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 outpatient benefits offered under the Pioneer Generation (PG) package are designed to help our Pioneers better afford subsidised services (and from 1 January 2015, subsidised drugs) in public healthcare institutions, as well as at GP and dental clinics participating in the Community Health Assist Scheme (CHAS). As Traditional Chinese Medicine (TCM) is a form of complementary medicine, PG subsidies do not apply at TCM clinics. There are currently more than 40 charitable TCM organisations providing easy access to affordable TCM services in the community. Seniors who wish to seek TCM treatment may do so at these TCM clinics.”
“Admission into public hospitals is prioritised based on the severity of patients' conditions. For surgical emergencies, such as major trauma, our public hospitals maintain 24-hour emergency surgical services to respond to these needs promptly. For patients requiring non-urgent surgical operations, these are usually pre-planned. The median waiting time across public hospitals for such planned surgical operations for subsidised patients was 14 days in 2013. Our public hospitals adopt a multi-pronged approach to manage pre-planned surgeries. For example, where appropriate, patients can undergo day surgeries. About 60% of surgeries Page: 162 in our public hospitals are now performed as day surgeries, removing the need for an admission. Day surgeries benefit patients as they are more convenient and save patients time and the cost of an inpatient stay. For some surgeries, patients can also be admitted on the day of surgery, instead of one or two days earlier. Such patients would attend a pre-admission outpatient visit for a pre-operation assessment and preparation. There are also ongoing efforts to increase surgical specialists and operating theatre capacity. The number of specialists in the main surgical specialties has increased from about 800 in 2008 to 1,100 in 2013 and on 25 September this year, the National Heart Centre Singapore opened its new building with three new operating theatres.”
“The B2 and C class wards are currently designed for natural ventilation, taking into account affordability and infection control considerations. Some patients, particularly the elderly, also prefer a non-air-conditioned environment similar to their own homes. However, MOH does take additional measures when the environmental conditions warrant it. For example, when the haze intensified last year, MOH provided funding to healthcare institutions to purchase air purifiers and portable air coolers for use in naturally ventilated wards. This equipment can be used during a sustained severe haze, should it occur again. In addition to this, we are also looking at incorporating additional filter systems in the naturally ventilated patient wards for new healthcare facilities.”
“The Government provides subsidies for drugs on the Standard Drugs List or under the Medication Assistance Fund at our public healthcare institutions. These are drugs that have already been assessed to be clinically- and cost-effective. In our public healthcare institutions, Pharmacy and Therapeutics (P&T) committees determine which drugs are available and how doctors should use them. The ordering of higher cost drugs by doctors is also managed and monitored to ensure that they are clinically necessary for managing the patients' conditions. This is in line with our continued efforts to encourage our doctors to use clinically- and cost-effective generic drugs when possible and appropriate. There are published clinical practice guidelines which provide guidance to both public and private sector doctors on how best to treat disease conditions and the appropriate use of drugs. Doctors are ethically required to act in the best interests of their patients, including those who are PGs. This would include being aware of current best practices and providing their patients with cost-effective treatments. We strongly encourage doctors to prescribe generic drugs where possible, as they would be more affordable for patients than branded equivalents. We also encourage patients to engage their doctors on their treatment and charges and ask about using generics where possible. My Ministry will continue to monitor the claims made by clinics treating PGs and those under the Community Health Assist Scheme (CHAS). Clinics have been and will continue to be called upon to account for any exceptional claims.”
“Mdm Speaker, may I seek your consent and the general assent of Members present to move that the proceedings on the Private Members' Bills, namely, items 9 and 10 of the Orders of the Day on the Order Paper for today, be taken immediately after item 3.”
“MOH has also stepped up our efforts to raise public awareness of allied health professions as careers of choice, through our multi-year branding campaign – "Care to Go Beyond". We have also expanded the local training pipelines to meet the increasing demand for AHPs. The total physiotherapy, occupational therapy and speech therapy intakes at Nanyang Polytechnic and the National University of Singapore have increased by 75%, from 124 in 2007 to 218 in 2013. We will continue to review the manpower demand and supply regularly Page: 81 and build up the local training pipelines. MOH and MSF will continue to work together with social and ILTC service providers to explore ways to enhance manpower attraction and retention to support the growth of healthcare and community care services.”
