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 Committee has just submitted an interim update to me on the findings and recommendations. We will be studying these closely and will start pursuing key interim proposals even as the Committee continues its work. Beyond our own plans and efforts, the COI report has provided us valuable inputs and useful recommendations. We will follow up on them, but I will highlight our thinking and plans in response to some of the key recommendations. First, enhancing governance and organisational structures. The COI has recommended that we enhance our security structure and readiness across IHiS and the public healthcare institutions. We need to better organise and govern our cybersecurity oversight and efforts and give cybersecurity considerations more weight in decision-making. It is an important area that is also being reviewed by the CAC I mentioned earlier. CAC has highlighted the need for clearer cybersecurity risk ownership and accountability between IHiS and the public healthcare clusters, underpinned by a strong relationship to avoid fragmenting our healthcare IT strategy. It also highlighted the need to elevate cybersecurity roles and functions to strengthen management oversight over cybersecurity, supported with the appropriate resources and expertise. MOH agrees and we will implement the following organisational changes in line with these guiding principles. At the Ministry, the MOH Chief Information Security Officer (CISO) is currently also the Director of Cyber Security Governance at IHiS. We will separate these roles. The MOH CISO will be supported by a dedicated office in MOH and report to the Permanent Secretary. The MOH CISO office will be the cybersecurity sector lead for the healthcare sector.”
“This has been fully implemented. In assessing and developing these measures, IHiS had benefited from the inputs and advice of CSA. I would like to record our thanks for CSA's support. Parallel measures were also taken by SingHealth in patient engagement. SingHealth took steps to contact more than two million patients and successfully reached around 97% of them. These include all patients who visited SingHealth Specialist Outpatient Clinics and polyclinics from the start of 2015 to the attack, including those whose data were not accessed, in order to reassure them. SingHealth has since also taken steps to improve the accuracy of patients’ contact information for better patient engagement. For example, it has identified patients without valid contact details so that staff can update the patients’ contact details at their next visit. Since November 2018, SingHealth has been sending short message service (SMS) to all patients on the day of their outpatient appointments to remind them to approach counter staff to update contact details if there are any changes. SingHealth will be sharing their learning points with the other clusters and we will be making similar improvements across public healthcare institutions. On our part, MOH has initiated independent security reviews on key public healthcare IT systems to identify vulnerabilities and recommend measures to address them. At a broader systemic level, MOH has appointed a Cybersecurity Advisory Committee (CAC) to conduct a horizontal review of the cybersecurity governance structures and processes across the public healthcare clusters and IHiS. The Committee is chaired by Prof Tan Chorh Chuan and comprises industry experts. It is supported by independent consultants from KPMG.”
“I will instead focus on the healthcare family’s responses and follow-up actions. The COI findings and recommendations will play an important role in guiding our actions and our cybersecurity direction going forward. Following the discovery of the cyberattack, IHiS implemented several measures to tighten cybersecurity. These included: (a) creating firewall rules to block further malicious callbacks to the suspected command and control servers; (b) reloading servers with clean images to eliminate any remaining presence of the attacker; (c) disabling the tool used by the attacker to enter the network; (d) implementing temporary Internet Surfing Separation (ISS) for the public healthcare sector; (e) accelerating the deployment of Client Advanced Threat Protection (ATP) to public healthcare servers and endpoint devices. ATP identifies threats based on the techniques used by more advanced threat actors and is better able to detect customised hacking tools designed to bypass conventional defences; and (f) IHiS has also improved its incident response processes and SOPs, with clearer channels of reporting and escalation criteria. Subsequently, in November 2018, IHiS announced further measures which are being implemented progressively across public healthcare agencies. Let me highlight a few key ones. Database Activity Monitoring (DAM) has been implemented for the SingHealth electronic medical record database. DAM provides more comprehensive alerts and blocks database queries from unauthorised sources. DAM will be extended to the electronic medical record databases of all the other healthcare clusters by mid-2019. IHiS has strengthened the security of domain controllers, by limiting login access and requiring two-factor authentication for administrative access.”
“Mr Speaker, Sir, thank you for allowing me to make this Statement on the COI into the cyberattack on SingHealth's IT system. The healthcare system’s foremost priority is our patients' well-being. This encompasses not just safe and effective care, but also the protection of their personal data. We, the healthcare family, have a responsibility to our patients to ensure both these aspects. The cyberattack on SingHealth's IT system has resulted in the data of a large number of patients being illegally accessed. Once again, I apologise to our patients on behalf of our healthcare family. We are deeply sorry. Minister Iswaran has provided a summary of the COI’s findings and recommendations. I would like to thank the COI for its comprehensive work and detailed findings on the incident. I agree with the COI that we were lacking in several areas. Some of our IT personnel did not have sufficient levels of cybersecurity awareness, training and resources to respond to the attack. Certain staff with key roles in IT security incident response failed to take essential actions, resulting in missed opportunities to prevent the attack or minimise its impact. There were vulnerabilities in our IT system that were exploited by the attacker. Examples include servers that were not adequately secured against unauthorised access, and weak passwords and administrator account controls. There were gaps in the management of IT assets, compliance with security policies, as well as inadequate remediation of known system vulnerabilities. The public healthcare family needs to do much better. I welcome the COI’s wide-ranging recommendations. These have been touched on by Minister Iswaran. So, I will not go through in detail.”
“Between 2014 and 2017, about 6% of all MediSave withdrawals were for MediSave account holders' parents' healthcare expenses, which includes inpatient, day surgery and outpatient expenses. The details are as shown in Table 1 below.”
“MediSave helps Singaporeans set aside part of their income over their working years to save up for healthcare expenses in old age when their healthcare needs are typically higher. Between 2013 and 2017, about half of Singaporeans aged 65 and above who passed away had about $5,500 or less in their MediSave. For those who pass away at an older age of 85 and older, half had $4,000 or less left in their MediSave Account. The data are summarised in Table 1 below. Some of them have also benefited from the Pioneer Generation Package, which includes annual MediSave top-ups of up to $800 and additional MediShield Life premium subsidies.”
