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 6 of 7.
“Currently, for Singaporeans and PRs, only a couple aged between 18 and 21, or if one of them is below 18, have to go through marriage counselling before they can get permission from the Registry of Marriages (ROM) to marry. I suggest all couples applying to get married must attend pre-marriage counselling courses. The courses will help them understand the importance of marriage and parenthood. Some people might feel that getting married itself is already complicated enough with the preparation of the wedding banquet, applying for a flat, selecting a honeymoon package and health check and so on. Having to attend the compulsory marriage counselling course would be too troublesome! I would say that attending the pre-marriage counselling course is as important as learning how to drive before you can drive safely on the road. The most basic consideration is to avoid accidents. The courses can prepare the couples psychologically so that they can cope with challenges in their married life. Many couples spend a huge amount of energy planning a grand wedding. In recent years, this fad has become even more extravagant. The venue, menu, bride's car, wedding gown and suit, and jewellery have to be carefully selected. Some couples even borrow money to have a dream wedding, resulting in financial difficulties later. Actually, the most important is to affirm feelings for each other and know his or her personality, character, values, purpose of life and family background. They must reach mutual agreement in terms of how to handle money, raise children and live with other family members; otherwise, they would surely quarrel frequently after getting married. These should be the things that must be prepared carefully before marriage.”
“Family Courts and Youth Courts under the State Courts, as well as the Family Division of High Court, will all come under the Family Justice Courts to improve the efficiency of family justice administration; (b) strengthen the case management process; empower the Courts to adjudicate and resolve family disputes more effectively; (c) couples with under-aged children will have to go through compulsory counselling before proceeding starts, so that they understand the impact of divorce on their children; (d) appoint children's representatives or social workers to attend the Court proceedings so as to better protect the children's interests in the divorce process; (e) a judge-led approach to reduce acrimony and disputes; (f) family justices cases will go through different tracks depending on their different nature to ensure trial efficiency; (g) introduce a new accreditation framework so that trained lawyers can become qualified family justice practitioners; (h) strengthen social services by setting up four branches specialised in divorce in addition to the current three branches specialised in family violence to provide dispute settlement and counselling services. I support all the above recommendations. I think the Committee has taken into consideration a wide array of issues both within and outside the legal boundaries. I have one suggestion, however. Although it does not come under the ambit of the Family Justice Bill, it relates to marriage. I raise this issue at today's debate hoping that the Minister can give it his serious consideration. Page: 54 To reduce the likelihood of a marriage ending up in divorce, we must improve our marriage counselling system.”
“There are also a small number of dysfunctional families. Leo Tolstoy said in the very beginning of Anna Karenina that all the happy families are similar but unhappy families have their own unique problems. Our elders also say every family has some difficulties to deal with. Divorcees or people in the midst of divorce proceedings come to see me at the Meet-the-People Sessions, usually seeking help in accommodation, finance and children's education. Some bring their children along to see me. The confused, tired and helpless look on an innocent and young face makes my heart ache. As the saying goes, "Even an upright official can't settle a family quarrel", as the reasons behind a divorce can be complicated and it will not be easy for relatives, friends or even Members of Parliament to try to mediate. The Government can only provide more marriage and family counselling services and improve Page: 53 legal processes to prevent the escalation of conflicts and reduce the anguish of family members. The main recommendations proposed by the Committee for Family Justice led by Senior Minister of State Indranee include the following: (a) establish the Family Justice Courts through the new Family Justice Bill.”
“Thank you, Mdm Speaker. In Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Statistics released last week by the Department of Statistics (DOS) showed that divorce cases in Singapore rose 4% last year compared to two years ago. Divorce cases have continued to rise over the years from 1,721 in 1980 to last year's 7,525, a 4.5 times increase in 34 years. This is a very worrying trend. The family is a country's foundation. A broken family is not just a personal problem, but also a country's problem. As the saying goes, "A peaceful family will prosper"; with a harmonious family, people can work and study with peace of mind and their business would be booming. As a result, the country would prosper as well. To protect and strengthen the family ties, the Government has always been promoting pro-family lifestyles by formulating pro-family policies and measures, such as giving newly wed couples preferential treatment. The problem is, it is easy to fall in love but difficult to live together. American writer John Gray has used the euphemism of men being from Mars and women from Venus to describe the differences between men and women. These differences can cause misunderstanding and relationship issues. To overcome various issues arising from a marriage, even the most loving husband and wife must remain enlightened and understanding, care for and support each other to ride over times of difficulty. I am pleased to see that most Singaporean families are able to withstand pressure. When I visit households, I often see touching scenes such as loving aged couples, devoted kiasu parents and multi-generation families living in the same block or area. Having seen so many people savouring the joy of family life, I can feel its value and importance strongly.”
“" To which they said, in Cantonese, "Yut Fai, Yut Ho", that means "Make it faster". And they all said, "You know, as we are already old and we have been waiting for this for some time, we want to move into our new houses as quickly as possible!" Moving on, I then took the opportunity to ask them if they had heard of the Pioneer Generation Package and MediShield Life. Well, again, quite reassuringly, all of them had heard about it. And one lady in her 70s, well and truly one of our Pioneer Generation Singaporeans, immediately pepped up, tightened and said, "We want the same for MediShield Life, Dr Chia. Make it as fast as possible. Yut Fai, Yut Ho", and the reason was so that all of them could feel calmer "Onn Sum", which, in Cantonese, is to be calm in their hearts about this. So, on behalf of these residents of mine and from my perspective as well, I do support this Motion very strongly, and hope that MediShield Life be implemented as soon as possible, so that from cradle to grave, Singaporeans can have the assurance that they will have little to worry about hospitalisation expenses. Health insurance for all and for life is yet another major step towards building a truly inclusive Singapore. 4.41 pm Page: 69”
“I hope that employers, insurers and the relevant agencies can move quickly to make corporate health Page: 68 plans more portable, or companies can move towards strategies where employees are reimbursed for participating in their own medical insurance plans or, perhaps, even through additional Medisave contributions which can be used for the payment of MediShield Life premiums, a scheme which I note the Civil Service has already implemented for some of its employees. The Labour Movement and NTUC should also be applauded in this regard because they have long called for employers to adopt portable medical benefit schemes for their employees. Given the changes introduced by MediShield Life, I would like to join the unions to urge our employers to review and revise their current employees' medical benefits to one that is much more portable and much more flexible. Such moves would reduce the burden of premium payments for many of us due to the duplication of medical insurance policies. In closing, let me just share a recent experience that I had with some of my residents. An en-bloc redevelopment programme was recently announced in Tanglin Halt, which sits in my constituency of Queenstown. It is something that many of the residents there have been asking for for many years and, although they were happy staying there, the buildings were old and needed frequent maintenance, and further major upgrading was not practical. Walking around Tanglin Halt last week, I stopped to chat with a group of seniors to see if they had any concerns. Thankfully, they said, "Well, not much, Dr Chia, we have been waiting for this for some time and we are glad that it is finally happening." So I asked, "Anything else you would like? Anything I could help you with?”
