, I will be focusing on strengthening the care of our seniors. The numbers are familiar to all of us. Just five years ago, under 10% of our population was aged 65 and above. In 2013, that number had crossed the 10% mark, and by 2030, this would increase to 24%. Our old age support ratio would drop from today's 1:5.2 to 1:2.3 in 2030. While these statistics may sound alarming but, in fact, getting old is not necessarily bad news. What we need do is to focus on functional age, not chronological age. Healthy lifestyles and preventive health measures play a big part in ensuring that an older person remains as functional as possible, enabling him/her to lead an active and fulfilling life in his/her golden years. Socially and economically active seniors will lessen concerns about the support or dependency ratios – 60 will be the new 40; 80 the new 60, and so on. In the Ministry of Health's (MOH) Addendum, one of its priorities is to intensify efforts to keep Singaporeans healthy, such as through plans to reduce obesity and smoking. As a society, we must work together to make ageing a positive experience for all. And in my opinion, there are three important criteria for positive ageing. First, one must be healthy and stay connected to the community.”
“First, and I accept that this may not be within this Bill's remit, it is not entirely clear what manner of redress and compensation would be available to research participants should they suffer adverse effects, whether directly or indirectly, from their involvement in the said research. Second, on the other hand, particularly when cell or tissue samples are obtained from subjects, whether the said subject has any rights to additional remuneration should the results of the research lead to clinically and commercially viable therapies. Finally, in the hopefully unlikely event that research or tissue banking activities have to be suspended, as spelt out in Part 8 of the Bill, could the Minister elaborate on the process by which the suspension order will be reviewed and then either rescinded or perhaps lead to a permanent cancellation of the study? Although professionals in the field of biomedical research do appreciate the generally light touch adopted by this Bill, some remain concerned about the process of review and appeal should issues arise that could lead to a suspension of their research study. With that, I support the Bill.”
“The problem is that these guidelines are not mandatory in nature and are not legally abiding. In recent years, there are more and more biomedical research projects in Singapore and they are getting more complicated in nature as well. This is driving and promoting the development of the biomedical research industry in Singapore. In order to ensure that all biomedical research activities relating to human bodies are conducted in accordance with the research and ethical standards, and to protect the safety, privacy and welfare of patients and donors of human tissues for research purposes, the enactment of this new legislation is necessary. The Bill clearly spells out the role and responsibility of the individuals and organisations involved in these research projects and imposes strict controls on some restricted items of research. These include: Firstly, collection of the patients' human tissue can only be conducted with the prior consent of the patient. Secondly, regulation of research involving the combination of human and animal stem cells. Thirdly, prohibition of the commercial trading of human tissues. May I ask the Minister, in order to ensure that the research institutions abide by the regulations, what kind of audit process does the MOH have? Can the Minister disclose what Page: 106 are the audit institution and details of the audit process? Upon implementation of this new law, our legislative framework will comply with the standards of the leading countries in this area, such as the US, UK and Australia. I believe this will help to raise Singapore's status in the international scientific research field. (In English): I have three further questions for the Minister.”
“This is an important Bill because although biomedical research in Singapore occurs within a closely regulated ethical and safety framework that is supported by related legislation, such as the Medicines Act, Human Organ Transplant Act, Human Cloning Act and so on, we do not as yet, have a formal legislative framework that covers the conduct of biomedical research in Singapore. I am reassured, however, that this Bill strengthens the existing ethical and regulatory framework that safeguards the rights of the patient. This is critical, as it will increase the confidence of the public in the conduct of medical research in Singapore and encourage the participation of the public in medical research. Page: 105 When a patient or a member of the public is invited to participate or contribute to a medical research study, many greet such an offer with a degree of distrust and trepidation. This should not be the case. In many developed nations, patients often compete to be eligible to participate in such research, either because it allows them the opportunity to contribute to the greater good, or because it gains them expedited access to advanced therapies which may otherwise not be open to them. In these countries, a comprehensive legal and regulatory framework sustains this environment by affording greater peace of mind to these research participants. Mdm Speaker, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Mdm Speaker, I support the Human Biomedical Research Bill. MOH has provided a set of guidelines by the Ethics Review Committee to all public and private hospitals and research institutions. Generally, the ethics committee of most organisations will follow these guidelines.”
“Mdm Speaker, this is an important Bill, and I would also say a timely one, building upon a process of public and professional consultation that was begun over 10 years ago. However, and particularly as a researcher in the biomedical sciences myself – and I herein declare my interest in this area – I am acutely aware that the pace of scientific discovery is so rapid and the scope so broad that it is challenging to construct comprehensive and durable legislation. This is an important Bill because without biomedical research there will be no progress in the development of therapies that cure human disease, alleviate human suffering, or make our lives more active and fulfilling. Where we are today, and where we will be in the foreseeable future, the noble search for the next magic drug, the next miracle cure, cannot happen without the use of human tissues and the participation of human subjects. The development of new cures for cancer, new implants to replace worn-out body parts, vaccines for diseases like dengue fever and Ebola, all these cannot happen without the use of human tissues and the participation of human subjects. Further to this, there is also an increasing number of therapies that involve the use of human cells and tissues, and although the concerns may not be as great or as complex as those that surround organ donation and transplantation, nonetheless many of the same issues regarding the procurement, storage and usage of these biological materials need close scrutiny.”