“Caregiving needs will grow as our population ages, and the Government is expanding home and community care services to support families and provide caregivers with peace of mind. As of 2017, we have about 8,300 staff providing direct care1 to seniors in the long-term care sector2. However, families and friends are also an important source of care and support for our seniors. Based on the National Health Surveillance Survey conducted in 2010 and 2013, around 6% to 8% of Singapore residents aged 18 to 69 provide regular informal care or assistance to family and friends with health issues, long-term illnesses or disability. As informal caregiving arrangements vary, we do not have available estimates of the total value of informal caregiving to make a direct comparison with formal caregiving. Some working persons may leave the workforce to focus on family responsibilities. Based on the Ministry of Manpower's 2017 Comprehensive Labour Force Survey, 202,000 residents left their jobs within the last three years and were not looking for a job. Of this number, about 12,500 residents cited family caregiving to families or relatives as the main reason, and the majority of these residents were females, married and aged 40 and over. We also recognise the important roles that family caregivers play, and the need to take a whole-of-community approach to support them. The Government will continue to review how we can further encourage ageing in place and provide more direct and holistic support for caregivers of seniors.”
“Foreign domestic workers (FDWs) applying to work in Singapore are required to be screened for active tuberculosis (TB), including having a chest x-ray, within two weeks of their arrival in Singapore, before they are issued with Work Permits. FDWs are also required to undergo screening for active TB upon two years of stay in Singapore. From 2013 to 2017, an average of 146 new FDW applicants a year were diagnosed with active TB when they applied for Work Permits. FDW applicants found to have active TB will not be issued Work Permits and have to return to their home countries, unless otherwise supported by their prospective employers. In the same period, about 200 FDW Work Permit holders were diagnosed with active TB per year, out of an FDW population of between 214,500 and 246,800. As active TB can still develop later after screening is negative, it is imperative that persons who display symptoms of active TB, such as unexplained prolonged cough of three weeks or more, seek early medical attention, so that active TB can be detected and treated early. With treatment, persons with active TB rapidly become non-infectious and would no longer transmit the disease. Strict adherence to TB treatment will help ensure cure and minimise the risk of relapse of the disease. Therefore, to reduce the risk of TB transmission, we seek the support of employers with FDWs displaying TB symptoms to seek medical attention for their FDWs early. Employers should also support and ensure that their FDWs receive TB treatment via Directly Observed Treatment (DOT) and comply with medical appointments.”
“The Ministry of Health (MOH) started a three-year pilot on Pre-Implantation Genetic Screening (PGS)1 in 2017. Under the pilot programme, patients who fulfil at least one of the following clinical criteria will be eligible: (a) age 35 years old and above, regardless of prognosis; (b) two or more recurrent implantation failures, regardless of age; and (c) two or more recurrent pregnancy losses, regardless of age. Eligible patients from the three public Assisted Reproduction (AR) centres, namely, National University Hospital (NUH), KK Women's and Children's Hospital (KKWCH) and Singapore General Hospital (SGH)) can be referred to the NUH lab to undergo PGS. Patients from the private hospitals can also be referred to the three public AR centres for assessment. As of December 2018, 221 patients were recruited under the PGS programme and MOH will review the pilot programme after completion.”
“HPB provided all the 72 account holders with advice on how they could unlock their accounts and reset the passwords. HPB has included a security advisory in HealthHub to remind users on the need to use strong passwords for their online accounts and to refrain from using the same password for different websites and applications. In December 2018, further precautionary measures were also implemented, including (a) introducing an authentication at the point of login that protects against automated attacks by malicious bots; and (b) introducing a One Time Password (OTP) for the redemption of Healthpoints. IHiS and HPB have not detected further incidents of unusual log-ins since. They will continue to strengthen their systems for better protection, monitoring and response to cyber threats.”
“The Health Promotion Board (HPB) and Integrated Health Information Systems (IHiS) investigated a case of unusually high number of attempts to log into HealthHub on four days within a short period, that is, 28 September 2018, 3 October 2018, 8 October 2018 and 9 October 2018. The investigation revealed that attempts were made with more than 27,000 email addresses. Ninety-eight percent of the email addresses used were not related to HealthHub account identifiers (IDs), and these attempts were unsuccessful. Nevertheless, 72 accounts were successfully accessed during the four days. The high volume of email addresses not related to HealthHub account IDs and the repeated attempts suggest that the email addresses used were likely to have been obtained from other compromised sources. No evidence of a breach in the HealthHub system has been found. The unusual log-in attempts and access were limited to the basic tier of HealthHub, which contained the user's self-populated profile and any Healthpoints accumulated through participation in HPB programmes. Access to other e-services requires SingPass and two-factor authentication and were not affected. As a precaution, access to all HealthHub mobile application and HealthHub website e-services were suspended from 9 to 14 October 2018. The 72 HealthHub accounts of concern were locked, and HPB contacted each of the account holders to ascertain if the log-ins were legitimate and to alert them of the access to their accounts. The investigation found that none of the accounts were adversely affected. Fifteen users had legitimately logged into their accounts, while two users suspected that their accounts were accessed without authorisation. It was inconclusive as to whether the remaining 55 accounts were accessed without authorisation.”
“The objective of publishing fee benchmarks is to provide all stakeholders a reference on the reasonable ranges of professional fees for common surgical procedures in the private sector. The benchmarks will guide private sector healthcare providers in charging appropriately. They will also enable patients and payers to make more informed decisions. Doctors should take reference from the benchmarks in setting their fees and advising their patients. They should also be prepared to explain to patients where their charges exceed the range, such as when addressing a highly complex case or in exceptional circumstances. Today, the Ministry of Health (MOH) already monitors overall hospital bill sizes and doctors' charges. Where we observe charging patterns that could be of concern, we will query the healthcare providers, investigate and take follow-up actions if necessary. MOH welcomes feedback on the fee benchmarks. These would help to guide future review and refinement of the benchmarks.”