“While I do not quite support the provision of such incentives at this time given our current healthcare environment, I think it is still important that premiums for Integrated Plans, or IPs, to remain affordable, so that more Singaporeans can enjoy greater flexibility in making healthcare choices beyond the basic level of care offered by MediShield Life. I fully agree with the Committee's recommendations that such plans should be more greatly simplified and standardised and that the Government or the Ministry should take a more active role in scrutinising and regulating these plans. Finally, I remain concerned that the continued lack of portability of employer-provided medical benefits leads to relative over-insurance. I am sure that many in this House may have duplicate medical coverage and these are health plans provided by our employers. This coverage that is provided by our employers ceases once we change employment, and this is a source of distress and anxiety for many Singaporeans. However, according to estimates, currently, only about one in 20 employers provide portable health insurance for their employees, despite there being tax incentives to do so. When MediShield Life is launched, all of us will be covered under MediShield Life but many of us will still choose to take up an Integrated Plan as mentioned before.”
“However, when all has been said and done, at the root of everything and the best way of restraining healthcare spending and keeping premiums low is simply for all of us to remain healthy. We have to focus on health promotion and maintenance and stay focused. MediShield provides protection mainly for catastrophic illness that requires hospitalisation and some have asked for MediShield Life to also cover more health protection services such as health screening. Though I do support the general principle, I am not sure that MediShield Life should be the key funding avenue for such services and I feel that the Government should continue to support health promotion actions through other schemes and incentives, which I know it is already pursuing today. One quick word on private and integrated insurance plans. Although it was not the remit of the Review Committee to look at these plans, I do applaud their initiative in making some recommendations in this regard. This is because over 60% of Singaporeans hold such plans and they provide additional medical insurance cover for those who value greater choice and flexibility in their healthcare options. There are many countries which actually encourage their citizens to take up insurance cover from private medical services by offering rebates and other incentives. This is because their philosophy is that public hospitals should just focus on emergency work, low-income patients, very complex cases, and education and training.”
“The renal dialysis and mechanical ventilation rates, that means where doctors put a tube down into your lungs to help you breathe, are among the highest in the world although this does not seem to correlate with the calculated disease burden in that country. The point is this – and as what our Health Minister has also just pointed out – more is not always better and healthcare use should be based on rational decisions and on outcomes. This leads to my next point – which is another factor that could unexpectedly and significantly increase healthcare costs – the introduction of costly new treatments and procedures. It is important that such novel treatments be rigorously validated before being approved for widespread use and reimbursement. Many countries establish expert panels that help make such decisions about the value of such treatments, such as the UK's National Institute for Health and Care Excellence (NICE) which helps decide which treatments would be allowed under the Britain's National Health Service. Currently, the Health Sciences Authority (HSA) in Singapore grants approval for the use of drugs and medical devices. But HSA looks mainly at safety and basic efficacy. We do not yet have a central body that evaluates the true efficacy and value of medical interventions, from a best practice and cost-effectiveness perspective. I would ask MOH to consider the establishment of an independent body for this express purpose, to make recommendations concerning the sustainability of various treatments. Such an independent panel would also serve the wider objective of informing Singaporeans and deciding on the treatments that Page: 67 truly make a difference.”
“Since clinic Page: 66 visits and, in particular, medication costs are covered under this NHI insurance scheme, many Taiwanese would go to their nearby medical clinic just to obtain medications that one would normally purchase either from a pharmacy or a nearby supermarket. Moreover, they would also tend to see their family physicians for minor ailments, such as small aches or minor coughs and colds, whereas patients in other countries would normally choose to observe and self-medicate. Patients with such typically self-resolving problems often expect to be prescribed antibiotics even when there is no medical requirement for them to do so, or doctors feel pressured by their patients for these antibiotics to be prescribed, since failure to prescribe is viewed by patients as belittling their medical problem and as inadequate care. And if they do not do so, then the doctor gets the reputation of being a poor doctor and the patient moves to another clinic or doctor. Aside from driving up healthcare spending to unmanageable levels, this has also led to a public health crisis because Taiwan now probably has one of the highest antibiotic resistance rates in the world due to the overuse of these powerful antibiotics and new prescription guidelines do not seem to be of much help. Furthermore, hospitals in Taiwan have become increasingly procedure intensive. Government hospitals in Taiwan have limited federal funding, since an increasing amount of the national healthcare expenditure is being channelled to fund claims under NHI. As such, hospitals and clinics seek to generate more revenue by just increasing the number or volumes that they provide.”
“Despite this, it is certain that there will be some individuals and families who might still have difficulties with premiums, and I am heartened by the Minister's reassurance in this regard, that help will be available. However, keeping MediShield Life sustainable and keeping premiums affordable should not depend on enduring Government subsidies. Rather, the focus should remain on keeping medical costs low and keeping everyone healthy. Universal and more comprehensive medical coverage, particularly in the fee-for- service system such as that found in many countries around the world, runs a very real risk of fuelling over-consumption and inappropriate use of medical services. In Taiwan, they launched their National Health Insurance (NHI) programme in 1995. NHI bears many similarities to MediShield Life, such as mandatory enrolment and comprehensive lifelong cover, but it also covers outpatient care, for instance. NHI began with much fanfare but four years after its inception, it started to sink into deficit, and it has been sinking rapidly ever since. In fact, two years ago, it narrowly avoided bankruptcy and with debts of very close to US$5 billion, it may not be so lucky to escape insolvency the next time round. One might ask how did this happen? Well, there are many reasons for this, such as a stagnant economy and more familiar themes to us such as a rapidly ageing population with declining birth rates, but inappropriate utilisation of healthcare services figures fairly prominently as well. The Taiwanese record one of the highest per capita clinic visits in the world, but they are not significantly healthier than citizens of other nationalities.”
“The Canadian public care system, for example, has budget limits on elective procedures and this affects waiting times for such procedures, whereas the wait for some types of surgical treatments in Australia under the public system can be over a year in some regions. What this does is that it spawns dual track systems where private medical services become increasingly in demand and can command increasingly exorbitant fees due to a lack of alternatives. This paradoxically leads to over-coverage: citizens in these countries already pay a premium in taxation to help fund these social healthcare systems, yet they feel increasingly compelled to purchase private insurance plans to obtain more choice with respect to medical treatment. You end up paying much more if you feel that having more Page: 65 choice and more control over your medical destiny is important to you, and many people do, in fact, feel that way. Following the announcement of MediShield Life with its improved coverage, many were understandably concerned about how the new premiums would turn out. Reassuringly, the Review Committee has recommended fairly moderate premium increases, and I say this because it has to be taken in the context of the slew of upgraded benefits: lifelong coverage, removal of lifetime claim limits and markedly improved co-insurance terms. The announcement of both fixed and transitional subsidises by MOH has further moderated premiums quite significantly and, together with the increase in employer Medisave contributions, ensured that almost everyone will be able to service premium payments through Medisave alone.”
