Gan Kim Yong
Singapore
“Consumer complaints relating to the secondary resale market for tickets to major events and concerts have generally remained low. Nonetheless, to protect the public from scams on secondary ticket resale platforms, the Police have imposed Code of Practice requirements under the Online Criminal Harms Act to require designated online service…”
“Singapore does not condone the use of forced labour. We criminalise forced labour in Singapore under various laws. Relevant Government Ministries and agencies, such as the Ministry of Manpower, Ministry of Home Affairs and Singapore Police Force, play their part in investigating complaints of suspected breaches in domestic laws that relat…”
“The Association of Banks in Singapore (ABS) discontinued the PayNow nickname feature as scammers had been exploiting the use of nicknames to impersonate legitimate entities and trusted individuals.”
“As of end-2025, around 6,900 private residential buildings have registered their solar installations with SP Group for the export of excess solar-generated electricity to the grid. The installed solar capacity of these residential buildings is 115.3 megawatt-peak (MWp), or around 5.5% of all current installed solar capacity in Singapore.”
“The one-year pilot extension of liquor trading hours has seen strong interest from businesses. As of 31 May 2026, the Police have approved 88 applications for the extension of liquor trading hours from public entertainment outlets in these areas.”
“The Government does not make projections of domestic or regional demand for renewable diesel or sustainable aviation fuel. Demand depends on commercial considerations, evolving market conditions and regulatory developments across different jurisdictions.”
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“The Ministry of Health (MOH) does not keep track of the number of people with minority sexual orientations or gender identities seeking mental healthcare. Public mental health services are available to all Singaporeans, irrespective of gender identity. Over the years, MOH has worked with partner agencies, healthcare institutions and community service providers to develop and expand mental health services for persons who require care and support. In addition, the Institute of Mental Health has set up the Gender Care Clinic in 2017, offering counselling and mental health support for persons experiencing emotional difficulties pertaining to gender identity. As the service is relatively new, it is premature to infer trends at this point in time. Healthcare providers caring for persons with mental health conditions are trained to support these persons with empathy, sensitivity and due consideration for their specific care needs.”
“The Health Sciences Authority (HSA) adopts a risk-based approach in the regulation of health products. Pharmaceutical medicines, which contain inherently potent medicinal ingredients and are used in disease treatments, are stringently evaluated by HSA before they can be approved for registration. Supplements and traditional medicines do not require registration, but any addition of potent medicinal ingredients in such products are prohibited. HSA also carries out post-market surveillance, adverse reaction monitoring and routine sampling and testing on the safety of marketed health products. When unsafe products are detected, HSA issues alerts to keep the public informed and takes action against the parties concerned. Dealers who import and supply products containing prohibited ingredients are liable to prosecution and, if convicted, may be imprisoned for up to three years and/or fined up to $100,000. In the past three years, HSA has prosecuted three persons for selling illegal weight loss products that contained undeclared medicinal ingredients. The illegal weight loss products are typically purchased by consumers over the Internet or overseas. HSA has thus been conducting public education on the dangers of buying products from unfamiliar sources, unknown websites or persons posting offers on online platforms.”
“The number of severe pressure injuries in community hospitals has remained stable, at approximately three cases a year, in the last five years. The Ministry of Health (MOH) currently does not mandate reporting of pressure injuries in nursing homes, as they are assessed to be a lower-risk setting. This is based on studies which have shown that the pressure injury risk and impact are higher and more severe in patients requiring higher levels of care. Nonetheless, based on discussions with nursing homes, MOH and the Agency for Integrated Care (AIC) have not noted an increasing trend in pressure injuries. Our healthcare professionals monitor patients for pressure injuries, and implement preventive measures for at-risk patients, which include those who are malnourished or critically ill. Examples of such preventive measures are the use of air mattresses and turning patients regularly. MOH and AIC have been encouraging cross-institutional sharing of learnings and quality improvement initiatives. MOH has also recently convened a Pressure Injury Workgroup, comprising nursing wound experts across the care continuum, to explore and develop further preventive and management measures.”
“For women who are unable to conceive due to issues with their egg quality, there are several avenues currently available to them in obtaining donor eggs for their assisted reproduction (AR) treatment. Altruistic egg donation is allowed in Singapore. However, due to the invasiveness of the ovarian stimulation and egg retrieval procedure, there is a limited number of egg donors. AR practitioners would generally counsel their patients to seek egg donations from relatives or close friends. Alternatively, egg donations can also be received from unrelated donors, and these are frequently from women who are already undergoing their own AR treatment. AR centres are mandated to provide counselling for couples before the start of any treatment, and to discuss, amongst other issues, the couple's wishes regarding the eggs or embryos that remain after their treatment is completed. Women who wish to donate their remaining frozen eggs or embryos to other couples can do so, and the AR centres will facilitate the egg donation at the appropriate time.”
“Merdeka Generation (MG) Package recipients who had been invited to collect their MG Packages from community clubs or events but were unable to do so will have their packages sent to them by post instead. Whether they receive the package at community events or by post, all eligible MG seniors will receive the same MG Package benefits and MG welcome folders. As of 26 July 2019, all the MG packages have been delivered.”
“Hand, Foot and Mouth Disease (HFMD) is a common childhood illness that is usually mild. Most children recover from HFMD on their own without treatment. As HFMD infections are not reportable and the majority are mild, the Ministry of Health (MOH) does not track the number or percentage of children who have contracted HFMD at least once during their life. The key to controlling the spread of HFMD is to maintain high standards of personal and environmental hygiene, and to seek medical treatment early when the child is unwell. MOH works closely with the Ministry of Education, Early Childhood Development Agency and People's Association to ensure that educational institutions, including childcare centres, remain vigilant and take measures to minimise the spread of infectious diseases. Parents should also ensure that their children with HFMD remain at home for the duration of the illness as advised by the doctors, to prevent spread to others.”