“The current minimum legal age (MLA) for the purchase, use, possession, sale and supply of tobacco products is 19 years. This was raised from 18 years on 1 January 2019 and will be raised progressively to 21 years by 1 January 2021. Offering a cigarette to a person below the MLA is an offence under section 10 of the Tobacco (Control of Advertisements and Sale) Act (TCASA). Receiving a cigarette is also an offence if they are under the MLA under section 11 of TCASA. The main focus of Health Sciences Authority's enforcement efforts is on curbing the sale of tobacco to underage persons. Errant retailers are liable to a maximum fine of $5,000 for the first offence and $10,000 for subsequent offences. In addition, the tobacco retail licence will be suspended for the first offence and revoked for subsequent offences. Between January 2015 and October 2018, 90 retailers have been caught for selling tobacco to underage persons. In addition, anyone caught buying or acquiring any tobacco product for a person below the MLA, is liable on conviction in Court, to a maximum fine of $2,500 for the first offence and $5,000 for subsequent offences. Similarly, anyone caught giving or furnishing tobacco product to a person below the MLA, is liable on conviction in Court, to a maximum fine of $500 for the first offence and $1,000 for subsequent offences. Between January 2015 and October 2018, 18 people had been caught for such offences.”
“A global study across 80 countries found a significant decline in sales of less healthy food products in countries where laws restrict their advertisements. Excise duties have been adopted in about 45 jurisdictions globally, and overseas evidence show that the duties can encourage the industry to reformulate and reduce sugar content in their drinks. In the United Kingdom, for example, over half of the manufacturers took steps to lower or remove the sugar content in their drinks before the duty came into effect, so as to avoid paying the duty. More details are available in the Government's public consultation paper. The Ministry is reaching out to a wide range of public stakeholders as well as the industry in our public consultation. We welcome views on measures to reduce sugar intake from pre-packaged SSBs and will carefully consider all feedback received from the public and industry, as well as evaluate the local and overseas evidence thoroughly, before making a decision.”
“These efforts show encouraging signs of progress. The average sugar level of pre-packaged SSBs have declined from five to three teaspoons per 250-millilitre serving between 2007 and 2017. The proportion of pre-packaged SSBs purchased that carry the HCS label has also increased from 30% in 2012 to 44% in 2018. Nevertheless, we can do more. Singaporeans continue to consume 12 teaspoons of sugar daily, of which more than a third still comes from pre-packaged SSBs. To further reduce Singaporeans' sugar intake, our Ministry has, therefore, initiated a public consultation on four possible measures on pre-packaged SSBs: mandatory front-of-pack (FOP) nutrition labels, advertising regulations, a ban on sale of higher-sugar SSBs, and a sugar tax or, more accurately, an excise duty imposed on manufacturers and importers of pre-packaged SSBs. As far as we are aware, there are no studies that directly compare the relative efficacy and impact of the four proposals. In fact, the proposals are not mutually exclusive and they often work together and reinforce one another in promoting healthier and less sugar choices. Nevertheless, for the individual measures, there is clear evidence to suggest that they would each help to contribute to reducing Singaporeans' sugar intake. For example, evidence shows that mandatory FOP nutrition labels are effective in helping consumers make healthier choices. Among the different types of FOP labels, studies conducted globally and locally found that nutrient-summary labels are more effective than nutrient-specific and warning labels in helping consumers make healthier choices. Studies have also shown that restricting advertisements can reduce consumption of the product.”
“The Health Promotion Board (HPB) adopts a multi-pronged strategy to encourage Singaporeans to eat healthily and reduce their sugar intake from food and drinks. First, we highlight to Singaporeans the importance of reducing sugar intake and encourage them to choose lower-sugar alternatives. To do this, we introduced the Healthier Choice Symbol (HCS) in 2001 to help consumers identify healthier, lower-sugar food and drinks while grocery shopping. We also couple this with consumer promotions, such as the nationwide Eat Drink Shop Healthy (EDSH) Campaign to encourage healthier choices. Second, we make more healthier alternatives available when Singaporeans eat out. To do this, we partner the food and beverage (F&B) industry through the Healthier Dining Programme (HDP) to encourage them to offer healthier options, including lower-sugar drinks, as part of their permanent core menu offerings. Currently, there are more than 1,200 F&B operators, hawker centres and coffee shops onboard the programme. We have also worked with the Ministry of Education (MOE) and other Government agencies to ensure that all packaged drinks sold at MOE schools and Government premises are lower in sugar. In addition, freshly prepared hot drinks at Government premises are served without sugar by default. Third, we encourage the industry to lower the sugar content of their products. To do this, HPB extended the Healthier Ingredient Development Scheme (HIDS) in April 2018 to include sugar-sweetened beverages (SSBs), desserts and sauces. This provides grants for the development and marketing of healthier food ingredients. Since then, six companies have tapped on the HIDS grant to develop 39 lower-sugar products, such as lower-sugar Asian drink mixes for coffee shops and F&B outlets.”
“The effort seeks to build community-wide awareness and recognition of caregivers and their caregiving needs and brings together community partners to show collective support for caregivers. We want to encourage more of such ground-up local efforts, as part of a whole-of-society effort to support our caregivers. However, we recognise that more can be done. A review is presently being undertaken to look into strengthening support for senior caregiving. As part of the review, MOH has been engaging caregivers and other stakeholders to gather feedback and discuss ideas since September last year. Areas under review include improving care navigation in the community, enhancing caregiver support in areas, such as respite services, and working with community partners to offer more socio-emotional support to caregivers. MOH and partner agencies are developing specific recommendations in these areas, and more details will be provided in due course.”