“But it is prudent to be cautious and we should cast a wary eye towards the experiences of other countries that have similar national health insurance programmes, all of which had glittering starts but are increasingly mired with the same healthcare problems they were originally designed to circumvent. Taking one step back, some have asked: why bother with a national medical insurance at all? Why not have a social public health system where the majority of medical services are provided at minimal cost, or perhaps even free, such as in Hong Kong or in the UK? There are several problems to this approach, however. First, and I think we all acknowledge it, such systems are very expensive to maintain; and second, such systems can be relatively inefficient in that emergency services are relatively well addressed, but non-emergency medical services and highly specialised care, which comprise a large proportion of hospitalisations in developed nations like ours, tend to be quite severely rationed and can be of uneven quality. Some of us might have read or heard of starry-eyed accounts about how someone residing in or visiting such a country had some sort of a medical emergency and was whisked in and out of a hospital having to pay just a token amount of $30, $40, or $50. The flip side – and there is always a flip side – would be the many unhappy accounts by irate patients waiting lengthy periods for elective procedures by anonymous medical teams. Put it another way, if you break your leg, you are probably quite well off in such a system, but if you need your gall bladder taken out, a stone removed or hip replaced, you would probably be less enthusiastic about the options.”
“And it is also right and proper that the Government provides the assurance to all Singaporeans such that the revised premiums are affordable and promises that special provisions be made to help citizens and their families who may still find difficulties with some of the payments. The Pioneer Generation Package that was recently announced, provides a massive boost in this respect as our seniors face the highest potential premiums yet possess little in their Medisave accounts. Many have spent their most productive working years before the introduction of either Medisave or MediShield. Concerns do remain. Will the improved benefits meet the present and future needs of Singaporeans in an evolving healthcare landscape? Will this grand insurance scheme be both sufficient and sustainable, given that both advances in healthcare and demand for healthcare can be unpredictable? Will we be able to keep premiums in check and keep premiums affordable by all over the next decade or so? Will we be providing too much, too quickly and running the risk of over-consumption? And will such a generous scheme encourage greater abdication of personal responsibility for one's health? Page: 64 I have reason to be optimistic. The 3M financing framework that has been built up over the past few decades, and as mentioned, a world-class healthcare system and a resident population whose health is world leading, provides a firm foundation for MediShield Life to remain relevant and robust for the next decade and beyond.”
“When we look more closely at this group of patients, it appears that, well, they either did not have MediShield or had conditions that were not covered under their existing policies, or their bills were very large due to the complexity of their conditions Page: 63 and the length of their hospitalisation, such that the coverage they already had under MediShield was insufficient, and there was also not enough in their Medisave accounts to cover the deficit. We also noted that there was a very small but, still, a number of elderly patients who had dropped out of MediShield as the premiums had gone up too much for them in their older years. The announcement of MediShield Life which promises more comprehensive and much improved coverage for everyone and for as long as he or she shall live, should address most of these concerns, and I warmly support it. I wish at this junction to record my thanks to the MediShield Life Review Committee for their efforts towards making MediShield Life a reality. It is evident from their comprehensive report that they have taken a lot of care and time listening to ordinary Singaporeans from all walks of life, as well as to healthcare insurance professionals, and have managed to somehow synthesise these myriad suggestions and concerns into a practical package that should serve our future healthcare needs for years to come. Under MediShield Life, the inclusion of all Singaporeans, regardless of pre-existing medical conditions, is an exceedingly bold rule that promises to build a more equal and inclusive society. It is right and proper that the Government steps in to bear the majority of the huge costs required to make this happen.”
“Mdm Speaker, we have one of the best healthcare systems in the world and we are one of the healthiest countries in the world, if not the healthiest according to recent surveys. But despite this, Singaporeans are concerned about medical costs, particularly when treatment in the hospital is required. Singaporeans are not alone in this regard because even in countries where medical and hospital care is by and large free, their citizens are also worried about healthcare costs. I will touch on this seemingly paradoxic observation later. All of us here, I am sure, hope to be remain healthy and never see a doctor, let alone the inside of a hospital ward. Most of us strive to remain healthy, but illness is unpredictable, and the cost of treating illness is difficult to plan for. So, this is why we have hospitalisation and major illness insurance, such as MediShield, to give us peace of mind. In August last year, the Government Parliamentary Committee for Health made recommendations regarding how MediShield could be improved to give better peace of mind to Singaporeans for their hospitalisation expenses. We noted that after Government grants, over 90% of patients seeking subsidised care in Government hospitals had bills that could be comfortably addressed by both Medisave and MediShield, with many not requiring any upfront cash payment at all. There still remains, however, a small but significant number of patients who have difficulties with their hospital bills. Why is this so?”
“So, if we focus on this good piece of news, then it will be easier for us to understand that because we are all living longer, we may then need more in our CPF accounts to prepare for this longer period of life. The President called on us to keep Singapore Special and Unique, by being "united in engaging our hearts and minds". I am confident that Singaporeans will work together to make this so and grow from strength to strength, staying Happy, Healthy and with Hope in the Home we love and with all our Heart. With this, I support my colleagues in this Motion of thanks to the President. 1.46 pm”
“Presently, we have alarm systems in some homes which can be activated in case of emergency, but there may arise situations when the resident is unable to activate this system. There are now simple, cost-effective monitoring systems which require no deliberate actions from the resident. For instance, many of us now use wearable technology, such as these little armbands that help our activities during the day. There are sensors that detect movement and appliance use, or the usage of electricity and water within a given home. These smart systems may be used to alert the community when something of concern might have occurred to a resident who lives in that home but, at the same time, these systems are relatively private and relatively unobtrusive. A final point I wish to make is that, aside from the hardware and the software that are needed to make our society senior-friendly, the Government has to maintain its effort to engage and communicate with seniors. The Pioneer Generation Package is a wonderful programme and it is heartening that the relevant Ministries have really gone all out to reach out to these seniors to explain what it means to them. However, judging from recent feedback from the ground, some seniors are still unsure of other Government policies, such as the periodic raising of the Minimum Sum Page: 13 requirements for CPF. I would submit that, perhaps, it would be worthwhile to turn these stories on their head and to focus on the fact that the key reason why we are doing this is because, as a nation, we are more healthy and the average life expectancy has risen.”