“I thank the Senior Parliamentary Secretary for the very comprehensive reply. The question is that there are probably some parents with children with pre-existing illnesses, but not of a very severe nature, who are agreeable to have their children participate in these overseas trips. But there might be concern that if something does happen of a medical nature to their children, the policies purchased for them by the school may not cover them for these illnesses. There certainly do exist policies out there which do cover pre-existing illnesses admittedly for a premium. But I do not think it is a prohibitive one. So, I would just like to ask again if MOE would consider giving this option to the schools in question. With regard to the cost, I suppose it is something that can be decided by the school or the parents or amongst both parties.”
“One supplementary question. I was wondering, based on events such as this, whether there is a consideration to maybe have a separate category, as the Minister mentioned earlier about partially or not truly combustible materials, so that you can look into potential sources of combustible hazards.”
“I thank the Minister for the response. ActiveSG has received a very good response from all Singaporeans and that is the main reason why I tabled this question. Two supplementary questions. The first is that many Singaporeans who are in the programme would like to know how long this programme would be continued and whether there are any parameters for determining what is the period that this programme will run, whether there will be a limit to it and if there are any parameters which will determine this. The second is that there is some feedback about how we can best expand the use of ActiveSG. There have been calls to allow the use of these credits, for example, to participate in so-called privately organised events, such as marathons and cycling events and so on. There have also been some calls, for example, to allow the use of credits for people to spectate at sports events, for example, at the recently-concluded SEA Games. So, I was wondering whether the Ministry would consider thinking about some other avenues in which ActiveSG credits can be used.”
“I would just like to ask the Minister of State: there has been a suggestion that perhaps because of a good guideline to CHAS participant clinics to add in the remaining balance on the CHAS accounts as part of the itemised bills. I note that some clinics do give some information to the patients but this is not across the board. And I was wondering whether MOH could consider giving some sort of advisory to this effect.”
“Yes. First of all, I wish to thank all Members who have participated in this afternoon's very healthy discussion, especially Minister Gan Kim Yong, Senior Minister of State Amy Khor, Minister of State Lam Pin Min and Senior Parliamentary Secretary Muhammad Faishal for their careful and considered replies and explanations. I would also like to record a note of gratitude to MOH for their remarkable efforts towards keeping Singapore and Singaporeans amongst the healthiest in the world. We look forward to future Page: 146 steps to encourage all of us to not only live longer but also to live better. With that, Mr Chairman, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn. The sum of $7,645,726,700 for Head O ordered to stand part of the Main Estimates. The sum of $1,645,498,700 for Head O ordered to stand part of the Development Estimates. Page: 147”
“Thank you, Mr Chairman. I just have three clarifications. The first two are in regard to primary care addressed to the Minister of State. For the first clarification, I am very happy to hear all the developments in the upgrading and new polyclinics that we can look forward to. But it seems that a lot of these improvements will only be operational in a few years' time. Given that we do recognise that our polyclinics are already operating at near to full capacity, what steps will the Ministry be taking to make sure that the primary care needs of Singaporeans continue to be served in the interim? The second clarification is related to the point that was raised by hon Member Mr Ang Wei Neng about overcharging in primary care with CHAS, PG and all these schemes. Are there any measures to perhaps look at over-consumption? An example has been reported recently, where some people raised concerns that with the coming of CHAS and the PG package, as there has been a sharp rise in the frequency of dental visits by some seniors. The last clarification is a short one. It is with regard to the Flexi-Medisave Scheme. When it was first announced, the Ministry said that they would open it to public feedback and they will try and see whether they can fine-tune the scheme before its launch in April this year. I was wondering whether there have been any changes to that scheme.”