“Allied health professionals (AHPs), like physiotherapists, occupational therapists and speech therapists, play an important role in our healthcare sector by providing therapy treatment to patients to facilitate their recovery and improve their quality of life. As of 2 June 2014, 607 physiotherapists, occupational therapists and speech therapists in the intermediate and long-term care (ILTC) and social service sectors were registered with the Allied Health Professions Council. With registration, we will be able to raise the recognition and enhance the attractiveness of the profession. The Ministry of Health (MOH) and the Ministry of Social and Family Development (MSF) have implemented several strategies to support service providers in retaining AHP manpower, both local and foreign. These include additional funding to the providers to keep wages competitive with the market and provision of subsidised training programmes to help new AHPs adapt to the work environment and deepen their expertise. MSF, MOH, the National Council of Social Services and the Agency for Integrated Care have also supported therapy hubs which provide therapy services to social and ILTC institutions to help them better meet service needs. With greater economies of scale, these hubs can also facilitate better career development opportunities for the therapists, leading to better attraction and retention of the AHPs. MOH also introduced a central employment scheme called CREATE, or Career Resourcing and Development of Allied Health Talents, in 2012 to recruit and deploy AHPs to ILTC institutions to meet their manpower needs. Thirty-three physiotherapists, occupational therapists and speech therapists have come on board the scheme so far.”
“Such coordinated care and monitoring ensures that these patients receive adequate support and thus minimises the risk of readmission.”
“The readmission rate for patients within 30 days after discharge from public hospitals was 11.7% in 2011 and 12.2% in both 2012 and 2013. In 2013, the readmission rate was 6.2% for KK Women's and Children's Hospital and the readmission rates for the other hospitals are similar and ranged from 13.4% at Singapore General Hospital and National University Hospital to 15.1% at Alexandra Hospital. The readmission rates for patients aged 65 years and older had remained stable around 19% from 2011 to 2013. In 2013, the readmission rates for patients aged 65 years and older ranged from 18.5% at Tan Tock Seng Hospital to 21.1% at Khoo Teck Puat Hospital. Overall, our public hospital/institution readmission rates are comparable to the United States, but higher than some other countries, such as the United Kingdom. Several factors contribute to readmissions, such as the patient's conditions and disease type, the quality of inpatient care, the transitions to primary and community care, and the follow-up care, including rehabilitation care. The home environment and family support is also an important contributing factor. Readmission rates also vary across hospitals due to the different case mix, that is, type and range of cases seen. We will study the request on the publication of readmission rates. MOH monitors the readmission rates regularly and shares the results with the public hospitals annually for their consideration in implementing measures to reduce readmissions. Hospitals have implemented various programmes to reduce readmission rates. For example, Tan Tock Seng Hospital's Virtual Hospital Programme involves assigning a care manager to monitor patients who have a history of multiple admissions.”
“In recent years, MOH has received requests for the provision of Pre-implantation Genetic Screening (PGS) to identify chromosomal abnormalities in embryos created through in-vitro fertilisation (IVF), with the aim of improving the chances of conceiving. However, these requests were not approved because the effectiveness of PGS in improving the chance of live births for women with fertility problems, such as advance maternal age, recurrent miscarriages and recurrent IVF failures, is unclear at present. In addition, there is a risk of it being used to select embryos for non-medical reasons, such as sex selection for social reasons. My Ministry will continue to review the provision of PGS as new evidence emerges. Currently, there are safeguards in place for abortion. Majority of the pregnant women seeking abortions have to undergo pre-abortion counselling, where they are provided information and emotional support to aid them in making an informed decision. This includes explanation of the medical procedures, potential risks and after-effects of undergoing an abortion. The law also mandates a "cooling-off" period of at least 48 hours from the time a woman is counselled to the time when her informed consent is obtained for the procedure. This ensures that the woman has sufficient time to consider her decision carefully. Page: 147”
“As part of the recent 2013 Marriage and Parenthood package, the Government co-funding for Assisted Reproduction Technology (ART) treatments was enhanced to cover up to 75% of treatment costs, capped at $6,300 per cycle and $1,200 per cycle for three fresh and three frozen treatment cycles respectively. Couples with more than one child will also be eligible for co-funding. Prior to the enhancements, ART co-funding is only provided to cover up to 50% of treatment costs, capped at $3,000 per cycle for three fresh cycles. The age criterion for the ART co-funding scheme, currently set at 40 years old, is based on current clinical evidence which shows that the chance of conception for a woman who undergoes ART treatment decreases with age, with significantly lower success rate after 40. The ART co-funding scheme is meant to encourage couples with difficulty conceiving to seek treatment early and hence focuses on those who start their cycle before turning 40 years of age. We will continue to monitor the clinical evidence and update the eligibility criteria where appropriate. Page: 136”
“Madam, I thank the Member for the questions. Firstly, he asked which are the hospitals that charge for temporary beds in the transit area. The Changi General Hospital and the Singapore General Hospital consider the patients as inpatients once they are taken over by the inpatient team and, therefore, their stay during the Emergency Department after they have been taken over by the inpatient team will be charged according to the wards. He also asked whether there are different rates charged. When the patients are transferred to the ward, they receive the same level of care and treatment as all other patients. Generally, they will be subjected to the same charges that are imposed at the Page: 35 respective wards, whether they are B2 or C Classes. But some hospitals do exercise some flexibility, taking into account the environment and whether there is a need to help the patients. So, some hospitals do offer reduced charges for some of these wards, taking into account various factors.”