“The President, in his speech, noted that our seniors did much to build today's Singapore and deserve our full support, and we have a duty to help the elderly remain active and healthy. Progress is inevitable. As we become an increasingly connected and "smart" city, we will expect to see fewer traditional bank branches, post offices or, indeed, coin- or card-operated phones in the Page: 12 community. We will have to help our seniors navigate these unsettling paths of change, leveraging on the very same technological advances that have caused these disturbances. Redesign automated cash machines and tellers to be more senior-friendly, and create simplified technological solutions within neighbourhoods so that seniors can access information services. Perhaps, provide staff during certain hours of the day at these otherwise self-service, automated facilities to guide seniors to utilise this new-fangled technology. (In English): I have just described how we can perhaps adapt the community to make it more senior-friendly. The other problem we will face is that we can expect to see more seniors growing old alone. While we can do many things to keep seniors engaged within the community, the Government should look into using technology also to monitor the well-being of such seniors, in as unobtrusive and respectful a manner as possible. I am thankful to MOH for disbursing the City for All Ages grant to allow communities to promote Ageing-in-Place. In my ward in Queenstown, we have been using this grant to understand the needs of seniors, provide services, such as shuttle buses to the nearby polyclinic and, later, to embark on a small pilot programme to provide personal or home monitoring for seniors who live by themselves.”
“These are some things that we have to be mindful of even as we make our healthcare more affordable and more accessible. But universal, state-backed health insurance, such as that which is to be offered through MediShield Life, is, nonetheless, vitally important to plug certain healthcare financing gaps. There are certain conditions which incur significant costs to the patient and the family which require better coverage than what is offered today, such as cancer treatment and kidney dialysis. I hope that these needs will be met through MediShield Life or other supplementary programmes. Let me now turn my attention to how we prepare for an older Singapore. However much attention we place on our health, we will grow old. Singapore is growing old, and her people are growing old even more quickly. But as I have said on many occasions, growing old is not something to be feared but to be embraced. Going back to the 5Hs I mentioned earlier, we hope to grow old not only Healthily, but also Happily and with Hope in our own Homes. Mdm Speaker, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Though I do feel that retirement homes and villages are useful and serve specific needs, I hope that Singapore will not develop into a country where there are enclaves for the young and for the old. The elderly should age gracefully and actively within the community, and the community should provide an environment which allows this to happen. I am glad that an Inter-Ministerial Committee has been set up to strategise a whole-of-Government approach towards preparing Singapore for an ageing society.”
“The Government Parliamentary Committee on Health last year delivered a position paper on Healthcare Affordability to MOH based on numerous dialogues with the public and healthcare professionals. Since then, many of the concerns and proposals contained in that paper have been addressed by MOH, for which we are, indeed, grateful. But as we move to an era of even more affordable and accessible healthcare, we will also have to learn as a nation to utilise healthcare appropriately. This is not just about dollars and cents, but using healthcare in an unwarranted and excessive manner may do us more harm than good. Let me share one cautionary tale. In one state in the United States, they conducted an experiment where certain of the citizens were given expanded health insurance coverage through a lottery system. The hope was that if the citizens did not have to worry about healthcare expenditure, then, they would actually try to stay healthier by going to see the doctors more regularly. However, the researchers found the converse. They actually found that these "lucky" people – so to speak – who won the lottery, ended up making even more visits to Emergency Rooms at hospitals, and often for simple conditions that could be treated by their general practitioner or GP. In fact, their self-reported health scores were worse than Page: 11 before they won the lottery. More and newer is not always better. Many health supplements and even some forms of health screening have little if any health benefits, and overuse of certain medications have risks. There are countries where, because of the pattern of reimbursement for antibiotics, they saw a high incidence of resistant strains of bacteria because of the change in the pattern of prescription.”
“In developed countries, diseases related to poor diet, such as excessive sugar, salt and fat, present a far greater public health burden than that Page: 10 posed by food poisoning and related problems. Let us look at a few examples. Britain's Food Standards Agency, between 2001 and 2011, set targets for the reduction of salt in various food categories and got food companies to achieve these targets over time. Over this period, sodium consumption in the UK fell by 15%. But what was more important was that this was accompanied by a significant decrease in the average blood pressure of the British. This was also accompanied by a 40% drop in deaths from heart attacks and a 42% drop in stroke deaths. Reducing the salt content in our food gradually over several years means that it is less likely consumers will taste the difference and also helps to shift our preference away from salty foods. The work by the British Food Standards Agency mirrors the success seen by other countries, like Finland and Japan, which have managed to reduce sodium consumption through various government-led measures and consequently enjoyed substantial reductions in heart attacks and strokes. Admittedly, some similar measures have met with less success. For example, Denmark's fat tax and New York City's scuppered attempt to outlaw oversized sodas, but that should not deter us from continuing to push for healthy eating choices. Continue to highlight healthy hawker cooking, or perhaps have advisory health notices on unhealthy foods, like we now do on cigarette packaging. These are critical moves we have to make as a nation. The crisis is not so much that we have an ageing population but whether we are an ageing and also unhealthy nation.”
“Even then, I found it difficult not to feel a little bit sheepish when I was talking about this, because it seemed as though this was all that Singaporeans aspired to. Certainly, these are things that many of us would still like to have, but I am happy that the younger generation seems to have started to move beyond these material aims. Is there a new definition of the Singaporean Dream? I suppose there are many viewpoints about this but why not let us try Happiness, Health and Hope, and a respect and appreciation of Home and living with Heart? A central pillar of this new Dream is Health. The landscape of healthcare in developed societies is transforming from that of disease treatment to that of health maintenance and wellness. All of us are aware that each of us is personally responsible for our own health, but this does not mean that the Government should not act to nudge us towards being better keepers of our own health. Freedom of choice is important but, sometimes, it may not be a bad idea to save us from making less than wise decision where our well-being is concerned. Tobacco and smoking legislation is a widely accepted form of governmental oversight which has had far-reaching positive public health effects over the past few decades. Let me here take the opportunity to laud the Health Promotion Board's recent efforts to raise the legal age for buying tobacco products. The other clear and present health risk facing modern societies lies in the food we eat. There have been many calls in recent years for the Government to act more decisively in making the food we eat more healthy. There are many rules and regulations which safeguard food safety in terms of freedom from toxins and harmful biological agents like bacteria, but what about unsafe nutritional choices?”
“Thank you, Mdm Speaker. The President, in his speech to Parliament, spoke from his heart about his vision for how Singaporeans can build a better life for themselves and their children amidst a challenging and changing environment. Just over two years previously, when he spoke during the Opening of this Parliament during its First Session, he likewise called on all Singaporeans to be as one, to build an inclusive and inspired society. I rise today to speak to thank him for his wise words, as I did then during the Opening of the First Session of Parliament. Singapore has not stood still since that day in October, and, likewise, this Government has been hard at work all this time listening to the people, working with the people and working for the people. Page: 9 Back then, one of the measures several of my colleagues and I pushed for was to give our seniors greater peace of mind where healthcare was concerned. I asked for greater subsidies to be given to senior citizens and that this should be calibrated to their age: the older a Singaporean is, then the more healthcare financial support he or she gets. The announcement of the Pioneer Generation Package and also MediShield Life which will provide universal healthcare insurance to all Singaporeans regardless of pre-existing illnesses, have exceeded all my expectations and then some, and have been warmly welcomed by all. These are the sort of bold moves by the Government which make me truly proud to be part of this governing party and to be a Singaporean. There was a time that whenever we spoke of the Singaporean Dream, there was the inevitable mention of the dreaded 5Cs: cash, credit card, condo, car, country club.”