“Mr Chairman, the dangers of smoking are well known and the statistics continue to horrify. Tobacco smoking is the leading preventable cause of death in Singapore, and it is estimated that seven Singaporeans die each day from causes related to smoking. Second-hand smoke may be responsible for 250 deaths in non-smokers in Singapore each year. Although the rate of smoking in Singapore continues to fall, the rate in the young seems to be increasing in recent years. And so I would like to ask MOH what plans it has to reduce the smoking rate amongst the Singaporean population to below 10% by 2020. And beyond the Point of Sale Display Ban which comes into effect in 2016, are we considering other measures such as plain or standardised packaging for cigarettes? And what has been the effect of targeted programmes, such as the Workplace Smoking Control Programme and the "I Quit" movement? And could the Ministry provide further details on the recently announced intention to disallow shisha smoking, and also if there are other plans to control similar products that have a high health risk profile? Healthy Individuals”
“Finally, I would like to ask if the plan to launch MediShield Life by the end of this year or earlier next year is on track, as many Singaporeans are looking forward to the implementation of this landmark universal health insurance programme. MediShield Life”
“Mdm Chair, I would like to request for an update on the progress of the discussions on the fate of Integrated Plans (IPs), with the advent of MediShield Life, specifically on the standardised IP schedule that was previously announced, which is supposed to be pegged to the B1 rate in Government hospitals. Is there any indication when this standardised IP schedule will be rolled out? Presently, about two-thirds of Singaporeans have Integrated Plans, which cover B1 and higher class wards in public and private hospitals. This is partly because many patients continue to value being able to have greater choice when it comes to hospitalisation for medical treatment. B1 class wards offer an attractive choice for patients because patients still receive Government subsidies yet still offer the choices and many of the benefits offered by private hospitals. The Government has accepted the MediShield Life Review Committee's recommendation that the five private insurers offer a standardised B1 plan IP. However, there are concerns that there would be little room for insurers to offer competitive benefits since the B1 plan is standardised. What are the Minister's thoughts on this? Page: 95 Another concern would be the escalation of IP premiums once policyholders reach the age when they are more likely to make claims and yet, this is exactly the time when they face tightened finances with retirement. As their Medisave accounts get depleted, such policyholders will naturally downgrade to MediShield Life, leaving the IP providers to cream off all the premiums already paid off over the years when the policyholders were younger. How does the Ministry intend to address or look at this problem?”
“And some seniors have expressed that they found it difficult to have to top up their Medisave account from their CPF monies before they can withdraw money from their CPF accounts when they reach the age of 55. Assoc Prof Fatimah Lateef: Madam, the 3 "M" system forms a fundamentally sound basis of financing healthcare costs in Singapore. Over the years, it has evolved and adapted to appropriate changes, to suit the needs of our population and healthcare demands. Medisave use for outpatient payment and chronic disease management, too, has been liberalised over the years. Healthcare costs, too, have increased. Drugs have now moved on from first generation ones to third, and even fourth generation ones, with greater bioavailability, safer profiles and lesser side effects. With schemes like CHAS and the Pioneer Generation Package, we are also steering more towards preventive care, primary care, ambulatory care and community-based care. With the increasing and rapidly ageing population as well as the rapid upsurge in the numbers of those with chronic disease burden, can the Ministry consider further flexibility and liberalisation in outpatient Medisave usage? This can be in the areas of the ceiling allowable for deductions annually and the addition to the list of 15 diseases that can be currently covered under the CDMP – for example, to include Parkinson's disease, dementia management, epilepsy and chronic arthritis, such as rheumatoid arthritis; and for the Flexible Medisave scheme which will be introduced later this year, for those more than 65. Can we consider these for patients who are younger and have chronic diseases? This is the group that is struggling much with out-of-pocket payments.”
“Mdm Chair, with the advent of the Pioneer Generation Package and other Government grants and subsidies which are more generous towards the elderly, especially those in the lower income groups, the amounts needed to be withdrawn by senior citizens from their Medisave accounts will be reduced. Hence, the burden on Medisave as a means of healthcare financing will be lower. I also welcome the introduction of the Flexi-Medisave scheme from April this year, which will allow seniors to further reduce out-of-pocket expenses. However, as I often call for during the COS, I would like to once again ask the Ministry to include more chronic conditions under the Chronic Disease Management Programme (CDMP). I have always felt that this is an excellent programme and that it should be expanded wherever possible. I hope the Ministry will review this once again this year. Including more conditions will reduce the cash outlay required and encourage patients to be more compliant with treatment. I would also like to renew my call for the CDMP withdrawal limit to be calibrated perhaps to the number of chronic conditions that a patient has. Thus, a patient suffering from three chronic illnesses should be allowed to withdraw more than a patient with only one chronic illness. Finally, in line with the ongoing review of the CPF system, I would also like to ask that consideration be made such that the Medisave Minimum Sum may be adjusted for the Page: 93 elderly, as they may have difficulty meeting this requirement following retirement. I have already said earlier on that because of all these schemes, the burden on the Medisave account will actually be less for seniors.”