“Based on records submitted by care providers to the Ministry and Health (MOH), in the fourth quarter of 2018, around 16,000 Singapore residents were using subsidised home and/or community care services, of which around 7,000 used subsidised home care services. Around six in 10 subsidised home care clients were female. Around half were aged 80 and above, around three in 10 were aged 70 to 79, and the remainder were aged 69 and below. The vast majority of home care clients would be home-bound with chronic conditions or disabilities and require assistance with some Activities of Daily Living (ADLs), in particular, in the area of mobility. Around one in 10 home care clients also use community-based care services, such as day rehabilitation or respite care services. Depending on the needs of patients, the most commonly used home care service is home nursing, which is, on average, about $95 per visit before any subsidies and about $20 per visit for a client receiving the maximum subsidy. The Integrated Home and Day Care (IHDC) pilot introduced in 2016 bundles both home- and community-based services and gives us an estimate of the expenditure of clients using services in both settings together. Depending on the bundle, the fees range between $1,100 and $2,300 per month before any subsidies, and about $300 to $600 per month for a client receiving the maximum subsidy. Singaporeans who need further financial assistance after subsidies can apply through the medical social workers or the providers for MediFund or other assistance.”
“There are three public healthcare assisted reproduction (AR) centres, namely, the National University Hospital, Singapore General Hospital and KK Women's and Children's Hospital. Today, Singaporean couples who undergo assistive reproductive technologies (ART) treatments at these centres can receive co-funding of up to $7,700 per fresh cycle and $2,200 per frozen cycle, for three fresh cycles and three frozen cycles. A frozen cycle costs less than a fresh cycle because a fresh cycle requires the whole ART process like egg stimulation, egg retrieval and fertilisation. While the co-funding for each fresh cycle and frozen cycle differs, the amount of co-funding does not decrease with each successive ART attempt. We have sufficient capacity at the public healthcare AR centres for co-funded ART treatments. Couples can commence their ART treatments when they have completed their necessary applications, counselling and tests and are assessed to be medically ready. Patients who prefer to seek treatment at private hospitals can use MediSave to help offset the costs, up to the prevailing withdrawal limits. The Ministry does not have information on the number of couples seeking ART treatment overseas. The current age limit for ART treatment in Singapore, including in-vitro fertilisation, is set at 45. Women aged 45 and above who wish to undergo ART treatment may appeal to the Ministry of Health (MOH), through their ART practitioner. In assessing the appeal, MOH may seek advice from its panel of experts where necessary. The average time for processing an appeal is currently about a week. As advancements in ART have improved the safety of ART procedures, the Ministry is reviewing the maximum age limit for women to undergo ART treatment in Singapore.”
“The Health Promotion Board's (HPB's) National Nutrition Survey tracks fat rather than oil consumption. In the 2018 survey, total fat consumption per person was 98 grammes (gm) compared to 91 gm in the 2010 survey. Saturated fat, which is unhealthy, has decreased from 38% to 36% of total fat consumed while daily trans-fat intake halved from 2.1 gm to 1 gm over the same period. The World Health Organization's (WHO's) recommendation is that no more than one-third of dietary fat should come from saturated fat, and to eliminate all artificial sources of trans-fat from the food supply. Average daily sugar intake per person increased slightly from 59 gm in 2010 to 60 gm in 2018. This is in excess of the WHO recommended upper limit of 50 gm or 10 teaspoons per day. Pre-packaged drinks remain the largest single contributor of sugar in our diet. The average salt intake amongst Singaporeans was nine gm in 2018, compared to 8.3 gm in 20101. While the methodologies to estimate salt intake in 2018 and 2010 were different, both figures clearly show that Singaporeans' average salt intake exceeds the WHO recommended intake of five gm per day. The majority of our salt intake comes from sauces, seasoning and salt added during food preparation. Much remains to be done to reach WHO's recommended targets. The Ministry of Health and HPB will continue to promote healthier diet and increase the availability and accessibility of healthier choices. Citizens, too, can play their part through healthier food and lifestyle choices.”
“The Community Care Manpower Development Award (CCMDA) was launched in April 2017. It supports the community care sector in attracting new entrants and developing in-service staff. A budget of about $12 million was set aside to support the programme up to 2020. To date, we have committed close to $8 million under CCMDA to support around 250 individuals to pursue training and skills upgrading opportunities in fields, such as nursing, physiotherapy, occupational therapy and gerontology. Over 200 awardees are in-service staff, of whom about 10% are mid-career candidates. The other awardees comprise students and general practitioners.”
“We estimate that there are currently about 9,000 Merdeka Generation seniors who require permanent help with at least three out of six Activities of Daily Living. The Ministry of Health (MOH) is rolling out CareShield Life, which is a long-term care insurance that provides peace of mind and protection against uncertainty of disability care in old age. CareShield Life will provide lifetime payouts in the event of severe disability. The majority of Merdeka Generation seniors are still healthy and able-bodied today and will be able to join CareShield Life from 2021. To encourage them to join CareShield Life, the Government will provide a $4,000 sign-on incentive under the Merdeka Generation Package. Lower- to middle-income policyholders will also be eligible for subsidies that help keep premiums affordable. Those who still face difficulty paying their premiums can apply for additional premium support. For those who already require permanent help with at least three out of six Activities of Daily Living and are hence ineligible to join CareShield Life, they can apply for financial help through the new Government-funded ElderFund which will be introduced by MOH in 2020. In addition to CareShield Life and ElderFund, MOH will also roll out a new Home Caregiving Grant later this year and MediSave withdrawals for long-term care next year. Together with subsidies of up to 80% for long-term care services, all these initiatives will make long-term care more affordable for Merdeka Generation seniors.”