“Madam, I thank the Minister for the reply. Just one supplementary question. I was wondering what were the criteria for the setting up of digital signboards at bus stops. Many residents have asked for digital signboards to be put up at certain bus stops. I was wondering what the criteria for the selection of these bus stops are. Page: 45”
“Mdm Speaker, like the hon Member Mr Baey Yam Keng, I have also come across cases where patients and my residents have said that sometimes, they are not aware of where to go to for financial Page: 12 assistance. For example, some of them may not have even heard of the medical social work department. My supplementary question is whether MOH intends to start a campaign or put in place a programme to publicise the various avenues of financial assistance available to patients of both public hospitals and polyclinics. Assoc Prof Dr Muhammad Faishal Ibrahim: Again, Madam, I thank the Member for his suggestion and feedback. It is similar to Mr Baey Yam Keng's supplementary question earlier. I would take this back to my Ministry.”
“It is not a case where if the employee "gains", the employer "loses" and vice-versa. Much as it is a cliché, in employment matters, the goal should be a "win-win" situation. It is fair to state that an employer who fulfils its legal and ethical obligations as an employer is more likely to have a committed and motivated workforce. And that is certainly a pivotal factor to a company being competitive, innovative and resilient. This Bill sets the tone for a fair workplace, and I hope it would nudge employers into seeing their important role in this larger scheme of things. I would like to conclude by quoting Deputy Prime Minister Tharman Shanmugaratnam from his 29 October speech at the NTUC Ordinary Delegates Conference. I quote, "Workers are not just an essential part of the economy. Page: 81 They are at the core of Singapore society." So, everything to do with workers – wages, employment conditions, the workplace environment – everything to do with workers is at the "core of what we are trying to do in building an inclusive society." In the Singaporean context, workers increasingly are PMEs. Madam, I hope that, in time, the Employment Act will cover PMEs and the whole array of employment conditions. This Bill deserves the strong support of this House and I commend MOM for effecting the changes and for recognising that the workplace is very much an integral part of the social compact and how it plays a big part in our combined efforts towards an inclusive society. On that note, Madam, I support the Bill. 5.01 pm”
“In the fact sheet on this Bill issued by MOM, it is stated that, "This will provide employers time to assess suitability of the PMEs to their jobs". But an unfair dismissal is about wrongful dismissal and has nothing to do with one's unsuitability for a job. If one is unsuitable for a job and one is let go, that is not wrongful dismissal, in my view. On clause 2(7), which deals with deductions for accommodation, amenity and service, the 25% sub-cap is necessary to prevent employers from making inappropriate salary deductions. A suggestion for future amendments is to better specify what "service" includes, and to emphasise that an employee not only must accept these deductions but that they are not to be imposed on the employee. An employee must have a genuine choice whether to accept such accommodation, amenity and service. Madam, the Bill also enhances the penalties for failure to pay salary, and also provide for enhanced powers for employment inspectors in their jobs. The inclusion of the appropriate legislative text in clause 2(22) of the Bill on the criminal liability of a body corporate and the rebuttable legal presumption that an offence committed by an corporate employer is attributable to a real person should clarify that officers, members and partners of a body corporate, unincorporated association or partnership cannot hide behind the corporate veil. Madam, the Employment Act is Singapore's primary labour law. Timely and robust reviews are crucial in ensuring that the Act remains relevant. Much as the Act needs to balance the rights of employees and the interests of employers, I hope that employees and employers alike, whether Singaporean or not, will not regard the matter as a zero-sum equation.”
“Can the Minister provide a road map as to when PMEs could be brought under the provisions of Part IV of the Employment Act which is concerned with matters such as rest days, work hours, and other conditions of service? These are equally important matters as well for PMETs. I should add that the intent here is not to be prescriptive but rather to ensure that employers do not exploit the meaning of what a "professional" job is to the extent of requiring a professional to put in inordinate working hours. Here, I am thinking of whether something similar to clause 2(17) of the Bill can be considered to set minimum levels of conditions of service for professionals. Madam, we must appreciate that there is a asymmetry of power at the workplace, even for PMEs. We should not assume that PMEs are more than capable of looking out for their own interests and rights. The proposed amendments to increase the pool of employees who are protected by Part IV of the Employment Act will be well-received by the labour market, particularly employees. I now turn to clause 2(29) of the Bill, which relates to overtime payments under Part IV of the Act and also sets out the set formulas to calculate such payments. Could the Minister clarify why the formula found in the Fourth Schedule is pegged at $2,250 when the salary threshold of non-workmen is proposed to be set at $2,500? I would like to move on to the proposed amendment in clause 2(2) of the Bill on seeking redress against unfair dismissal. This provision requires PMEs to have served the employer for at least 12 months to be eligible for the redress Page: 80 procedure. May I ask the Minister why this time bar of a 12-month minimum service period is required?”
“Like the CPF (Amendment) Bill, which this House has just passed, I warmly welcome the various amendments and additions in this Bill, including the proposals to extend the Employment Act's coverage to PMEs, to improve the employment standards for employees and to provide needed and greater clarity to the various leave provisions found in the Child Development Co-Savings Act. As our employment landscape changes, so must the Employment Act to adjust, adapt and advance the interests, rights, obligations, and duties of all stakeholders in the employment market. So, the proposal to extend the Employment Act, except for Part IV, to cover persons employed in a managerial or executive position and earning a basic monthly income not exceeding $4,500, is timely. However, I would like to ask the Minister how the threshold figure of $4,500 is arrived at. Page: 79 Similarly, could the Minister explain how the proposed salary threshold of $2,500, for non-workmen under Part IV of the Employment Act, was arrived at as well? The threshold salary is pertinent when the evolving employment landscape is considered. The Population White Paper, issued in January this year, indicated that the number of Singaporeans in PMET jobs is expected to rise by nearly 50% to about 1.25 million by 2030. This compares with the figure of about 850,000 today. During the same period, the number of non-PMET jobs is expected to fall by over 20% to 650,000, compared to with 850,000 non-PMET employees today. Overall, two-thirds of Singaporeans will hold PMET jobs in 2030, compared to about half today. That being the case, would it not be better to bring PMETs fully onboard, and not just in relation to the payment of their salaries as is the case today?”