“Caregiving needs will grow as our population ages, with one in four Singaporeans aged 65 and above by 2030. Guided by the Action Plan for Successful Ageing, the Ministry of Health's (MOH's) approach towards supporting caregivers, includes expanding and deepening the range of care options available for their loved ones, so that caregivers can have peace of mind. To this end, we have added 2,600 day places and 2,300 home care places since 2015. We have also made respite care at nursing homes and eldercare centres more accessible so that caregivers can have a reprieve in caregiving. Overall, around $800 million was spent in 2016 on the long-term care sector, which could help to meet these caregiving needs and to ensure that quality care is affordable and accessible. Besides these efforts, other programmes are in place to support the psychosocial and mental health needs of caregivers. For example, community outreach and community intervention teams are available to provide caregivers with emotional support, psychosocial education and counselling, equipping them with more insights about their loved one's conditions and how they can be better supported. Caregiver support networks are also a valuable source of peer support and mutual help. In addition, support for caregivers of persons with disabilities has also been enhanced under the Third Enabling Masterplan. For example, SG Enable recently set up a "Caregiver Pod" at the Enabling Village to facilitate peer support group activities and training, and to make it convenient for caregivers to access information, referrals to disability services and support. We have also seen ground-up initiatives, such as the Caregiving@Southwest programme recently launched by the Southwest Community Development Council in December 2018.”
“The Health Sciences Authority (HSA) is responsible for providing a safe and adequate blood supply for our patients. It works closely with the Singapore Red Cross (SRC) to recruit voluntary blood donors under the National Blood Programme. SRC leverages its networks with companies, communities, hospitals, religious groups, schools and the uniformed groups to recruit blood donors. About 73,000 blood donors contributed to the blood programme in 2017, giving a donor participation rate of 1.8%. This is comparable to countries and cities in the Asia Pacific region, such as Australia, New Zealand and Hong Kong, where donor participation rates range between 1.9% and 2.2%. Overall, our donor pool has been adequate to meet blood demand. Nevertheless, occasional blood shortages may arise, especially during festive seasons or school holidays, when many blood donors travel overseas. In such a situation, the SRC will ramp up recall efforts through social media, text messages and direct donor calls. More mobile blood drives may also be set up across the island. During rare instances when blood stocks fall below a critical level, HSA may work with hospitals to postpone some non-urgent surgeries until the blood stocks improve. HSA and SRC may also launch an appeal for blood donations through the mass media. We have embarked on efforts to improve our outreach. For example, HSA has built satellite blood banks closer to where donors live, work or study. HSA and SRC have also focused on getting more young people to become regular blood donors. Frequent mobile drives are also set up at schools, polytechnics and universities. We encourage the community to volunteer to become regular blood donors, particularly as demand will increase over time.”
“There are currently three human papillomavirus (HPV) vaccines available in Singapore – Cervarix, Gardasil and Gardasil 9. In Singapore, HPV vaccination is recommended for females aged nine to 26, and MediSave use is extended for vaccinations using Cervarix or Gardasil. These two vaccines protect against HPV infection from two of the most common types (16 and 18), which account for 70% of cervical cancer cases, and have been shown to be both clinically- and cost-effective in the local setting. Gardasil 9 is a relatively new vaccine which potentially extends protection against additional cancer-causing HPV types. The Ministry of Health is currently in the process of evaluating its cost-effectiveness, compared to the other HPV vaccines.”
“ACE will continue to work on increasing the impact of its work so as to enable Singaporeans to have access to clinically effective and cost-effective health technologies.”
“The Agency for Care Effectiveness (ACE) was established in 2015 as our national health technology assessment agency to facilitate the adoption of clinically effective and cost-effective care. ACE's evaluations are published as Drug or Medical Technology Guidances, as well as Appropriate Care Guides for doctors and patients. Its evaluations are also taken into account in the Ministry of Health's (MOH’s) decision on the extension of public healthcare subsidies. Drugs and medical technologies evaluated to be both clinically effective and cost-effective are subsidised. Over the last three years, ACE has completed 62 technical evaluations of health technologies. ACE also published 28 Drug Guidances, and two Medical Technology Guidances. In addition, ACE produced nine Appropriate Care Guides focused on effective primary care for chronic diseases, such as diabetes and chronic obstructive pulmonary disease. ACE has prioritised health technologies and medical conditions which are of high impact to patients and our healthcare system. MOH tracks the uptake of health technologies that have been evaluated to be clinically effective and cost-effective, and it has been on an uptrend versus alternatives that are less effective. For example, dapagliflozin was evaluated by ACE and subsequently included as a subsidised drug for Type 2 diabetes in early 2017. The usage share of dapagliflozin relative to alternatives increased from 40% in 2016, to 65% in 2017. In addition to their work in health technology assessment, ACE also negotiates with manufacturers for fair prices for selected health technologies. ACE’s work in this area has helped to improve access and affordability of healthcare services.”
“Polyclinics provide subsidised care for the management of acute and chronic conditions. Subsidies are available for doctor consultations, as well as drugs, tests and other services assessed by the polyclinic doctor to be clinically appropriate for the patient. Some private general practitioners (GPs) today refer their patients to polyclinics for specific services, such as X-rays or tests. As these patients are not assessed by polyclinic doctors, our doctors are unable to determine whether the ordered tests or investigations are appropriate. Therefore, they are considered private healthcare services for which polyclinic subsidies do not apply. Nevertheless, the Ministry will review how we can better support Community Health Assist Scheme (CHAS) patients whose care is managed by CHAS GPs, including ways to improve access to clinically appropriate subsidised tests and investigations. We thank the Member for his feedback.”
“MOH takes a risk-based regulatory approach. Chiropractic services are a form of complementary and alternative treatment and are currently not licensed under the Private Hospital and Medical Clinic Act. There is also no statutory legislation to regulate practitioners of complementary and alternative medicine practitioners, including chiropractors. Chiropractors are encouraged to practise self-regulation, register with their professional association, that is, The Chiropractic Association (TCA) (Singapore) and adhere to industry standards set by the association. TCA (Singapore) has developed a code of ethics, scope of practice and advertising guidelines for their profession. While there are no regulations involving chiropractors and their services, they are subjected to provisions under the Medicines (Sales and Advertisements) Act. For example, their publicity is not permitted to contain any diagnostic or treatment claims for any diseases and medical conditions. Doing so might contravene the Act and result in penalties. Complaints in this area can be sent to the Ministry of Health. For other disputes, customers can find recourse through the Consumers Association of Singapore. The Ministry will continuously monitor the risk to patient safety and periodically review the need to license chiropractic professionals and their services.”