“Madam, for 2013, the median time for admission to a ward from the Emergency Department was about 2.5 hours. Patients at the Emergency Departments are prioritised and attended to based on the severity of their conditions. While patients wait to be admitted to an inpatient bed, they will continue to receive medical treatment, nursing care, clinical monitoring and other services, as well as meals that they may require during this transit period. Their safety and care remain the focus of our care teams at the Emergency Departments. Page: 34 During the transit period, patients would be charged for services that have been rendered. Medisave and MediShield can be used for these charges if the patients are subsequently warded, subject to the prevailing daily and other limits and the number of inpatient days of stay. We have received appeals and queries earlier about the computation of Medisave and MediShield claims for patients who received treatment before their inpatient beds were ready. Some hospitals commence inpatient charges only when the patients are transferred to a ward and taken care of by the inpatient team. Ward charges are not imposed during the transit period at the Emergency Department and, consequently, the transit period does not count towards the inpatient days in the computation of Medisave and MediShield claims. Other hospitals consider patients as inpatient once they are taken care of by the inpatient team, even during the transit period. The time during this period contributes towards the length of stay and patients will benefit from higher claims for Medisave and MediShield. We are reviewing these two ways of computation to see how we can streamline the practices across public hospitals to minimise confusion.”
“Madam, may I take both Question Nos 10 and 11 together.”
“Medisave can already be used for selected treatments in the Specialist Outpatient Clinics (SOCs). This includes treatment of 15 common chronic conditions5, cancer treatment such as chemotherapy and radiotherapy and scans required in the course of cancer treatment. We are also increasing subsidies for specialist treatment. From 1 September 2014, lower- to middle-income Singapore Citizens will enjoy higher subsidies of up to 70% for services at the SOCs, up from 50% currently. From 1 January 2015, they will also enjoy higher subsidies on their drugs. Pioneer Generation elderly can enjoy additional subsidies for subsidised SOC services and drugs. To further help elderly patients lower their cash payment for outpatient treatment, the Ministry will be extending Medisave use for all scans required for diagnosis and treatment, up to $300 per year. We will also introduce a new Flexi-Medisave scheme in the first half of 2015, whereby elderly patients will be able to use up to $200 a year for their outpatient medical treatment at SOCs, as well as at the polyclinics and clinics under the Community Health Assist Scheme (CHAS). These moves will help patients pay less cash for their outpatient treatment at the SOCs. Page: 147”
“The Changi General Hospital (CGH)'s additional beds have been planned as part of the CGH-SACH Integrated Building for which works started in 2012. The new Integrated Building will progressively open from end 2014 and will have over 280 beds when fully open in 2015. CGH has been ramping up its manpower in preparation for this planned expansion. Page: 146 In addition, about 150 beds will be added in the National University Hospital and Singapore General Hospital to cope with any surge in acute care demand. As new facilities such as the NUH Medical Centre, the Academia and the National Heart Centre have been completed, the space in existing buildings has become available for new uses. These additional beds will be housed in renovated spaces within the existing hospitals as part of their plans to remodel and refresh their facilities. None of these additional beds will be housed in temporary structures. As JurongHealth and Sengkang Health had recruited staff in preparation for the opening of the Ng Teng Fong General Hospital (NTFGH) and running of Alexandra Hospital, there is also sufficient manpower in the system to operate these additional beds safely.”
“The Ministry of Health (MOH) is guided by the objective of ensuring that our public healthcare facilities are functional, patient-friendly, cost-effective and make optimal use of space. To ensure financial prudence, MOH rigorously reviews and scrutinises the planning parameters for new healthcare facilities. Aside from the appropriate clinical service provisions, these include the level of amenities, space allocation and cost benchmarks across different types of facilities. Public sector infrastructure projects exceeding $500 million in budget are subject to further review by Ministry of Finance's Gateway Process, in order to optimise the land, space, and maximise cost-effectiveness of the project. As with all public sector projects, the procurement of construction services for public healthcare infrastructure is through public tender to ensure that healthcare infrastructure projects are awarded to the tenderers with the most competitive bids, based on price and quality considerations. To instill financial discipline on the public hospitals in managing and maintaining their infrastructure, the Government requires the healthcare institutions to fund their own general renovation (for example, reorganisation of existing spaces for greater efficiency and patient flow) and refurbishment works (for example, repair of building fixtures due to wear and tear), as well as the replacement of their furniture and equipment.”