“Nurses form the largest professional group in our healthcare workforce. Our overall registered nurse to population ratio of around 7.5 nurses per 1,000 population in 2018, is comparable to that in Hong Kong, Taiwan and South Korea. Seven out of 10 of our practising nurses work in the public healthcare sector. In tandem with our expansion in public healthcare capacity, the number of nurses working in the public healthcare sector has increased from around 21,700 in 2013 to 25,600 in 2018. To meet future demand for healthcare services in an ageing population, we have expanded efforts to attract more Singaporeans to join nursing as well as to develop and retain serving nurses. Some examples include (a) raising the profile of nursing, such as through the Care to Go Beyond Campaign; (b) creating multiple pathways for mid-career professionals entering the profession, including professional conversion programmes; (c) raising the capacity and range of nursing training courses; (d) reviewing nurses’ remuneration to remain competitive; and (e) improving career recognition and progression. To ensure that the nursing workforce is sustainable, we have also embarked on efforts to raise productivity. These include initiatives on automation, streamlining of nursing work, and shifting of care from hospitals into the community where appropriate. The Ministry of Health will continue to regularly review our nursing manpower needs, taking into consideration demographic and disease trends. We will also continue to work with educational and training institutions and healthcare providers to ensure that we have a nursing workforce that can serve the needs of Singaporeans.”
“Under the Chronic Disease Management Programme (CDMP), MediSave can be used to reduce the out-of-pocket costs for outpatient treatment of chronic conditions. The conditions covered are selected in consultation with a Clinical Advisory Committee comprising clinical experts. The factors considered include level of disease burden, effectiveness of early intervention, and availability of clear clinical guidelines. The conditions covered under CDMP are reviewed on a periodic basis as new information and evidence emerge. In June 2018, for example, ischaemic heart disease and pre-diabetes were added to the list of CDMP-approved chronic conditions. We will continue to periodically review the list of supportable conditions, including chronic skin conditions, to meet the needs of Singaporeans, while ensuring that MediSave balances are not prematurely depleted. Beyond CDMP, other support for treatment of chronic conditions, including subsidies for different chronic skin conditions, are widely available for all Singaporeans at Community Health Assist Scheme general practitioner clinics, polyclinics and, where the condition is serious, subsidised specialist outpatient clinics. Singaporeans aged 60 and above can also tap on Flexi-MediSave to defray their out-of-pocket costs for outpatient treatments. Singaporeans who still face difficulties managing their medical bills can also approach the Medical Social Workers at our public institutions for assistance.”
“There are currently 149 MediFund-approved institutions (MFIs) spanning all healthcare settings, including public acute and community hospitals, specialist outpatient clinics, polyclinics and Government-subsidised nursing homes. Over each of the last three years, close to half of subsidised patients received services at more than one MFI, most of whom visited two MFIs each year. One percent of subsidised patients received MediFund assistance at more than one MFI, most of whom received assistance at two MFIs each year. Each MFI has an independent MediFund Committee, made up of representatives, such as community leaders and professionals, to assess MediFund applications. They are typically supported by Medical Social Workers (MSWs) and other staff who help assess a patient's circumstances. Apart from assessing MediFund applications, MSWs also serve a wider group of patients and caregivers, such as extending social and emotional support and making referrals to other social services or assistance schemes. For this reason, MFIs are unable to determine specifically the cost of processing MediFund applications alone. We periodically review MediFund processes to improve and streamline them where possible. For instance, needy patients on Public Assistance today do not need to undergo further MediFund assessment at MFIs. We are also in the midst of rolling out system enhancements, led by our MSWs, that will streamline the application process and improve information sharing. This will make it more convenient for MediFund patients who visit more than one institution.”
“Public healthcare institutions do not allow their staff to use platforms, such as WhatsApp, to communicate sensitive medical information to patients. Instead, they are encouraged to do so at face-to-face consultations, and the Cluster Chief Information Officers (CIOs) have been asked to remind users of this. For selected medical information, patients can also log on to HealthHub via the secure Singpass platform to view the information.”
“Based on data reported by healthcare providers, there were about 600 Medical Social Workers (MSWs) working in the public healthcare and community care sectors1 in 2018. Within the Agency for Integrated Care (AIC), there are about 110 staff coordinating care for care recipients and their caregivers in hospitals and in the community and helping them with information and referral to the various services and support programmes. The ratio of MSWs and AIC staff numbers to the population of care recipients over the age of 65 may not be meaningful as they work together to support care recipients across all age groups and not just care recipients over the age of 65. They also work with other community partners to coordinate care and support for seniors.”
“We encourage members of the public to keep up to date with the Government's travel advisories and exercise personal responsibility and hygiene during their travels, especially to affected countries. This way, it will protect you against the risk of being infected and bringing emerging diseases to Singapore.”
“WHO keeps member nations informed of such incidents and may recommend public health measures if necessary. By working with WHO and other countries, we can better monitor the emerging global situation, obtain early warnings of public health threats, assess the potential risk to us and take early measures to prevent and detect such diseases. Where appropriate, we institute measures at our borders. For example, temperature screening is currently conducted for all travellers from the Middle East to detect cases of the Middle East respiratory syndrome coronavirus (MERS-CoV), an infection that can cause severe respiratory illness. However, temperature screening may not be effective against other diseases, such as Zika, because most infected persons have no or mild symptoms. There is also an incubation period during which an infected person may not display any symptom. MOH, therefore, works with our healthcare institutions and professionals to maintain vigilance. We send out alerts and circulars to keep our hospitals, polyclinics and primary care doctors updated on the latest disease situation, and to inform them of the criteria for evaluating and reporting possible cases. The recent Monkeypox case, for example, was detected by vigilant doctors at the Tan Tock Seng Hospital and National Centre for Infectious Diseases. Finally, when we have a confirmed case, we will take decisive actions to contain the spread and treat the patient. MOH has worked with healthcare providers and relevant Government agencies to isolate the case, conduct contact tracing and quarantine close contacts if necessary, and carry our environmental disinfection. The public has an important role to play, too.”