“Page: 78 Even as the Government is working to expand employment protections for Singaporean workers, many developed countries around the world are in fact scaling back on such protections, which peaked globally approximately a decade ago. This was well detailed in a recent OECD Employment Outlook report. Overly restrictive employment protections may have the negative effect of dampening hiring sentiments and reducing business competitiveness, which Singapore, as a small nation, can ill afford. Other than protecting workers, the Employment Act also impacts labour force reallocation and hence, it's robustness. I hope that the Ministry will continue to streamline the processes and procedures through which employees covered by the EA can seek redress or restitution. New initiatives like WorkRight are working right, but many procedures still seem complex and too lengthy for the average worker. For my final point, I hope that with the ongoing revisions to the Act and future amendments to the Act, we will also look at expanding provisions for leave, such as marriage or compassionate leave, caregiver's leave, or even leave for community work, in view of the increasing emphasis on social and family development. We now have a Ministry for Social and Family Development and thus, I think it is only appropriate that the Employment Act is similarly aligned. With this, I support the Bill. 4.53 pm Assoc Prof Tan Kheng Boon Eugene (Nominated Member): Mdm Speaker, I support this Bill.”
“Mdm Speaker, thank you for allowing me to speak in support of the amendments to the Employment Act. The Employment Act of any nation is a vital statute that protects the interests of its workers, and is hence a key legislative instrument that safeguards the social and economic fabric of the country. The increase in the monthly wage threshold for non-workmen like clerks and sales staff, from $2,000 to $2,500 under Part IV, is particularly timely in view of the rise in wages that Singaporean workers have enjoyed over the past few years and ensures that the Act remains relevant to the majority of local workers. Like the hon Members Mr Zainudin Nordin and Mr Patrick Tay before me, I am also heartened by the bold step taken to expand the scope of the Act to cover junior PMETs, which is one of the measures that my parliamentary colleagues and I, together with many Singaporeans, have called for in the past few years. Although the unions and MOM have initiated many new programmes to promote and secure fair employment practices, as also detailed by Mr Patrick Tay before me, increasing globalisation and the complexities of the workforce suggest that some form of statutory protection is appropriate for more junior professionals and managers. I do not think that this calibrated approach will make hiring any more restrictive or less business-friendly. For instance, the minimum period of one year employment mandated before an employee can seek redress for unfair dismissal seems to be just right, allowing companies to suss out their new employees, and judging from comparisons to practices in similar jurisdictions, and also based on a number of scholarly dissertations on this subject. The United Kingdom, for instance, has only recently raised a similar requirement to two years.”
“This is a request which has been raised by more than a few of my constituents over the past few years and I believe that by allowing multiple withdrawals within the same year, while still maintaining the same constraints with regard to Minimum Sums, would encourage more prudent drawouts, as there would be less pressure on the account holder to withdraw more than he might require for the year. These amendments strengthen a sound and comprehensive social security savings plan for citizens, and I fully support the Bill.”
“CPF monies comprise a significant portion of the wage package, and CPF monies can variously be used during a worker's working life to help pay for housing and education, and also medical expenses. Hence, failure to properly make CPF contributions is actually no different from failure to pay wages, and should, perhaps, be addressed in a similar manner. Perhaps, the Minister could share with the House how the figures regarding the revised fines and penalties were arrived at, and whether the penalties could actually be further aligned with those under the Employment Act, for instance, $3,000 to $15,000 for first-time offenders, and double that for subsequent offences. As the Minister has just mentioned, the jail terms for both the CPF and Employment Act infringements are already becoming increasingly aligned. I hope that the Ministry will continue to review the penalties for such offences, and calibrate the fines to reflect rising wages, and also to be commensurate with the sums involved and the number of workers affected, so as to send a strong signal of deterrence. With regard to the expanded powers of enforcement and the WorkRight programme, I hope that both investigation and enforcement activities continue Page: 120 to be improved through continued investments in both manpower expansion and training. I have received good feedback from constituents regarding the WorkRight programme, and it has proved to be a good touchstone for dialogue on both CPF issues and employment rights. Finally, like many in this House and many Singaporeans, I am happy with the amendment which allows increased flexibility with respect to CPF withdrawals by account holders over the age of 55.”
“Mr Deputy Speaker, Sir, the Central Provident Fund is a unique implementation of a national pension and social security system, and plays a critical role in boosting the confidence of Singaporeans in their own financial security, both after retirement and even before. Measures to strengthen the CPF, particularly from the standpoint of compliance by employers, are always timely and welcomed. Page: 119 In recent weeks, MOM has revealed disturbing trends of non-compliance by employers over the past few years. Although these breaches have not been overwhelming in absolute terms, they have, nonetheless, been significant and increasing. The figures do not make for pleasant reading. In 2010, S$9.5 million were owed to about 6,000 workers from 2,600 companies. In 2011, about the same amount was recovered for about 10,000 workers from 3,700 companies. And just last year, S$9.4 million was recuperated for close to 7,000 workers from 4,000 companies while a further S$238.7 million was recovered from over 3,000 employers who were guilty of late contributions. In a reply to my recent Parliamentary Question on how many employers had been found to have violated the CPF Act over the past three years by illegally deducting from their employees' salaries to pay for the employers' contributions, such errant employers were thankfully few and numbered less than 20, but the amount recovered was still close to a quarter of a million Singapore dollars. It is the right of every Singaporean worker to be paid a fair wage, and it is the responsibility of every employer to ensure that this is so, and it is the duty of the Government to enforce this compliance.”
“I thank the Minister again for his reply. I am sure we will see a great increase in the need for social workers with all the new initiatives that are going out, for example, the social service centres. I was also heartened to hear in the Minister's reply, when he mentioned about the Social Work Associates. In terms of reducing the pressure of recruiting new social workers, all of whom will require a degree, is the Ministry looking at expanding the role for these Social Work Associates so as to increase the talent pool of social workers but, at the same time, reduce the immediate pressure of recruiting social workers?”
“I would like to thank the Minister of State for his very comprehensive reply on the options that are available to this group of Singaporeans. I have two supplementary questions. The first is considering the new BTO for Singles Scheme, could I clarify whether this particular group of single divorcees with no custody of their children can be considered also as first-timers or will they only be considered as second-timers? The second question is with regard to the debarment period for rental housing. For some of them who may not be prepared or be in a state to apply to buy a house – whether it is resale or BTO – whether the debarment period for rental housing for this particular group of low-income or single divorcees can be further lowered.”