“How many places are expected to be added every year and, of these, how many would be available for patients with dementia? The Healthcare 2020 plan had projected that 20,000 more healthcare professionals – including doctors, nurses, pharmacists and allied health professionals – will be needed between 2011 and 2020. Last year, the Ministry shared that 6,000 healthcare professionals had joined the workforce between 2011 and 2013. Were there any increases last year, and would the Ministry share details of the increases in the various professions? Data on Health Inequalities”
“Mdm Chair, I would like to ask about the progress of the Ministry's plans to build healthcare capacity, in terms of both manpower and infrastructure, across the whole of the healthcare delivery continuum. Deputy Prime Minister and Minister for Finance Mr Tharman mentioned in the Budget Statement that by 2020, we will be increasing the number of beds in acute hospitals by 25%, community hospital beds by 100%, and nursing home beds by 70%. In the five years leading to 2014, acute, community and nursing home beds had increased by a not inconsiderable 2,000 beds. Now, in a slightly longer time span, we are planning to add 11,000 beds altogether. This is a huge increase and I would like to ask the Minister to elaborate on how this number will be achieved, the challenges involved and strategies to overcome them. The opening of the new Ng Teng Fong General Hospital had been postponed by six months to July this year due to construction delays, and I am happy to hear that this is now all on track. But in the midst of tightening of work permits, does the Ministry foresee any issues with the construction of other facilities, including four new community hospitals at Jurong, Yishun, Sengkang and Outram which are opening this year, 2016, 2018 and 2020 respectively, and the Sengkang General Hospital slated for opening in 2018 and, finally, the Page: 89 12 nursing homes and six new polyclinics slated for end-2020? In view of our rapidly ageing population, I am also interested in the "one-stop" Senior Care Centres where the elderly can receive day care, dementia day care, rehabilitation and nursing services. How many centres are currently in operation and what is their total capacity?”
“I would like to ask the Minister how his Ministry intends to mould Singapore into a nation for all ages, and how we can go about changing the national conversation on ageing so that we bring about mindset shifts that reject ageism. [(proc text) Question proposed. (proc text)]”
“Are there plans to leverage on information technology or perhaps automated or mechanised technologies to provide access to good quality post-hospital care? There are already many countries which are experimenting with remote systems where caregivers can actually communicate with their charges over information technology systems, such as Skype or various forms of mobile devices. I think this would be a good way of trying to reduce the infrastructure and also manpower constraints or requirements of such care delivery. As a final point, I would like to ask the Minister for an update on the national plan he mentioned last year on addressing the needs of an ageing population. I have said previously in this House, and will reiterate this again, that an ageing population does not necessarily Page: 88 signify a crisis to the nation, unless we, as a nation, are unprepared for it. Think not of a "silver tsunami" but of a "silver boom" or a "silver dawn". Recently, a radio listener remarked that we have to change our attitude from regarding an older worker as "no good", to looking towards an older worker to show us "something good". And this is an admirable way of looking at this. A healthy senior may actually be more productive in both the social or work environment, than a younger but unfit person. Many discussions about age perhaps miss the point that perhaps the problem is not so much about age itself, but rather the overall fitness of the individual. Increasing age has typically been associated with increasing infirmity, but this paradigm can and should change if we all learn to live better and healthier from our youthful days.”
“The majority of patients with high cholesterol alone are generally well and have no symptoms, but billions of dollars are spent every year on medicines that reduce cholesterol, with the aim of avoiding or reducing the risks of getting a heart attack. Many of us take this as a truism. But, actually, controversies rage in the medical community about who we should treat, how much to treat, and given that all these drugs have their fair share of side effects as well, what is the actual value that these drugs have in terms of averting significant diseases? We will have more challenges and controversies of a similar nature in the future. Recently, there has been news about promising prospects for drugs that could soon be developed that would "cure" obesity. For such a drug, should taxpayer monies be used to subsidise the use of such a drug? What would be the true value of such treatment? And would it also abrogate personal responsibility for one's health? Let me now move on to my final area of concern. Another challenge concerns post-hospital care, otherwise referred to as the intermediate and long-term care sector. Nursing homes, day care, home care, rehabilitative services, these all fall under this broad category. Due to remarkable advances in medical treatment over the years, more and more patients are surviving horrifying injuries and previously what would be fatal diseases. But that does not necessarily mean that these patients return to their original functional state. More and more patients will need long-term assistance with daily living, and I hope that the Minister can comment on our plans to address the challenges in providing these services in a sustainable way, given our tight labour market and infrastructure constraints.”
“It has been previously suggested, of course, that, for example, if one does not see a doctor, then perhaps there could be additional top-ups to their Medisave accounts or perhaps additional rebates for MediShield Life. The idea against this no-claim bonus type of scheme is that it could deter some patients from seeking early medical treatment in order to receive more financial gains. I believe that this programme which I am suggesting would prove to be a good way to nudge more Singaporeans towards living healthily. After all, it can be argued that every dollar that goes towards health promotion and disease prevention would go much farther if that same dollar went towards disease treatment. The second challenge concerns how we can make access to health and medical information more equal and symmetrical. Empowering patients with the right information allows them to make better choices for themselves in regard to their own care, and this could help deter over-treatment and over-consumption. I would like to renew my call to the Ministry to set up a medical therapy and health technology advisory board, which can build consensus on the best available scientific information and provide easy-to-understand information to the general public on the merits of various types of treatment. Such a mechanism will become increasingly important in the years to come as treatments become more varied and complex, and also more expensive, Page: 87 hence, placing increasing cost pressures on healthcare spending. I also foresee more and more conditions becoming medicalised. This is not new. Having high cholesterol in the blood is one good example.”