“In the last three years, there were two reported cases of severe emerging infectious diseases brought in by infected travellers. In May 2019, we had an imported Monkeypox case from Nigeria. Monkeypox is a rare infection transmitted primarily from animals to humans and occurring mainly in central and west Africa. It causes fever and rash and can occasionally be fatal. In May 2016, we had an imported Zika case from Brazil. Although Zika does not generally cause serious illness, it may cause microcephaly in babies of infected pregnant women. Subsequently, in August 2016, we reported our first locally transmitted cases, which were not linked to the case from Brazil, but to another unidentified imported case of a different Asian lineage of Zika. In addition to these severe emerging diseases, there are also many common infectious diseases that are imported into Singapore. Between 2016 to 2018, there were 1,869 cases of imported infections, of which dengue and traveller's diarrhoea were the most common causes, followed by malaria, chikungunya and measles. Given the high volume of international travel, there is always a risk that travellers may bring in emerging infectious diseases. The Ministry of Health (MOH) works closely with international bodies and foreign counterparts to prevent importation of such diseases. We also work with our local healthcare institutions and relevant Government agencies to prevent, detect and contain such imported cases. At the international level, the World Health Organization (WHO) requires countries to notify it of events that constitute a "public health emergency of international concern" and may ask them to undertake measures to limit the risk of spread across borders.”
“In March 2018, MOH announced the requirement for minimum co-payment for new IP riders. From April 2019, new IP riders must incorporate a co-payment. Insurers are also improving their claims management measures with the use of panels and pre-authorisation processes and stepping up their claims scrutiny over questionable charges. Ensuring affordable and sustainable healthcare and healthcare insurance will require each stakeholder – doctors and healthcare providers, patients, insurers and the Government – to play a part.”
“Over the last five years, premiums of the private insurance component of private hospital Integrated Shield Plans (IP) have increased by an average of 7% per year. The increases have been more pronounced in recent years, especially for IP riders which typically have zero co-payment. Between 2016 and 2019, premiums of riders and the private insurance component of IP rose by an average of 24% and 10% respectively each year. These trends are largely reflective of increases in private hospital insurance claims. Such increases in claims and premiums are not sustainable in the long term. The Ministry of Health (MOH) has thus introduced a range of initiatives to address concerns over over-charging and over-consumption of private healthcare services, while ensuring that patients continue to have access to good quality and appropriate healthcare. The initiatives are aimed at encouraging doctors and providers to prescribe and charge appropriately, helping patients to make more informed and appropriate decisions, and guiding insurers to have more suitable healthcare insurance design. Doctors and healthcare professionals should make recommendations and decisions on care options that are both clinically effective and cost-effective. To help them, MOH's Agency of Care Effectiveness has been issuing appropriate care and drug guidance since 2017. In November 2018, MOH started publishing fee benchmarks for private sector professional fees. These will guide appropriate charging among healthcare providers and enable patients and payers to make better informed decisions. Co-payment is an important healthcare financing design feature to ensure that all stakeholders have a stake in their healthcare decisions.”
“To meet our healthcare needs, the Ministry of Health regularly reviews our medical manpower supply and demand, taking into account population demographics and disease trends. In 2018, there were around 14,000 registered doctors in Singapore. This translates to a ratio of 2.4 doctors per 1,000 population, which is comparable to developed countries, such as Japan, the United States and the United Kingdom. With the increase in capacity of our local medical schools in the past few years, as well as more Singaporean doctors returning from overseas education, the proportion of local doctors in our healthcare system increased from 82% in 2012 to 90% in 2018. We expect the proportion of local doctors to increase further with a steady inflow from local and overseas medical schools. As we transform our healthcare model, our manpower needs will change and we will need to regularly review and adjust our manpower plans.”
“MediShield Life provides universal basic health insurance coverage for life for all Singapore Residents, including those with pre-existing conditions. MediShield Life, together with Government subsidies, MediSave and MediFund, will keep the costs of basic healthcare affordable to subsidised patients. This is the Government’s commitment to all Singaporeans. Integrated Shield Plans (IPs) are optional plans offered by private insurers that provide additional coverage, catering to different preferences beyond MediShield Life, including private healthcare services. IP insurers have their own underwriting processes and make independent decisions on the provision of coverage to applicants, based on the insurers’ risk assessments and other considerations. IP insurers may choose to reject applications from those with certain pre-existing conditions or provide cover for individuals with pre-existing conditions with exclusions or risk-loading on premiums. The premiums across insurers also differ. The Ministry of Health (MOH) does not intervene in the underwriting process for IPs. Where MOH works closely with IP insurers would be in areas, such as public education and financial counselling for the public, as well as the management of healthcare costs in the private sector. The requirement for co-payment among IP riders imposed from April 2019, to bring about more affordable and sustainable healthcare and healthcare insurance, is one such example.”
“Over the last five years, the Ministry of Health's (MOH's) total expenditure has increased from $4.7 billion in financial year (FY) 2012 to $10.2 billion in FY2017. As a proportion of overall MOH's budget, funding to the public acute hospitals decreased from 77% to 66% over the same period, as we have spent significantly more in preventive health, primary care and intermediate and long-term care. The allocation to capital spending and operating cost is about 15% and 85% respectively.”