“Mdm Chair, there is much discussion and interest in defining the Singapore identity and the Singapore spirit, and I wholeheartedly agree that this engagement is a critical part of community and nation building. MND has shared its vision on how it intends to celebrate our built heritage; but heritage is far more than just being about buildings, like what Mr Sitoh Yih Pin has just mentioned, and constitutes a living and evolving journey, with visual and aural history being equally important. A shared past, either experienced or encountered, improves the fabric of society and makes our lives richer, and guides us towards the future. As such, I hope the Minister will share with us its plans on how it intends to preserve Singapore's heritage, in all its various hues and forms. I am particularly interested in the Heritage Town initiative. My constituency of Queenstown will be 60 years old this year, and as Singapore's first housing Page: 25 estate it would be quite appropriate to call her the Queen of Estates. The rich historical tapestry of districts like Queenstown and others like Tanglin Halt and Tiong Bahru can be recognised though programmes like the Heritage Town initiative, and bring the community together by getting residents to focus their efforts on celebrating a shared past. I hope that the Minister can provide updates on this and other initiatives, and share with us his thoughts on how else our heritage can be safeguarded. Heritage: What makes us Singaporean”
“Once a foreign PMET is hired, there should be skills transfer to the locals and there should be a wind-off period so that local PMETs can take over the jobs. A concrete national policy must be drawn up to make employers legally obliged to hire Singaporeans first, especially for attractive PMET jobs, such as those in the banks. This would reduce bias brought about by foreign employees in a recruiting position, hiring their fellow countrymen and shifting their own village to Singapore. Perhaps, our e2i can play a greater role. That means, for those companies which have job vacancies, they should go to e2i first. Only when e2i cannot help them to fill the vacancies, then they are allowed to take in foreigners. In that situation, e2i is a place to help our locals to get their jobs and also the place to help the companies to fill their positions. I once received a very long email from my friend in NUS who told me that his young daughter, after working for some time in the bank, decided to quit because she was surrounded by foreigners. She went to Europe to look for a job. After some time, she was not successful and went to America and, this time, she also could not get to work in America. It was not because there were no jobs but she could not get the permit to work in America. By putting locals first, we tap on and expand existing potential and bring only the best into our nation. With skills transfer, the Singaporean Core PMET workforce can be assured and they do not have to leave to search for greener pasture overseas. 5.45 pm”
“Australia has recently streamlined its 457 visa process and done away with labour market testing, but the overall intent of the reform is to strengthen the citizen-first approach and prevent abuses of the system. I would propose that MOM study the various measures being used internationally and develop a system which is fair to both employers and employees, and I would support a system which includes some manner of statutory declaration by employers that they have exhausted all reasonable avenues to recruit a Singaporean citizen, before applying to employ a foreigner under an Employment Pass or even an S Pass. If such a system is applied in a sensitive, calibrated manner and on a sectoral basis, it would not adversely affect the autonomy or competitiveness of businesses, and will nudge them towards a reduced reliance on foreign employees and encourage companies to invest more in local talent development. This, I believe, will ultimately leave them in a more robust position. Singaporean Core PMETs Er Dr Lee Bee Wah (Nee Soon): Madam, as we continue opening our doors to foreigners, we must ensure that PMET jobs go to Singaporeans first. Companies in countries like the US and Australia often adopt policies that prioritise local talents over foreign talents. American companies have to prove that they are unable to hire American citizens before they can recruit foreigners. Australian companies are highly selective with their recruitment criteria, and would only accept foreigners who possess skills and qualifications on their skill Page: 146 occupation list. It is high time we reviewed our foreign work pass procedure and provide employment only to foreigners who can fulfil the needs of our employment industry where locals cannot.”
“Madam, I would like to renew my call and support calls that have already been made by fellow Members like Mr Patrick Tay and Ms Foo Mee Har that we relook at labour market testing to ensure that PME job opportunities for Singaporeans are suitably safeguarded. I think we all recognise that there are fair employment practice guidelines in place. Unions are working hard with employers to advance such fair hiring practices but I believe that some degree of legislating, mandating that companies consider Singaporean citizens first for PME positions should be enacted. The priority should be to ensure jobs for Singaporean workers and to get them into these positions, while guaranteeing that businesses can obtain the skilled employees they need when they are unable to do so in the domestic Page: 145 employment market. Many developed countries have enacted legislation to this end, but, as mentioned in my speech last week, this has not led to significant drops in either workplace vibrancy or its competitiveness, and has not resulted in these countries being labelled as either closed or anti-foreigner. The USA has one of the most comprehensive systems of market testing, with explicit guidelines on the type and number of advertisements, the provision of additional steps like the use of employee referral programmes, and very well-defined time intervals for the entire recruitment procedure. The UK uses the Codes of Practice and a Points-Based Tier System, and also employs a Resident Labour Market Test. Hong Kong has a more liberal employment policy for foreigners, but still has a general policy in this regard.”
“Thank you, Mdm Chair. I would like to seek two clarifications on two points raised by the Minister of State earlier. The first is that I do welcome the announcement that guidelines for nursing homes will be tightened and I also note that she did mention that the cost will be kept under control despite these new guidelines. But I am sure we all appreciate that cost is one of the major considerations and I would like to seek more clarifications or assurances that MOH is looking at this in terms of cost containment. The second question refers to the Seniors' Mobility Fund. I think when this was first announced, there were some headlines when my colleague Ms Indranee Rajah was reported in the papers how she and her grassroots leaders made house-to-house visits to increase awareness of this scheme. I think many Members are doing the same. So, I would also like to ask MOH how do they propose to increase awareness of this programme this time round.”
“Singaporeans who participate regularly in approved wellness programmes or demonstrate that they adhere to a healthy lifestyle could receive tax rebates or pay discounted rates at public healthcare institutions or pay lower healthcare insurance premiums. We can also consider rewarding companies that support exercise and wellness programmes for their employees, and which also invest in the health of their workers. 4.15 pm While I appreciate that MOH already has subsidised health screen programmes in place, I would support the use of MediSave for such health screening which further lessens out-of-pocket expenditures. More effort should also be spent educating the public about healthy living, and how they can improve the health of themselves and their families. Sometimes the approach can be blatant; for example, explicit front-of-label labelling of calorie counts and even health risks on unhealthy foods, similar to what is being done on cigarette packs. Finally, I would support expanded recognition and benefits for volunteers who help to promote healthy lifestyle; for instance, the Health Ambassadors of the Health Promotion Board. This could be similar to the system for frequent blood donors, so that they can enjoy privileges for care at polyclinics and Government restructured hospitals.”