“The Government Parliamentary Committee (GPC) for Health believes that the approach should be multi-pronged: firm or gentle, nudge or push. Firm pushes, such as legislation, may be necessary, for instance, in the arena of tobacco control or even eating choices. But we should be more prepared to try more gentle approaches as well. One of the central new proposals in this year's Budget was SkillsFuture with SkillsFuture grants and accounts, and Page: 86 this encourages Singaporeans to invest in themselves and in their careers. Should we not consider perhaps a HealthFuture scheme, with financial grants and a HealthFuture account which Singaporeans can use for health maintenance or promotion purposes? Should we not be encouraged, as a people, to invest in our own health, for now and for the future? This HealthFuture account would be a distinct entity, apart from our Medisave account. The HealthFuture account could take one of many forms. For example, it could be a unique account into which the Government, employers and individuals contribute. Or it can be earmarked from one's Medisave account, or perhaps even take the form of a tax credit. Singaporeans can make use of their HealthFuture credit to participate in healthy lifestyle programmes, such as smoking cessation or weight loss programmes, exercise classes perhaps in collaboration with ActiveSG, or use it for tailored health screening tests or health monitoring. Those that use their HealthFuture credits wisely and show consistent good health outcomes can receive additional credits, incentivising their proactive health choices. I just want to make it clear that this is different from providing financial incentives for Singaporeans who do not make use of medical services.”
“Madam, I beg to move, "That the total sum to be allocated for Head O of the Estimates be reduced by $100". Over the past few years, MOH has made significant steps to finetune the service delivery and financing framework for healthcare in Singapore. Primary healthcare flexibility and financing have been significantly improved through various schemes, such as the Community Health Assist Scheme (CHAS), the Pioneer Generation package and, more recently, Flexi-Medisave. 3.00 pm Infrastructure as well has been improved with initiatives, such as Family Medicine Clinics and Community Health Centres. The capacity and capability of our hospitals have also been steadily improving, reducing concerns about the bed crunch, with more acute and community hospitals coming online in the near future. Nursing home capacity and quality have also been resolutely raised over the past few years, and we look forward to the formal roll-out of MediShield Life next year. This grand vision of the direction in which healthcare in Singapore is heading was outlined a few years ago under the Healthcare Vision 2020 Master Plan. If I may be so bold, I would like to first ask the Minister to share with this House his vision for healthcare in Singapore beyond 2020. Beyond lingering concerns about how we can continue to afford and sustain healthcare spending, and in spite of what has been achieved thus far, I see three key challenges in the decade ahead and beyond. The first challenge is how to empower and encourage our citizens to live healthier and to live better. We all recognise the importance of keeping healthy and disease prevention, but walking the walk is far more difficult than talking the talk. How do we get our people to make healthy life choices?”
“Mdm Chair, entrepreneurs have highlighted the increasing cost of doing business in Singapore, as have many SMEs. And according to the 2014 SME Development Survey that was conducted by DP Information Group, which covered about 2,800 SMEs, about half, or 48%, of the businesses cited high manpower costs as their top business concern and one-third, about 31%, cited high rental costs as the other main problem. In a separate survey conducted by the Singapore Chinese Chamber of Commerce and Industry last year, 83% of SMEs surveyed struggled with increasing business costs. This was an increase of 8% over the same period the year before. Almost half also faced thinning profit margins. The main contributing factors were – as one would expect –escalating manpower, land and rental costs. Another problem that I would like to bring up here is this issue of increasing compliance costs, such as licence fees, which are increasingly becoming a significant business cost and concern in Singapore. In our tight labour market, the problem of increasing manpower cost will not be solved anytime soon. I would like to ask the Ministry what the Government is doing to ensure that Singapore remains a cost-competitive and business-friendly environment. In addition, what measures will the Government implement to encourage more SMEs to access schemes and grants to help them grow? Consumer Protection”
“What are its strategies to leverage upon Singapore corporations' reputation as a trusted brand associated with reliability and high quality? Does MTI have specific plans for different sectors such as food, education, retail, environmental services, technology and info-communications? And, finally, will the Ministry care to share if there are targeted approaches to assist companies in different markets, particularly our big neighbours such as China, Indonesia and India? Jobs through Internationalisation”
“Mr Chairman, our local businesses must globalise in order to grow and remain relevant. Our homegrown companies still have a long way to go internationally, both in terms of the size of their businesses and geographical coverage. However, we should not let our small size or population limit our capacity to build world-class companies with strong brands. We have a few non-Government-linked firms which have done us proud – Creative, OSIM and Hyflux are examples that come to mind. With the Government's support, I am sure we can achieve even more of such successes. Many small countries have succeeded in building strong global companies and brands which compete with companies in bigger countries with more experience in their sectors. Page: 161 It is time that more of our local companies expand abroad. Besides the greater potential for revenue and profit growth, they can achieve higher productivity and develop new capabilities. We have just heard several Members discuss productivity, Government data over the past five years have shown that sectors with presence overseas enjoyed annual average productivity growth of over 5% compared to below 1% for those focused on our domestic market. IE Singapore's Year-in-Review reported that 50% of our SMEs now have overseas revenue and interestingly, even more are interested in markets beyond our shores. I appreciate the measures announced by the Minister to support companies looking to expand abroad. These include increase IE's schemes, the enhanced Double Tax Deduction for Internationalisation (DTDi) Scheme and the new tax incentive, the International Growth Scheme. However, I would like to ask how MTI will help our businesses capture opportunities in overseas markets specifically?”