“Singaporeans can benefit from subsidised outpatient treatments at all our polyclinics and hospitals, regardless of their insurance coverage. All Singaporeans receive subsidised treatments at our polyclinics. As for our public hospitals' Specialist Outpatient Clinics (SOC), patients with valid polyclinic referrals and Community Health Assist Scheme (CHAS) cardholders with valid CHAS clinic referrals, as well as patients discharged from B2 or C Class hospital wards, are eligible for subsidised medical treatments. Patients may opt for private SOC services or A or B1 Class wards for various reasons, including choosing specific doctor or taking advantage of private insurance coverage. Some of these patients may later request to switch to subsidised care due to financial concerns. Our public healthcare providers assess such requests on a case-by-case basis, taking into consideration factors, including the patient's financial circumstances. In the past five years, on average, we have received about 4,000 requests a year to switch from private to subsidised SOC care. Patients who are facing financial difficulties can approach the medical social workers to discuss available options.”
“MOH will continue to review our manpower strategies based on projected future healthcare needs, taking into consideration the changing healthcare context, and ensure we have adequate manpower supplies.”
“To meet our medical manpower needs, the Ministry of Health (MOH) has steadily ramped up intakes of our medical schools by 40%, from 354 in 2012 to 500 in 2018. Our medical schools will remain our primary source of new doctors. An average of about 200 overseas-trained local doctors returned each year in the last three years, more than double that in 2010. As our local pipeline has grown significantly over the years, we expect our need to recruit overseas-trained doctors to moderate and stabilise in the coming years. Of those who returned and registered with Singapore Medical Council between 2010 and 2012, more than nine in 10 continued to practise in Singapore even after five years and about four in five stayed in the public sector for five years or more. Our public healthcare institutions will continue to provide a conducive work environment for all healthcare staff by improving work processes for doctors and adopting technology to streamline workload. We are also providing more training and development opportunities for career progression. Our healthcare staff, including doctors, also have a wide range of opportunities to work in different institutions and settings within the healthcare sector. Beside doctors, we are also stepping up recruitment and retention efforts for other healthcare professionals like nurses. Over the years, we have increased salaries and broadened opportunities for nurses, including providing greater autonomy in their roles, and increasing opportunities and funding support for training. The intakes of our local nursing courses have also increased significantly from around 1,500 in 2012 to more than 2,100 in 2018.”
“We are unaware of any air filtration technology which would be effective at filtering out the harmful effects of cigarette smoke. The toxic constituents of cigarette smoke are both particulate and gaseous in nature. Residential air cleaning technology is unable to adequately remove all of the gaseous components, such as formaldehyde, benzene and carbon monoxide.”
“Nurses make up the largest proportion of our healthcare workforce, constituting more than 40% of the workforce in public hospitals today. In March 2018, the Ministry of Health (MOH) launched the Healthcare Productivity Fund – Smart Nursing Ward Programme, a key initiative under the Healthcare Industry Transformation Map. This programme supports hospitals in improving nursing processes and adopting smart solutions so as to reduce our nurses' administrative load and enable them to focus more attention on direct patient care. Some of the areas being looked into include inventory management, materials delivery, patient monitoring and patient transport. Some technology solutions being explored include Autonomous Mobile Robots (AMRs) and Radio Frequency Identification (RFID) technology. For example, AMRs were earlier piloted in some of our public hospitals to transport items, such as consumables and medication. One deployment saved as many as six Full Time Equivalents (FTEs). Under the Smart Nursing Ward programme, we are exploring to expand the use of these AMRs, by deploying them to deliver medical instruments. This aims to save time for nurses from walking back and forth between sterilisation facilities and Operating Theatres, enabling them to focus on direct care. As part of the programme's eligibility criteria, proposed projects are required to strive for at least 10% nursing time-savings. As the programme was only launched in March 2018, many of the projects have just been initiated or are being explored. It is thus premature to assess the progress.”
“Any further increases in MediSave withdrawal limits, whether for outpatient or inpatient care, should be considered very carefully and balanced against the longer-term sustainability of MediSave accounts to serve the needs of Singaporeans. We will also continue to consider appeals for usage of MediSave above the withdrawal limits and extend MediFund to those who need additional financial assistance.”
“Over the past two years, the Ministry of Health (MOH) received about 200 appeals from patients aged 62 and above to use their MediSave monies beyond the prevailing withdrawal limits. These appeals are considered on a case-by-case basis, taking into account factors, such as the need for more complex treatments, unforeseen complications and financial difficulties that make it hard for the family to pay the outstanding bill. About half of the appeals were approved. The MediSave withdrawal limits are set to be sufficient for the vast majority of subsidised healthcare expenses, after Government subsidies and MediShield Life payouts. In 2017, MediShield Life and MediSave together were able to cover about 92% of the post-subsidy bill for inpatient hospitalisation and day surgeries. For seniors aged 80 and above, more than seven in 10 hospitalisations in subsidised wards did not require any cash payment, and more than eight in 10 paid less than $100 in cash. There are no plans at present to lift the withdrawal limit. We do, however, recognise that the elderly have greater need for healthcare. In recent years, we have enhanced outpatient subsidies and introduced MediShield Life, and these have improved affordability for all Singaporeans, especially the elderly. We have also introduced targeted initiatives, such as the Pioneer Generation Package, specifically for the elderly. As for MediSave withdrawals, we just raised the annual MediSave limit for outpatient chronic treatments from $400 to $500 in June this year. At the same time, we lowered the minimum age under the Flexi-MediSave scheme from age 65 to 60, so that more Singaporeans can use up to another $200 of MediSave flexibly each year for outpatient care. MOH will continue to monitor the affordability of subsidised care.”