“Based on extrapolated data from the Retirement and Health Study1 (RHS) conducted in 2014, we estimate that there are currently about 110,000 to 120,000 family members or friends caring for persons aged 65 and above2. The number of care recipients aged 65 and above who are cared for by a family member or a friend is estimated to be about 85,000 to 90,000. Of these care recipients, it is estimated that around 60% are cared for by their children, 35% by their spouses, 10% by their grandchildren, 5% by their siblings and 10% by other relatives3. RHS does not record whether the caregivers are providing full-time or part-time care.”
“Most seniors prefer to age in place for as long as they can, within communities which they are familiar with, and supported by their loved ones. A study by the Duke-National University of Singapore (NUS) Centre for Ageing Research and Education (CARE) conducted from 2011 to 2012 found that 97.9% of persons aged 65 and above prefer to continue staying at home if they cannot live independently, supported by family, foreign domestic workers or home care services. Only 2.1% of persons aged 65 and above preferred to move to a nursing home if they cannot live independently. We are not aware of corresponding data on the preferences of caregivers.”
“When they do see the doctor, the children may be unwell and, therefore, not suitable for vaccination. Therefore, we would like to encourage parents, if possible, to bring your children for vaccination as soon as possible. HPB does conduct vaccination programmes in the schools to provide convenience for parents to have their children vaccinated. Dr Chia Shi-Lu also asked about potential actions against parents whose children are not vaccinated. We are looking into various possibilities, even at the preschool level, on how we can encourage and ensure that our children who go to preschools are vaccinated because this is important not only to protect the individual children but also to protect children who could not be vaccinated. Especially in infant care, many of them are below 12 months of age and they could not be vaccinated. Therefore, the older children ought to be vaccinated to protect them. At the same time, we are also looking at workers in the preschool sector to ensure that they are covered by vaccination or they have immunity, so as to protect the children under their charge.”
“I thank Dr Chia Shi-Lu for the four supplementary questions. First, for the cases which have been reported during the first four months of this year, let me share that among the 43, 33 were not vaccinated. Ten were vaccinated but, as all of us know, vaccination may not be 100% effective. Even among those who were vaccinated, up to 3% may not be effective. Therefore, we need to raise the overall population coverage to protect the small number of people who are unprotected despite vaccination. Among those who were not vaccinated, nine of them were infants before they were due for vaccination. The rest were aged between one and 54. So, there is a wide variation of ages. For the adults, we do not have specific data on how many of them were vaccinated. But there was a recent study in 2018 on seroprevalence. The study indicated that the vast majority of adults in Singapore had a very high level of immunity against measles. One of the possible reasons could be that in the early 1970s, measles was very widespread, a very common occurrence, and many of us who are adults could remember having measles during that time. Therefore, the naturally acquired immunity arising from actually contracting measles is prevalent among adults. Based on our studies, our immunity level is in the high 90% levels among the older adults. Dr Chia Shi-Lu also asked about the reasons why some of them did not go for vaccination. The factors are quite varied. A large majority of them were just passive, waiting for the next convenient occasion to bring their children for vaccination. Unfortunately, sometimes, that occasion never came. They hope that the next time when they see a doctor, they can bring their children, but their children stayed healthy, so never had a chance to see the doctor.”
“Earlier this year, we have also made it compulsory for foreign children applying for long-term passes to be fully vaccinated against measles. We have also put in place measures to facilitate and encourage vaccination. Vaccination is available free to all Singaporean children at polyclinics. The Health Promotion Board (HPB) sends reminders to parents whose children have yet to complete vaccination by two years old. HPB also provides catch-up vaccination in primary and secondary schools for students who still have not completed their vaccination. The measles vaccination coverage among resident children reached 95% for the first dose at two years of age and 93% for the second dose at seven years of age. Nonetheless, we cannot be complacent. MOH is looking into ways to raise the vaccination coverage further. Some of the measures being considered include sending reminders to parents ahead of vaccination due dates. This way, we ensure that children are protected as early as possible. We will also look into how we can raise the vaccination rate of children before they enter preschool and primary school. To protect the more vulnerable populations like infants and the immuno-compromised, we will study ways to ensure that workers caring for them achieve a high level of vaccination coverage. Even with these measures, we can continue to have sporadic cases of measles due to imported cases. We can expect to see more cases when there is an increase in global outbreaks. I would like to urge parents to bring their children for vaccination when it is due. By working together to improve and maintain a high level of vaccination coverage, we can better protect our population and reduce the risk of large local outbreaks.”
“Sir, measles is a highly contagious and serious viral disease and vaccination is the most effective protection against this infection. High vaccination coverage at the population level not only protects the individuals but also makes it harder for the disease to spread, thereby reducing the risk of large outbreaks. This way, it provides herd immunity which will also protect those who are unable to receive vaccination, such as infants under the age of 12 months and those who are immune-compromised. It is, therefore, important for countries to maintain a high level of vaccination. In recent years, there has been a global increase in measles outbreaks because of declining vaccination coverage in many countries. This has resulted in a significant increase of non-immune individuals in the community, making it easier for the disease to spread. Being a travel hub, Singapore is also exposed to imported cases. In the first four months of 2019, Singapore saw 43 measles cases, nearly three times more than the same period in 2018 as a result of increased global outbreaks. These were all sporadic cases or cases with limited spread and there was no community outbreak. We are monitoring the global and local situation closely. We have alerted our doctors to look out for measles cases and notify the Ministry of Health (MOH) promptly so that actions can be taken to prevent disease spread. We should also strive to achieve a high level of vaccination in Singapore. Our national immunisation schedule recommends that children should have their first dose of measles vaccine at 12 months of age and the second dose at 15 to 18 months of age. With the exception of those who are unable to be vaccinated because of medical reasons, the measles vaccine is compulsory for local children.”