“Mdm Chair, health maintenance and promotion is critical for the continued wellness of Singaporeans while ensuring that healthcare costs do not spiral out of control, in view of the challenges that an ageing population presents us. Now, this may sound like an MTI cut, but healthy workers are also known to be more productive and enjoy a longer and happier working life which would also help with the population and resident workforce difficulties that face us over the next two decades. Our disease burden is a function of our intrinsic constitutional makeup and extrinsic environmental and behavioural factors. We all know that we cannot choose who our parents are, but our genes do predict a certain propensity to health or disease. However, we can choose how we live our lives and so have a significant say in our own health. There is much that can be done to nudge Singaporeans to take greater ownership of their health. Unhealthy behaviour, such as smoking or poor diet, could be penalised but, by the same token, healthy lifestyle choices can be incentivised. Page: 117 Some countries have been studying the effects of imposing taxes on unhealthy foods or limiting the portion sizes of unhealthy foods. For example, New York City has recently attempted to curb the unhealthy consumption by limiting the size of soda servings, although just yesterday this move has been blocked by the courts. As I suggested last week, perhaps healthy foods like fresh fruit and vegetables or wholemeal grain can be made cheaper to make them more attractive to cost-conscious consumers.”
“Finally, I welcome the enhancements to the Seniors' Mobility and Enabling Fund because mobility is a critical element for building a City of All Ages. And the Seniors' Mobility Fund has been a great success since its launch. However, many Singaporeans may also look at mobility as not just about devices. Some patients, for example, may require taxis or special vehicles to transport them from their homes to healthcare institutions and back and such transport is costly. I hope that the Mobility Fund can be expanded to help defray these transport costs.”
“Mdm Chair, MOH has announced that by 2020, it will be adding 6,600 nursing home beds and tripling the number of rehabilitative care places from the current 2,100 to 6,200. Correspondingly, we will have to increase the number of staff under home healthcare from 4,000 to between 8,000 and 10,000 and under home social care, from 2,000 to 7,500. I would like to request an update on how MOH is achieving these target recruitment numbers. Currently, many of our elderly care services are running at full capacity and also face manpower shortages. We have been quite reliant on foreign manpower as not many Singaporeans are attracted to the sector due to the challenging working conditions. Can the Ministry provide an update on the Healthcare Professionals Conversion Program which is designed to encourage and facilitate locals to consider a career switch to the healthcare sector? I also asked last year what are the steps the Ministry is taking to maintain the quality of services under these conditions and prevent cases of abuse. Could MOH provide an update of their efforts to ensure that homes comply with the guidelines on handling patients and safeguard against abuse and lapses of care? As we build a City for All Ages and encourage aging-in-place, I also request the Ministerial Committee on Aging to provide an update on efforts to promote Page: 96 community-based services and ageing-in-place initiatives for seniors. One issue in particular is the monitoring of the elderly who live alone or with other elderly. I hope that efforts will continue to explore effective but yet minimally intrusive ways of monitoring the well-being of these seniors in their homes.”
“We, as a nation, should provide these families with all the assistance we can. This issue concerns the treatment of rare childhood diseases, most of which fall under the classification of inborn errors of metabolism, and this has been brought up in this House before. However, I feel it is important to bring this again to the attention of the Ministry. Some of these diseases, such as Pompe's and Gaucher's disease, can be effectively treated by medication, such that the children can grow up to lead normal productive lives. But the treatment is lifelong, and due to the rarity of such conditions, the medications required are prohibitively expensive and may cost several hundred thousand dollars a year. Presently, these costs are borne to a large extent by the Government and various charitable organisations, and parents contribute what they can. I understand that MediFund Silver can also be used in these situations. However, parents of these children are understandably concerned about whether these costs will continue to be covered, and I seek assurances from the Minister that we will continue to support the costs of such medications for this small group of patients. These children also typically require other treatments and considerations that incur extra costs to the family, and I hope that the Ministry will take these special needs into consideration and extend the necessary financial assistance. 2.30 pm Page: 87 National Vaccination Programme”
“Mdm Chair, let me begin by saying that I believe ElderShield to be an excellent safety net to maintain the livelihoods of our senior citizens should they have the misfortune to become significantly disabled. There are concerns about the scheme though. Even with supplemental policies, many have questioned whether ElderShield can adequately support them should they become permanently disabled, particularly since it is unsure whether future payouts will be corrected for inflation. Hence, there are many who have opted out of the system. I hope that MOH can address these concerns and strengthen ElderShield in future reforms, such that it becomes more robust and universal, so that it will achieve its stated aims as a social insurance policy. In 2007 and 2012, as claims were not as high as feared, rebates were returned to policyholders. I hope that consideration may be given to use future surpluses instead, either to adjust for inflation for future payouts, or to extend the payouts for claimants who only have basic coverage. The basic ElderShield coverage is for 60 months or 72 months, but most disabilities in seniors are Page: 86 permanent, and it would not be unreasonable to extend the payout period with these surpluses. I have constituents who are reaching the end of their ElderShield payout after six years, and they are understandably very concerned. I would like to ask what alternative means of support such claimants can turn to, following the end of the payout period under ElderShield. Treatment of Rare Diseases For my second cut, I welcome the introduction of MediShield and MediFund Junior for children, as having a severely ill or chronically sick child presents a great emotional and financial burden on the parents.”
“It may not be prudent to accumulate too much in MediSave, as the power of MediSave to buffer healthcare costs is limited and it should primarily be considered as a supplemental source of healthcare financing in the short-to-middle term, rather than to prepare for expenditures eight to 10 years away, or beyond. This "sinking fund" concept works better for insurance schemes with preloading considerations, but less well for what is essentially a savings scheme which, in real terms, functions mainly to cover smaller costs in the near term of three to five years. I also hope that MOH can explore health insurance schemes for outpatient care. I also call for MOH to consider calibrating subsidies to inflation, across the entire healthcare delivery chain. Such an inflation peg would help cushion Government-subsidised patients from inflationary pressures. And my final point is to renew the call —”
“Mdm Chair, inpatient hospital expenses are reasonably covered by the 3Ms framework. But I am going to focus this cut on out-of-pocket expenses for outpatient care. Many Singaporeans are still concerned about these expenses, despite the heavy subsidies already provided for primary and specialist outpatient care by the Government. The Chronic Disease Management Programme (CDMP) has indeed improved affordability for patients with chronic conditions, covering many conditions such as diabetes, hypertension, stroke and major depression. CHAS, which has been alluded to by many Members in this House and by the Minister, also helps Singaporeans who wish to remain under private care with their Page: 81 family doctors, to still enjoy healthcare subsidies from the Government, and also to be able to be referred for subsidised care in Government's restructured hospitals. I would like to renew my call along with that of many Members of this House that MOH continues to consider the liberalisation on the use of MediSave for outpatient care, whether for existing schemes such as CDMP and CHAS mentioned earlier, or for intermediate and long-term care, and perhaps for new segments, such as paediatrics, cardiological and cancer specialist care. These medical services, typically provided by specialists in hospital-based specialist clinics, require frequent and sometimes costly investigations, and often involve medications and treatments that are long-term and may be expensive. By further extending the use of MediSave, we can encourage better patient compliance with respect to management of these diseases, thereby improving outcomes and reducing chronicity and disability. I call upon MOH to review the sacred cow of MediSave adequacy calculations.”