“Let me just move on to a proposal that has been brought up in this House before and for which I would like to take up again. I would like to suggest that perhaps it would be worthwhile to look at defining or at least discussing, what the living wage in Singapore would be like in greater detail. This would be helpful not only in guiding Government assistance schemes or wage recommendations, but also to provide a frame of reference whereby we can engage in a more considered debate on how well or how poorly we are faring in regard to coping with living costs, relative to our income. We do have a lot of statistics about median household income and median household expenditure and so on, but these should not be Page: 72 taken as a surrogate of what is truly necessary to live decently in Singapore. Let me end by saying that this year's Budget is what I believe to be a bold one; it is a pragmatic one in providing for the present while still building for the future. The increase in Government spending has raised some eyebrows, but I believe that we need to continue investing in ourselves while still keeping a watchful eye on the bottom line, or we risk all that we have built up over the past 50 years. I support the Budget. 3.10 pm”
“While I fully support its aim to strengthen our social support network, like other Members of this House, I do have some concerns about its long-term sustainability. I am happy that the eligibility criteria appear to be more flexible and take into account not just what is the housing type but also things like household support and an individual's lifetime wages. But it is important to note that unlike the Pioneer Generation Package, it is to be a permanent scheme for the seniors of today and also for every cohort thereafter. Given the stark demographic reality of an ageing population, a shrinking tax base and a more sedate pace of economic growth, this would represent an increasing burden for Singapore. We already have a lot of other Government transfers, with Workfare, the permanent GST Voucher scheme and so on. Perhaps, we can look into how these other schemes could be better integrated into this Silver Support Scheme. It could help with reducing confusion among the population and even duplication. My last concern regards the situation of the average Singaporean, perceptions about the cost of living and all the debate that surrounds these issues. We have done well to grow our economy and provide opportunities for all Singaporeans, but most of us will accept that this landscape cannot be one of absolute parity. It is not easy to address the unhappiness over the competitiveness of modern living and the perceived cost of living well in today's society, though some would argue that we would do well to harness such sentiments to create an even more vibrant Singapore. But I say it is difficult to address such perceptions, partly because I think it is not easy to set up a good way of studying this problem.”
“Some may question the prudence of spending so much on something so intangible, but it is worthwhile to remind ourselves that we have always prided ourselves on our people being our most valuable resource. If so, then, surely, there is no better sense than to grow our best asset. Many successful businesses have acknowledged the value of being a learning business, a learning corporation. But it is also important to appreciate that being a learning organisation is not just about sending your staff or your employees for courses, one after the other. But it is also about developing the right learning culture and mindset among the employees. So, if we aspire to be a learning country, a learning nation, then beyond just being able to provide more support for our people to go to courses to upgrade themselves, I think effort must also be put into ensuring that we create the necessary mindset for a truly learning nation. It is important that if we are to remain competitive globally with a robust knowledge-based economy, it is critical that we never stop learning and adapting. Page: 71 Having said this, I would like to raise some concerns and ask for some clarifications on the SkillsFuture initiatives. First, what would be the selection framework for the recipients of the Awards and the Fellowships and how would the type of courses and fellowships be regulated? I am concerned that this might lead to the mushrooming of different courses or fellowships of widely varying merit, which may not necessarily translate into giving our workforce the right training for the right circumstances. Let me now turn to the Silver Support Scheme.”
“Mdm Speaker, I am happy to open with the observation that even as we celebrate 50 years of nationhood, this year's Budget firmly looks forward to building our nation for the next 50 years. I do applaud the expansionary intent spelt out in the Budget Statement that was made last Monday. I would like to just focus on three areas. The first concerns investing in future-proofing Singaporeans for the global workplace and investing in our workforce in SkillsFuture. As I was listening to the Budget Statement last week, it came to this bit about the new SkillsFuture initiative. It brought to mind the fact that my father had just two jobs in his lifetime and for our first television set at home – which was a Citroen – we had to wait about one decade, about 10 years, before they came up with the next model and they promptly ran out of business after that. Perhaps, that is telling. If we look at the situation today, the average Singaporean that enters the workforce would have had probably two jobs or more, by the time he reaches the ripe old age of 30 and could have changed at least twice as many mobile phones over the same period. The point is that employment is no longer as constant as before, either by design or by volition and product cycles get shorter by the year. What we learn over the past few years may not be sufficient to keep us relevant over the next few years, in an increasingly fast-changing global economy. It seems like a cliche, but the only constant thing in today's world seems to be change and Singapore has to be equipped for change. I support the moves by the Government to increase our investment in our people through the SkillsFuture initiatives.”