“Most of the rare diseases are diagnosed in childhood. While most of these diseases do not yet have an effective cure, early diagnosis and treatment for some of the diseases can substantially extend a patient's lifespan and improve his quality of life. To enable early diagnosis, our public healthcare institutions have implemented the National Expanded Newborn Screening Programme which covers more than 30 rare diseases. At our public healthcare institutions, patients with rare diseases can have access to subsidised inpatient and outpatient services. MediShield Life and MediSave can be utilised to pay for their hospital bills. Patients who need help with their bills may also apply for financial assistance, such as MediFund and Medication Assistance Fund. A small number of individuals with very rare conditions require medications that are very costly. Our hospitals do their best to assist these patients, for example, by negotiating price discounts with manufacturers for the medications where possible, waiving parts of their medical fees or drawing from hospital charity funds. The Ministry of Health recognises that more support is needed for these patients and is looking into providing greater support for them. More details will be made known later this year.”
“This approach is similar to that adopted in other countries, including the US, Canada and the European Union. HSA now requires companies supplying ARBs to ensure that future batches of their medicines are tested and do not have unacceptable levels of nitrosamine impurities before supply to Singapore. HSA has also been working with suppliers and international regulatory agencies to verify the cause of contamination and to formulate measures to eliminate the nitrosamines in the medium to longer term. HSA will continue to monitor the quality and safety of these medicines to safeguard public health.”
“On 28 March 2019, the Health Sciences Authority (HSA) recalled three brands of medicines which belong to the angiotensin receptor blocker (ARB) class of blood pressure medication and contain the ingredient losartan. All three medicines were manufactured by Hetero Labs Limited. Following the recall of several losartan medicines in the United States (US) due to the presence of a nitrosamine impurity, N-nitroso-N-methyl-4-aminobutyric acid (NMBA), HSA tested the suspected losartan medicines and they were found to contain trace amounts of NMBA which are above the acceptable limit1. Under HSA's drug regulatory regime, stringent standards are set on the quality and safety of medicines sold in Singapore. Before being approved for sale, the medicines are evaluated to ensure that they meet the required international standards of quality, safety and efficacy. After approval, HSA conducts post-market surveillance, which includes monitoring of global developments and risk-based product sampling and testing for compliance to quality and safety specifications. Products found to be deficient in quality will be withdrawn from the market. Manufacturers are also required to test all batches of medicines, including the levels of specific impurities, to ensure that they comply with stipulated standards. The routine tests required of the manufacturers are based on known impurities that may be generated during the manufacturing process, as it is not practical to exhaustively test for all types of impurities. In the case of the recalled losartan medicines, testing for nitrosamines like NMBA was not previously part of the testing parameters of ARB medicines as NMBA was not expected to be generated in the manufacturing process.”
“Based on the latest available expenditure data, the Ministry of Health's (MOH's) operating expenditure for financial year 2017 was $8.7 billion, of which about 3%, 11% and 6% were spent on mental health, diabetes mellitus and aged care respectively. MOH's expenditure on mental health comprises operating subvention to the Institute of Mental Health, psychiatry units in other public healthcare institutions and intermediate and long-term care facilities to provide subsidised patient care, as well as funding for various programmes under the National Mental Health Blueprint and Community Mental Health Masterplan. The figures do not include Government funding for other mental health initiatives, such as school allied educators to provide students with counselling and related support. MOH's expenditure on diabetes mellitus comprises operating subvention to public healthcare institutions and participating Community Health Assist Scheme (CHAS) clinics to provide subsidised care to patients with diabetes as well as health promotion activities under the War on Diabetes. MOH's expenditure on ageing comprises operating subvention to long-term care and social aged care facilities to provide patient subsidies for residential, day care and home care services. It does not include Government funding on other ageing initiatives or subsidies provided to the Pioneer Generation and Merdeka Generation, which are separately catered for under the Pioneer Generation Fund and Merdeka Generation Fund respectively.”
“Lastly, the newly launched Skills Framework for Healthcare and Social Service maps out the job roles and needed competencies in healthcare and helps employers to identify skills gaps and develop workplace-based skills training to meet changing industry needs.”
“Based on data reported by service providers, in 2018, there were 12,020 workers in Long-Term Care (LTC) providers who received subvention from the Ministry of Health. Table 1 below provides the breakdown by job groups and service types. We do not have details on the educational qualifications and skill level of LTC workers. About 40% of the LTC workforce are locals. To meet the growing demand for manpower, we have increased local training places, in particular, for nursing. Nursing intakes in the Institute of Technical Education, the polytechnics, and the autonomous universities have collectively increased by 30% from around 1,600 in 2013 to over 2,100 in 2018, the highest intake to date. The Agency for Integrated Care (AIC) has also partnered LTC providers to hold recruitment events, with more than 1,000 locals joining the community care sector in 2018. We are also working with LTC partners to improve healthcare productivity by adopting technology and assistive equipment, streamlining existing work processes, and facilitating bulk procurement of shared products and services to achieve manpower savings. As our population ages, there will be increased demand for healthcare professionals who are trained in areas, such as geriatric care, management of complex chronic conditions and end-of-life care. To develop and upskill the LTC workforce, AIC-appointed learning institutes offer subsidised training in areas ranging from clinical skills to leadership and people management. In addition, the Community Care Manpower Development Award offers scholarships for those working or wishing to work in the LTC sector to pursue the relevant advanced skills training.”
“Based on records submitted by care providers to the Ministry of Health, in the fourth quarter of 2018, there were around 16,000 unique Singapore residents benefiting from subsidised home and community care services, and around 12,000 on subsidised nursing home services. These figures include those using subsidised respite care services in each setting. Among the subsidised home and community care residents, around half were aged 80 and above, around three in 10 were aged 70 to 79, and the remainder aged 69 and below. Around three in five received the maximum subsidy. Among the subsidised nursing home residents, around four in 10 were aged 80 and above, around three in 10 were aged 70 to 79, and the remainder aged 69 and below. More than four in five of these residents received the maximum subsidy.”