“Eligibility for MediFund is determined by the individual MediFund committees of each institution, taking into account factors, such as the patient's financial background and the bill size. They have the flexibility to extend MediFund assistance to middle-income patients facing extenuating circumstances.”
“Regardless of whether they have private health insurance, all children can benefit from Government healthcare subsidies as well as tap on MediSave and they are all covered under MediShield Life. Those who need additional financial assistance can also apply for MediFund. Singaporean children, including those with chronic conditions, would receive subsidies of up to 75% at polyclinics and Specialist Outpatient Clinics. Those who require inpatient care can receive up to 80% subsidy at our public hospitals. Children who are Community Health Assist Scheme (CHAS) cardholders can enjoy up to $480 annually in subsidies for treatment of chronic conditions at participating CHAS general practitioner (GP) clinics. CHAS subsidies for managing chronic disease will soon be extended to all Singaporeans. On top of Government subsidies, MediSave can help pay for chronic disease bills under the Chronic Disease Management Programme (CDMP). Since 2015, all Singaporean newborns receive a $4,000 MediSave Grant for Newborns. So, even newborns would have MediSave balances they can tap on. Children who do not have enough MediSave and those with higher medical bills can tap on the MediSave accounts of their parents. MediShield Life covers all Singaporean children from birth, including those with congenital and neonatal conditions, regardless of whether they have private health insurance. Hence, parents can claim MediShield Life payouts for their children if they are hospitalised or require dialysis and chemotherapy for cancer. MediFund provides a safety net to help those who are unable to afford their healthcare bill, even after Government subsidies, MediShield Life and MediSave.”
“The Dementia Friends mobile app was developed as part of the Dementia-Friendly Singapore initiative and was officially launched on 25 October 2018. As at end October 2018, over 2,000 people have signed up as Dementia Friends through the Dementia Friends mobile app. The mobile app was designed for both caregivers of persons with dementia, as well as the wider general public. It allows users to access information about dementia and the available support services, receive updates on upcoming events on caregiving and, most importantly, enlist the help of the community to locate loved ones who might be lost. When persons with dementia are lost, caregivers can use the mobile app to activate the network of Dementia Friends. These Dementia Friends, who are members of the public, would then receive a notification from the mobile app to help keep a lookout for the lost persons. Go-to Points are listed in the mobile app, so that the persons who are lost can be brought to the nearest Go-to Point by nearby Dementia Friends to be reunited with their caregivers. We hope that the Dementia Friends mobile app can serve to mobilise community resources to support and respond to caregivers' needs. Members of the public are encouraged to download this mobile app and sign up as a Dementia Friend, and to also share this useful resource with relatives and friends, whether or not they are specifically trained.”
“The reported cases of Hand, Foot and Mouth Disease (HFMD) fluctuate from year to year, as shown in Table 1 below. The Ministry of Health (MOH) works closely with the Ministry of Education (MOE), Early Childhood Development Agency (ECDA) and the People’s Association (PA) to educate and assist preschools to curb and control the spread of HFMD. We provide guidance on personal and environmental hygiene and inspect preschools with large clusters to help them identify gaps. We also provide infection control guidelines to all preschools and work with them to remind parents to play their part by keeping their children home to rest if their children have symptoms of HFMD, such as fever, mouth ulcers and rashes on the palms, soles or buttocks. During the peak months this year from March to May and July to August, we reminded preschools to be more vigilant in screening children with HFMD symptoms and ensure high personal and environmental hygiene standards. ECDA also stepped up on health visits to preschools with ongoing transmission. MOH will continue to regularly review our policies and response measures with respect to the control of HFMD transmission.”
“The priority of the Ministry of Health (MOH) and public healthcare institutions (PHIs) is to serve Singaporeans' healthcare needs. Our PHIs are not allowed to actively market themselves to foreign patients. MOH has also recently asked PHIs to cease any contracts with service providers to assist foreign patients referred for medical treatment in Singapore. Today, none of our PHIs have contracts with such service providers anymore. There are foreign patients who travel to Singapore to seek medical treatment on their own accord. Between 2013 and 2017, such patients make up about 1.5% of the total inpatient and day surgery attendances at our PHIs. Those whose referrals were supported by contracted service providers constituted about 0.4% of attendances in PHIs that had such contracts. Revenue from such patients made up 0.8% of total revenue in these PHIs. Singaporeans remained the majority of patients treated in PHIs. Foreign patients have not impacted our PHI's delivery of services and subsidised appointment slots given to Singaporeans. In fact, the median waiting time for new subsidised specialist appointments has improved steadily from 28 days in 2013 to 22 days in the first half of 2018. MOH will continue to work with our PHIs to ensure that meeting Singaporean's healthcare needs remains our priority.”
“Obesity is a risk factor for developing medical conditions, such as high blood pressure, high blood cholesterol and Type-2 diabetes mellitus. Childhood obesity often persists into adulthood, when it can cause adverse health effects. Overweight children at the upper end of the cohort weight range are at higher risk of developing such medical conditions earlier. About 13% of our children aged 6-18 are overweight. Among the higher risk overweight1 students screened at the Health Promotion Board's Student Health Centre (HPB SHC) in 2016, less than 2% had impaired fasting blood glucose, and about one in three had elevated blood pressure or elevated blood lipids. To strengthen intervention early through lifestyle management, higher risk overweight children are referred by schools to the HPB SHC for assessment and lifestyle coaching. Those found to have an obesity-related medical condition are referred for specialist care at public sector hospitals. HPB works with schools to increase opportunities for physical activity and make healthier meals more accessible for students. Student Health Advisors are also deployed to secondary schools to provide counselling to help overweight students change unhealthy behaviours. To make healthy living a norm, NurtureSG also published a mini booklet on "Five Habit Hacks for a Healthier Child" to educate and empower parents with the skills to improve their child's health. The Ministry of Health and HPB will continue our efforts to foster healthy behaviours in our young to improve their physical well-being.”