“MediShield Life is, indeed, many things; it is many good things, but it is not about abrogating our individual responsibility for our own health and the health of our loved ones, it is not about the complete freedom to utilise health services as we choose. But what it is about is to afford us peace of mind so that even as we take positive steps to safeguard our health, should a medical catastrophe strike us or our loved ones, then we can be assured that we will have the medical treatment that we need, regardless of our circumstances, Page: 52 young or old. With that, I support the Bill. 2.03 pm”
“This ability to determine which treatment is allowed under the Scheme is already stipulated, as I note under clause 34(c) of the Bill. What I am advocating is that whether a treatment is covered by the Scheme should be based on scientific merit and, if this treatment is actually effective, then the Scheme should endeavour to cover it, regardless of the cost. The strong safeguards that we need are necessary to guard against this moral hazard of over-consumption, whether it is from the demand side by patients, or from the supply side by healthcare providers. My final point of clarification is a short one. I do know of many elderly residents, most of whom are Pioneers, who have never been covered under any medical insurance scheme and also have incomplete medical records. These residents or these citizens may sometimes encounter challenges going for a thorough medical review. I would like to seek clarification that these citizens can be automatically included in the scheme with the assumption that they have no pre-existing illnesses. Finally, I would like to conclude with just a brief comment on what MediShield Life does not cover. While improvements in coverage for outpatient cancer treatment and also for kidney dialysis are very welcome indeed, various aspects of intermediate and long-term care still face challenges in financing. As raised on previous occasions, our ElderShield system is still limited in its benefits in terms of its scope and schedule, and I hope that the Ministry will continue to look into these areas, beyond MediShield Life, since there is a continuum of care from the hospital all the way back to the community.”
“Our Government Parliamentary Committee (GPC) for Health has previously raised this issue about a need to more rigorously evaluate medical treatments and technologies, so that we can better control costs, and this perhaps can be better facilitated when we have a single payer system such as MediShield Life. In healthcare, as it is in many other aspects of life, expensive does not always mean better. As a doctor in Government practice myself, I find that some patients still feel suspicious or short-changed when they are given a medication which they feel is significantly less expensive than what they feel it should be. Often, this can be easily explained because of Government subsidies or because the patent for the original drug has expired, or perhaps a cheaper but better drug has been found. Page: 51 Another example is that of patients requesting for complex scans when the need is not supported by medical evidence, or asking for the newest procedure when older ones are measurably more effective, more reliable and more affordable. This is as much a challenge of public perception as anything else, but it is a reality and it will, nonetheless, continue to put pressure on healthcare providers and subsequently upward pressure on medical costs. Hence, I hope that the Minister could clarify a little bit further – I know he has already done so – on the roles and functions of the MediShield Life Council, as defined in clause 8 of the Bill. I understand that the Council will advise the Ministry on the parameters of coverage, and I hope that there will be robust mechanisms to evaluate what treatments are deserving of coverage, regardless of how much it costs.”
“All Singaporeans, as I understand, will also benefit from Premium Subsidies for the first few years after the roll out of MediShield Life, so as to allow time to adapt to the moderate increases in premiums from the Basic MediShield. It is also reassuring to note that most Singaporeans will be able to pay for their premiums completely from their Medisave accounts alone. Nonetheless, I do not think it would be unreasonable for us to ask the Ministry and the Government to consider expanding or increasing these subsidies, particularly for the vulnerable groups. And also for the majority of all other Singaporeans, I hope that the Transitional Subsidies Scheme can perhaps be looked at and extended beyond the first five years and perhaps even increased as this would soften the transition further for Singaporeans as they ease from MediShield to the universal scheme which is MediShield Life. My second concern concerns the change from the MediShield or the Basic MediShield system to a universal single payer national insurance health scheme. Notwithstanding the availability of integrated plans by various private insurers, this represents a pivotal shift in the way healthcare is delivered and paid for in Singapore. And although Singapore is well poised for this change as most Singaporeans already have MediShield and have MediShield accounts, from which they can service their premiums, the sustainability and affordability of such an ambitious scheme as MediShield Life will come under increasing pressure in the years to come, as our population grows older and our tax base shrinks, and also when medical technology becomes more expensive and perhaps if demand surges.”
“Mdm Speaker, for a young nation such as ours, just now maturing gracefully into our 50th year of independent existence, we should be justifiably proud of what we have achieved in terms of safeguarding the health of our citizens. In terms of health outcomes, no matter what measure you look at, in many independent surveys around the world, Singapore has always ranked quite high. So, by any measure, we are a nation of healthy people. But healthy people do and can fall ill and, sometimes, they fall ill very seriously indeed. When this happens, this is where MediShield Life or any form of medical insurance steps in. MediShield Life represents another significant step towards ensuring that Singaporeans have continued assurances with regard to their medical needs, specifically in the unfortunate event when they face a major illness. I warmly support this Bill, as I have done when the Scheme was first mooted and was later debated in Parliament last year. I do have three areas with regard to this Bill for comment, consideration and clarification. The first actually concerns the scheme itself rather than the Bill specifically and return to some lingering concerns about premium affordability. We appreciate the raft of measures to health affordability that the MediShield Review Council and later the Ministry of Health (MOH) has adopted, and which has just been detailed by the Minister in his opening speech earlier. There are the Pioneer Generation subsidies and grants for our Pioneers. Aside from these, there is a further $4 billion being set aside for financial assistance, particularly for Page: 50 those with low income and who are in particularly vulnerable positions.”