“Over the years, the Ministry of Health has grown the supply of home-based care services to enable more seniors to age in place. Today, we estimate that there are more than 70 home-based care providers providing a range of home-based care services, such as home medical, home nursing and home personal care services. Based on data reported by Government funded home-based care providers, the number of workers, excluding foreign domestic workers, providing home care services was 890 in 2016, 1,050 in 2017 and 1,120 in 2018. The number of seniors who have benefited from subsidised home care services was 5,200 in 2016, 6,000 in 2017 and 6,700 in 2018. The number of referrals to home-care services received by the Agency for Integrated Care was 15,800 in 2016, 16,300 in 2017 and 14,400 in 2018. The number of referrals is non-unique as some seniors may be referred to more than one service at different points in time. Not all referrals result in the take-up of services as clients may opt for alternative care options.”
“The Ministry of Health has been increasing home and centre-based care capacity to meet the needs of seniors who require these services. From 2015 to 2018, we added 2,300 home-care places and 2,700 daycare places, and vacancies have exceeded waitlists at the national level for both services. Waiting times for home-care services, daycare services and respite care services vary depending on factors, such as administrative processing time, care needs of the seniors, family preferences and available capacity of specific providers. Between 2016 and 2018, the median waiting time for home-care services was around seven days and the median waiting time for daycare services was around 20 days. We do not have detailed waiting times for respite care services. Typically, the time taken to access planned centre-based respite care services is within two weeks. Caregivers who face emergency situations that require more immediate access to respite services can call the Singapore Silver Line (1800-650-6060) or approach the Agency for Integrated Care Links for assistance. For seniors who require interim post-discharge support at home while awaiting long-term care arrangements, the Interim Caregiver Service is also available for patients discharged from hospitals.”
“With the addition of Duke-NUS Medical School1 in 2005 and the Lee Kong Chian School of Medicine in 2013, the annual intake of medical students across the three medical schools in Singapore grew from about 300 in 2010 to 502 in 2018. With more doctors being trained locally, we can moderate the number of approved overseas medical schools. The Singapore Medical Council's (SMC's) Schools Review Committee took into consideration various factors, including the academic standing and reputation of the schools, reflected by international and national rankings, as well as the performance of our doctors from these universities and how well they adapt to our system when they return to work in our healthcare institutions. Overall, SMC chose to retain schools with higher international and national rankings and where SMC's data indicates that doctors who graduated from the schools had performed satisfactorily and had fewer challenges adapting to the local practising environment. Singaporean students currently studying at, or who will be commencing their medical study before 1 January 2020, and doctors who have graduated from the affected schools will not be affected by this change. All doctors who graduate from overseas schools will be orientated to the local working environment, and they will be assigned a supervisor to ensure that they are able to adapt well. The Ministry of Health and SMC review the list regularly based on the evolving needs of Singapore's healthcare system. For example, SMC had reduced the number of approved medical schools in 1993 and had increased the number of approved medical schools between 2003 and 2007, to cater to the changing needs of our healthcare system.”
“Over the past five years, the number of MediSave withdrawals for parents' healthcare expenses has varied between 161,000 in 2014 and 193,000 in 2018, or 9.7% and 3.8% respectively of the total number of MediSave withdrawals. The average withdrawal amount ranged between $760 in 2014 to about $440 in 2018.”
“All patients who visit the Accident and Emergency (A&E) department in a public hospital are charged at a single flat subsidised rate for basic investigations and services, regardless of income. The payment process of A&E departments varies across public hospitals depending on their operational considerations. In emergency cases, such as when patients arrive via ambulance, they are always attended to first and payment is collected after treatment. In some non-emergency cases, the flat fee may be collected upfront, whereas in other cases it would be collected after the service is rendered. No one will be denied essential healthcare services, including A&E, due to their inability to pay. Patients who face difficulties in paying for their A&E fees can approach the medical social workers to seek financial assistance.”
“Notwithstanding these measures, we can expect infections with antimicrobial-resistant organisms to occur from time to time as microbes can naturally acquire AMR and antimicrobials still need to be used for treating infections. Healthcare institutions must, therefore, remain vigilant in surveillance and maintain high levels of infection prevention and control to prevent spread of AMR. The Ministry of Health (MOH) also works with healthcare institutions to monitor antimicrobial resistance and healthcare-associated infections. As AMR is a cross-border issue, MOH also participates in regional and global collaborations to tackle the AMR challenge. We launched the National Strategic Action Plan on AMR at end 2017 to outline our long-term approach towards AMR. This was the result of a joint review by MOH, National Parks Board, Singapore Food Agency, National Environment Agency and the Public Utilities Board, Singapore's national water agency. The plan is aligned to the global action plan on AMR. Under the plan, we are progressively implementing enhanced measures in the priority areas of Education, Surveillance, Research, Prevention and Control of Infection and Optimisation of antimicrobial use. The AMR Coordination Office was also established as the national coordinating body to facilitate the implementation of the National Strategic Action plan on AMR. Beyond actions taken by agencies and professionals, individuals, too, play a part in the prudent use of antibiotics or antimicrobials. We encourage patients and consumers to consult doctors on the best course of medical treatments, take antimicrobials according to doctor’s advice and only when indicated. Every one of us must also practise good personal hygiene to protect ourselves from infection.”