“National Health Expenditure (NHE) is commonly used to track healthcare spending. Between 2006 to 2016, our NHE increased at an average rate of 11% per year. In addition to healthcare inflation, the increased expenditure includes several factors, such as our ageing population, higher utilisation of healthcare services and capital expenditure on the building of more public healthcare facilities in recent years. The NHE figure for 2017 is not yet available. Over the same period, the Government has provided more support for healthcare. These include the Pioneer Generation Package, MediShield Life premium subsidies and the Community Health Assist Scheme (CHAS). Between 2006 to 2016, the Government’s expenditure on healthcare increased significantly faster by 17% and, consequently, the Government's share of NHE increased from about 30% to more than 40%. As a result of increased Government subsidies, while the growth in our NHE has been high, healthcare inflation, defined as the growth in prices of healthcare goods and services borne by Singaporeans, has been lower. Between 2007 and 2017, Singapore’s average annual healthcare inflation was 2.6%, compared to 2.3% for all goods and services. We will continue to monitor healthcare inflation closely and keep healthcare affordable for all Singaporeans.”
“The ECEG states that in "managing patients, a doctor must always place patients’ best interests above his personal interests and any business of financial considerations. The ECEG prohibits doctors from letting business or financial considerations influence the objectivity of their clinical judgement in their management of patients". In March this year, SMC reminded all doctors about these ethical principles through a circular. All stakeholders have to play their part to avoid over-servicing and keep healthcare affordable and sustainable for all Singaporeans.”
“It is difficult to accurately assess the prevalence of over-servicing. As an indicator, between 2013 to 2017, complaints of unnecessary or inappropriate treatment lodged with the Singapore Medical Council (SMC) averaged 19 each year. Several measures have been instituted to reduce over-servicing and encourage appropriate care. The Agency for Care Effectiveness (ACE) has developed a total of 39 guidances to date on what constitute rational accepted clinical practice, and appropriate investigations and treatments. These include guidances on the appropriate usage of selected high-cost medications, treatments and investigations, such as indications for the use of Positron Emission Tomography (PET)-Computed Tomography (CT) scans in managing cancer. The insurance industry has also started implementing measures to discourage over-servicing. Integrated Shield Plan (IP) insurers are developing or enhancing their pre-authorisation frameworks, where insurers would approve the medical treatment and estimated bill sizes prior to the actual procedures. This provides certainty to patients on what can be claimed under their insurance policy, while allowing insurers to assess the medical necessity of the treatment. IP insurers are also required to incorporate a co-payment of 5% or more into new IP riders from 8 March 2018. Co-payment in insurance is a key element that will encourage healthcare providers and policyholders to choose medically necessary and appropriate treatments for the patient's circumstances. When the SMC revised its Ethical Code and Ethical Guidelines (ECEG) in 2016, a specific section on Finances in Medical Practice was introduced.”
“Persons with mental health conditions surveyed expressed desires for improvement in their psychological well-being, level of independence and social relationships. In particular, a significant number were keen on employment. In the 2017 NCSS Study on Attitudes towards Persons with Mental Health Conditions in Singapore, negative attitudes from co-workers were found to be a major barrier to employing people recovering from mental health conditions. A follow-up study by NCSS found that implementing workplace adjustments, such as increasing work support and supervision, training of supervisors and managers, will facilitate the employment of persons with mental health conditions. The Tripartite Guidelines on Fair Employment Practices state that employers should recruit employees on the basis of merit. The Ministry of Manpower (MOM) and the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) treat workplace discrimination seriously and workers who face any form of workplace discrimination should promptly report the matter to MOM or TAFEP.”
“The Ministry of Health (MOH) has been working with healthcare institutions and professionals to implement the community mental health plan since its launch in 2017. One key emphasis is to make care in the community more accessible for persons with mental health conditions and dementia. As at June 2018, mental health and/or dementia services are available at 10 of our polyclinics. This will increase to 12 polyclinics, or half our polyclinics, by 2021. In addition, 155 general practitioner (GP) partners have been trained to diagnose and support persons with mental health conditions. These GPs are, in turn, supported by 19 trained community intervention teams, that enhance care for persons with mental health conditions through allied health services, such as counselling. The Agency for Integrated Care has also established a network of 34 community outreach teams, to reach out to persons with depression or dementia. These teams also carry out public education programmes to raise awareness on mental health and dementia conditions. To complement these outreach efforts, we have established six Dementia Friendly Communities to create an inclusive and supportive environment for persons with dementia and their caregivers. I understand that internationally, mandatory mental health school programmes are still in the nascent stage. Various initiatives have been implemented in our schools to promote the understanding of mental health. For example, the Health Promotion Board offers psycho-emotional programmes in schools to promote mental health literacy. On the impact of mental health conditions on different aspects of life, the National Council of Social Service (NCSS) conducted a study in 2016 to better understand the quality of life of persons with mental health conditions.”
“Folic acid and iron supplements are necessary for many expectant mothers and are subsidised under our Standard Drug List. Subsidised patients receive up to 75% subsidy for these supplements, depending on their means. In the last three years, the average amounts paid by subsidised patients for folic acid and iron supplements over the course of their pregnancy were $3 and $30 respectively. Overall, the total subsidies provided by the Government for the supplements were $11,300, $15,400 and $17,300 in 2015, 2016 and 2017 respectively. Whilst a daily dose of 400 micrograms of folic acid is generally sufficient for low-risk pregnancies, expectant mothers are typically prescribed five milligrams of folic acid per day. This is based on the recommended daily dose from preconception to the initial 12 weeks of pregnancy when there is higher risk of the foetus developing neural tube defects. As for iron supplements, most doctors prescribe routine iron tablets as general supplement from 20 weeks of pregnancy onwards. However, doctors also check for anaemia in the first trimester and also after 28 weeks of pregnancy to determine if a higher dose of iron supplement is warranted.”
“We can also play our part by washing our hands before and after visiting our friends or relatives in the hospitals.”