“I thank the Minister of State for her very comprehensive reply. I have two supplementary questions. First, I would like to ask whether or not the Ministry has any data on what is the prevalence of such complaints of a similar nature, maybe over the past few years. Secondly, even in the absence of some sort of regulatory framework at this point in time, I was wondering whether the Ministry would consider having some sort of feedback or surveillance mechanism to get an idea of this problem. In Page: 12 this particular case, it was brought to the attention of the public by a young person who is quite active on social media, but there could be many other Singaporeans who may feel offended and may not have a proper way of airing their concerns or grievances.”
“As such, what we are thinking is that we will continue to enforce such an action and step up action, so that at the end of the day, we want to protect our fellow Singaporeans and everyone here in Singapore from the health risks associated with shisha smoking, because we care for their lives.”
“Sorry about that. I have got two supplementary questions. The first is in relation to part (b) of my original Parliamentary Question (PQ). I am also mindful that with the widespread use of shisha – there are many retailers out there – I would just like to know whether there is any idea about how prevalent the retail sector is, in terms of sale of shisha, and how they might be affected by this ban. The second supplementary question is, in view of this transition period, I would like to hear a bit more about the details of this transition period, whether there is a risk that some of these retailers might stockpile stocks of shisha and whether there are any specific measures that we might look at to prevent illicit use or sale of shisha during this period. Assoc Prof Dr Muhammad Faishal Ibrahim: Madam, I would like to thank the Member for sharing with us his perspective as a medical doctor and also for his supplementary questions. For his first question: as at 31 October 2014, there are 16 licensed shisha retailers. They are located in Boat Quay, Capital Square, Clarke Quay, Kampong Glam and Holland Village. Essentially, we have provided that transitional period, so that it can help them to deplete the stockpile that they have and also to see how they can find ways to restructure their business model. We have developed a regulatory as well as enforcement framework among Health Sciences Authority (HSA), NEA and Customs to see how we can work together and look at how we can regulate some of these activities by the retailers. We understand the Member's concern about stockpiling and we are mindful of that.”
“I wish to thank the Parliamentary Secretary for his reply and I am very heartened to hear about the stronger measures that the Ministry is going to take against the use of shisha. The Parliamentary Secretary has quite correctly pointed out the two greatest risks: first, the misconception that shisha smoking is fairly innocuous whereas there is an increasing body of evidence which tends to show that it may be as dangerous as the normal forms of tobacco smoking. The other big concern is, of course, it Page: 18 might be a gateway to —”
“Mdm Speaker, I would like to thank the Minister of State for his reply. I am sure the Minister of State would agree that the greatest threat to us now would be the import of an Ebola case. I am heartened by the announcement that there are some new visa requirements. Two supplementary questions from me. First, with regard to the just-announced visa requirements, I know it is a bit early, but I would like the Minister of State to comment on what he feels is the efficacy of such a move and whether a more comprehensive travel ban might be a better move. Maybe a total travel ban from the affected countries, at least until the so-called backbone of the epidemic has been broken. My second supplementary question refers to whether or not there is any consideration for a travel ban for Singaporean nationals travelling to affected countries for non-essential reasons.”
“I thank the Minister for his very comprehensive reply. I have two related supplementary questions. The first is, I was hoping the Ministry could give us an idea of the quantity of services of a similar nature which are outsourced. Because I understand this lapse was due to the fact that it was handled by external agencies. So, the first is, perhaps, we could get an idea of the extent to which such types of services are outsourced. And number two, whether the Ministry is actively looking into ways of either reducing the amount of outsourcing that it is using or to maintain the same level, but looking at a more robust way of managing or surveying these outsourced services.”
“I just have a quick question: would the Ministry consider expanding the qualifying criteria for, let us say, Medifund, for these services for those who are truly in financial need?”
“I thank the Minister for his comprehensive reply. I just have one supplementary question, which is also more of a suggestion. I understand, for certain types of make-up pay, the NSmen get a notification telling them the amount paid, when it is going to be paid and so on. I was wondering whether the appropriate agencies will look into such a notification system for those who have smartphones or maybe through email alerts, so that the NSmen can be more aware when these things are paid. Of course, if the amounts are wrong or if there is no payment, then the NSmen will be aware of these lapses. I was wondering whether MOM could coordinate something to look into this form of Page: 19 notification system.”
“As the saying goes, "It takes 10 lifetime's efforts to sit on the same boat and 100 to become a couple" – to meet and become a couple is, indeed, a destiny which we must cherish. I hope Singapore couples can all understand this and treat each other sincerely. I support this Bill. 3.29 pm”