“The emergence of microorganisms, such as viruses, bacteria and fungi, which are resistant to standard drugs and treatments, a phenomenon also known as Antimicrobial Resistance (AMR), is a global public health issue. While AMR can occur naturally in some microorganisms, the misuse and overuse of antimicrobials, such as antibiotics globally in healthcare, as well as the animal and agricultural sectors, have led to accelerated development of AMR. Due to increased global connectivity, there is a growing risk of AMR being spread internationally. Singapore, being a global travel hub, is exposed to the importation of AMR organisms. Candida auris is one example of an antimicrobial-resistant fungus. It was first identified in 2009 in Japan and subsequently reported from other parts of the world, including Singapore. The first case of Candida auris here was reported in 2012. To date, a total of 16 cases have been detected in the public and private hospitals. Investigations showed that the cases are unlinked, and there is no report of local spread. We have put in place a number of measures to address the development and spread of AMR in Singapore. These include regulation on the prescription and retail of antibiotics to minimise the risk of misuse and overuse, and public education campaigns on the proper use of antibiotics, such as the Health Promotion Board's "Use Antibiotics Right" campaign in 2018. Within our public hospitals, there are Antimicrobial Stewardship Programmes to guide doctors in making appropriate antimicrobial drug use, and Infection and Prevention Control measures to reduce the risk of spread of antimicrobial-resistant organisms.”
“Between 2015 and 2017, the latest year with available data, about eight in 10 subsidised hospitalisation bills were paid with $100 or less in cash. As bill sizes vary depending significantly on the complexity of the treatment and length of stay, a median rather than an average is a more meaningful reflection of the cash payments for the remaining bills. As shown at Table 1, the median cash payment for these bills is about $500. There has been a reduction in the figure from 2015 to 2017 with the introduction of MediShield Life. We will continue to review our healthcare financing framework regularly. No Singaporean will be denied appropriate healthcare because of affordability reasons. Singaporeans who have difficulty coping with their medical bills can apply through medical social workers in public healthcare institutions for additional MediFund support.”
“Going forward, we will continue to step up our efforts to attract locals to this sector.”
“Based on data reported by Ministry of Health (MOH)-subvented service providers in 2018, there were 12,000 workers working in the Long-Term Care (LTC) sector1, of which about 40% are locals. We have been enhancing the attractiveness of LTC jobs to locals by (a) raising awareness and interest in job opportunities within the sector, (b) providing training and development opportunities, and (c) increasing salary competitiveness. For example, the Agency for Integrated Care (AIC) works with LTC providers and recruitment partners like Workforce Singapore and the Employment and Employability Institute to facilitate local employment and raise awareness of job opportunities in the LTC sector. In 2018, more than 1,000 locals have joined the LTC sector through various recruitment efforts. MOH and AIC also support LTC providers in staff training and development. For example, training for newly hired local support care staff2 can be funded under the Community Care Traineeship Programme so that they can be equipped with the requisite skills to perform in their new roles. Providers are also eligible for on-the-job training support of up to $10,000 per local support staff recruited to facilitate mentoring, supervision and development of new hires. Local staff may apply for sponsorship through the Community Care Manpower Development Award to pursue advance training in skills relevant to their work. Lastly, to increase local salary competitiveness, MOH works with employers to review salaries of workers regularly to ensure that they are adequately recognised for their efforts. Between 2012 and 2017, MOH had provided funding support to raise the wages of workers across participating providers which saw a 30% increase in aggregate over this period.”
“The Ministry of Health (MOH) takes a serious view of any attempts to defraud the healthcare system at the expense of Singaporeans. Fraudulent behaviour, such as inappropriate patient referrals for financial gains and making false claims for services, is wrong and unethical. It also raises the overall costs of healthcare in Singapore, leading to Singaporeans paying more for their healthcare services and insurance plans. Various stakeholders have a part to play in combating healthcare insurance fraud. MOH monitors the landscape of MediShield Life and Integrated Shield Plan (IP) claims and works with IP insurers to identify anomalous trends. For cases where criminal offences are suspected, MOH and insurers will refer them to the Police for further investigation. The Singapore Medical Council (SMC) provides guidance to doctors through the Ethical Code and Ethical Guidelines (ECEG) on ethical practice and professional standards to ensure the well-being of patients. In particular, ECEG prohibits doctors from letting business or financial considerations influence the objectivity of their clinical judgement in their management of patients. Doctors who contravene ECEG can be subject to disciplinary action by SMC. Doctors, healthcare staff, patients, insurance providers, financial advisors and members of the public should lodge a complaint to MOH, SMC or the Police if they suspect any fraudulent behaviour, or receive any suspicious propositions in relation to their healthcare services or health insurance claims.”
“The Community Health Assist Scheme (CHAS) was introduced in 2012. It provides subsidies for Singapore Citizens who are CHAS and/or Pioneer Generation cardholders and, in future, Merdeka Generation cardholders, for medical and dental care at participating private general practitioner and dental clinics. Since the scheme's introduction, the number of cardholders who benefited from CHAS medical subsidies in a given year increased by nine times, from about 60,000 in 2012 to about 550,000 in 2018.”
“In 2018, the median waiting time for consultation across all polyclinics was 11 minutes, an improvement from 14 minutes in 2017. Patients with chronic conditions who require regular follow-ups with the polyclinics can schedule their next appointments at the appointment counters after their clinic visits. Individuals requiring unplanned visits necessitated by sudden ailments can also book an appointment on the same day through online platforms, such as HealthHub and the polyclinics' online appointment systems. Alternatively, patients can also call the polyclinics' contact centres to schedule an appointment. With an appointment, individuals would only have to arrive at the polyclinic 15 minutes before their appointment time. As we move towards digital platforms, we are mindful that there may be individuals who are unable to use the online systems, including some seniors. For those who walk in without an appointment, there will continue to be healthcare assistants onsite to assist individuals with the registration process as well as help teach them to use online platforms.”