“The Ministry of Health (MOH) has been working with experts on the National Infection Prevention and Control Committee (NIPCC) to improve infection control in hospitals. The National Infection Prevention and Control Guidelines for Acute Hospitals, published in August 2017, outlines the infection prevention and control programmes that all public and private hospitals are required to put in place. These programmes cover standard and transmission-based precautions, active surveillance, outbreak response procedures, education of employees in infection prevention and monitoring of infection control practices. Our hospitals carry out audits regularly to assess infection control practices and address gaps, if any. MOH monitors the performance of all hospitals on standards developed by NIPCC. In April 2018, MOH completed the inaugural infection prevention and control peer review across all public hospitals. We also held a series of engagement sessions with the private hospitals to facilitate cross institutional exchange and learning. MOH has worked to strengthen key antimicrobial resistance control efforts through antimicrobial stewardship programmes, and maintains surveillance of antimicrobial-resistant organisms. While healthcare-associated Methicillin-Resistant Staphylococcus Aureus (MRSA) infections dropped from 0.84 per 10,000 patient days in 2013 to 0.38 in 2017, we cannot afford to be complacent. We need to continue to work with stakeholders, including doctors and healthcare providers, to strengthen antimicrobial stewardship. Finally, our hospitals have implemented measures to restrict the number of visitors to inpatients to reduce the risk of transmission of infections.”
“In collaboration with the community mental health partners, IMH and AIC co-develop joint workflow and protocol to facilitate the referral of these clients and also build the partners' mental health capability through training and case discussions. The Aftercare Programme has since expanded from the first site at Ang Mo Kio-Sin Ming, to Kembangan-Chai Chee and Kreta Ayer-Henderson sites as of end June 2018.”
“The Ministry of Health (MOH) works closely with our healthcare and community service providers to support persons with mental health conditions after they are discharged. Discharged patients who require further support in the community can be referred to the community outreach teams for the necessary supervision and help. This includes persons with no caregivers. Typically, after a patient has been discharged from the hospital, an outpatient appointment to follow up on the patient's condition will be arranged. For patients with moderate or severe but stable mental health conditions, they would be case managed by the Institute of Mental Health (IMH). This involves post-discharge monitoring, mainly through regular follow-up telephone calls and home visits, to ensure that patients attend their outpatient reviews and comply with medication. If required, patients can also be referred to other agencies and community outreach teams for social support. For patients who require more intensive follow-up, IMH deploys multidisciplinary teams to the patients' homes to provide treatment and counselling. A 24-hour crisis intervention helpline service and mobile crisis team are available when their mental health issues escalate. To complement IMH's work in providing post-discharge care and follow-up, MOH has also been building the capability of healthcare professionals and community partners to provide better supervision, treatment and support for persons with mental health issues within the community. Together with the Agency for Integrated Care (AIC), the Aftercare Programme was implemented in 2015 in parts of the central and south of Singapore. The programme aimed to support clients' smooth transition from IMH into the community.”
“The Ministry of Health regularly reviews our healthcare manpower needs taking into account population demographics and disease trends. We aim to build a strong local core of doctors to meet Singapore's healthcare needs. In line with the Healthcare 2020 Masterplan, we increased our local medical intakes through the expansion of the National University of Singapore (NUS) Yong Loo Lin School of Medicine and Duke-NUS Medical School, and the establishment of the Nanyang Technological University (NTU) Lee Kong Chian School of Medicine in 2013. Between 2012 and 2018, the total local medical intake increased by about 40%, from 354 to 500. The annual output of about 500 medical graduates from our local medical schools will contribute towards building a strong local core of doctors in our healthcare workforce. This will be supplemented by overseas-trained doctors, including Singaporeans returning to join our healthcare family. In Singapore, we had about 2.4 doctors per 1,000 population in 2017, a significant increase from 1.9 in 2012. Our ratio is higher than Hong Kong and Taiwan; comparable to those in South Korea and Japan; and lower than the United States and the United Kingdom. We need to be cautious when comparing these ratios across healthcare systems and be mindful of the differences in healthcare models, operating environments and national contexts.”
“Healthcare entities in the public and private sectors are licensed under the Private Hospitals and Medical Clinics Act. They are required to have in place adequate safeguards to maintain and protect their medical records against loss or unauthorised modification, destruction, access, disclosure, copying or use. They are also subject to requirements under the Personal Data Protection Act, which imposes obligations to protect personal data. For selected clinical conditions, additional safeguards are required due to the sensitivity of such conditions. Some are protected by legislation, such as the Termination of Pregnancy Act and the Human Organ Transplant Act. Other sensitive medical conditions are subject to additional technical controls to restrict access to records, in line with the Advisory Guidelines issued by the Personal Data Protection Commission for the Healthcare Sector in 2014. The Ministry of Health regularly inspects and audits healthcare institutions for compliance to ensure that licensees have taken reasonable actions to implement appropriate and adequate safeguards for the integrity and confidentiality of patients' medical records. If licensees are found to be non-compliant, they may be subject to penalties under the relevant Acts.”
“Vitamin D promotes the absorption of calcium by the body, which, in turn, keeps our bones strong and healthy. Most people obtain Vitamin D from skin exposure to sunlight, supplemented with dietary sources. A lack of Vitamin D may put a person at higher risk of conditions, such as osteoporosis. Other effects still being studied include the impact on immune function. According to the National Health Survey in 2010, 40% and 8% respectively of Singaporeans were deficient and very deficient for Vitamin D. However, not all people with Vitamin D deficiency would experience an impact on their health. Our survey findings are also comparable to other countries, such as the United Kingdom, the United States and South Korea. To ensure adequate levels of Vitamin D and proper absorption of calcium by the body, the Health Promotion Board (HPB) recommends a diet containing foods rich in Vitamin D, such as eggs and oily fish, and at least five to 30 minutes of sun exposure at least twice a week. To promote adequate nutrition, HPB rolled out "The Recipe for Healthy Ageing", a toolkit designed to raise awareness on nutritional requirements for seniors aged 50 and above and guide them on food sources that would meet their dietary needs.”