“Polyclinics also share with their patients the locations of nearby CHAS participating clinics to provide patients with information on where they can seek care after polyclinic opening hours. At least 300 CHAS participating clinics operate in the evenings. Some Family Medicine Clinics (FMCs) also open beyond the typical operating hours of GP clinics and polyclinics. The latest FMC at Bedok, for example, operates from 8.00 am to 9.00 pm daily, while Frontier FMC operates from 8.30 am to 7.30 pm on weekdays and from Page: 126 8.30 am to 4.30 pm on Saturdays. MOH is working with other FMCs to extend their operating hours. I would like to urge patients to visit their nearby GP clinics and avoid going to the A&E departments for minor illnesses. MOH will continue efforts to educate the public on non-emergency conditions that can be adequately managed by primary care providers so that patients are able to seek care at the appropriate setting and the A&Es can focus their resources on those who really need emergency services.”
“Several measures are in place to encourage and facilitate patients with non-emergency conditions to visit primary care clinics instead of the Accident and Emergency (A&E) departments of public hospitals. For example, Health Promotion Board (HPB) holds regular campaigns to help Singaporeans differentiate between emergencies and non-emergencies, and to encourage Singaporeans to use primary care services if their condition is not an emergency. HPB is also working with the College of Family Physicians Singapore (CFPS) on media campaigns to encourage more Singaporeans to have a regular family doctor. There will be greater familiarity and trust between the patients and their regular family doctor. This often allows medical conditions to be preemptively managed before they turn into emergencies. A&E departments too have been making efforts to encourage patients with non-emergencies to visit their nearby clinics instead. These arrangements are extended well beyond office hours, although the peak attendances at the A&E usually occur between 10.00 am and 12.00 noon. GPFirst is one example where Changi General Hospital works closely with partnering general practitioner (GP) clinics to encourage and empower patients to see their GPs first for mild to moderate medical conditions. This way, GPs can manage the non-emergencies and refer only the emergencies to A&E, thereby better utilising our A&E resources. Polyclinics have also been working closely with nearby GP clinics, especially those on the Community Health Assist Scheme (CHAS), to encourage patients to visit these clinics after polyclinic opening hours, instead of the A&E departments.”
“We are also working with the public hospitals to set up Medical Device Committees to ensure rational selection and utilisation of these devices. Page: 125”
“The Ministry of Health (MOH) has been monitoring healthcare charges in the private sector. Between 2007 and 2013, based on a sample of 10 common procedures, the increases in the median Surgeon Fees at the major private hospitals ranged from 3.2% per annum (for Hip Replacement Surgery) to 9.7% per annum (for Heart Bypass Surgery). Similar increases were seen at the 75th percentile level. The overall healthcare inflation rate was 3.4% per annum over the same period. Our samples do, however, show more variation in the rates of increase for charges above the 75th percentile level. This wider variation may reflect underlying differences in case complexity, individual patient conditions, or different charging practices among doctors. It is therefore difficult to determine the direct impact of the Guideline on Fees (GOF). Nevertheless, MOH has been working towards facilitating greater price transparency to help both patients and doctors make informed decisions. Since 2003, MOH has been publishing Total Hospital Bills for common conditions at both public and private hospitals. On 1 September 2014, MOH published information on the Total Operation Fees for 65 common procedures at public hospitals. We will continue to explore more avenues to provide useful information and guidance to doctors, patients and their families. Healthcare costs also rise as a result of the ageing population. As we grow older, we tend to consume more healthcare services which in turn drive up demand and costs. The increasing use of more expensive new technologies in diagnostics and treatment may also drive up healthcare costs. MOH has recently introduced Health Technology Assessment for medical devices to ensure they are both clinically- and cost-effective.”
“For example, consider a lower-income family of five where the father supports two elderly parents, his wife and a child and has a monthly income of $2,000. As their monthly income per household member is $400, the family will qualify for the highest tier of MediShield Life premium subsidies. The permanent subsidies will keep the MediShield Life premium for the whole family affordable at $128 per month, as the father’s monthly Medisave contribution of $180 is more than sufficient to cover the entire family’s premiums. For those with genuine financial need, Additional Premium Support can help with their remaining premiums in addition to the various Government subsidies, top-ups and family support. No Singaporean will fall out of MediShield Life due to inability to afford premiums. Page: 119”
“MediShield Life will be introduced in end 2015 to provide better protection against large hospital bills for all Singaporeans for life. Page: 118 The Government will provide significant help for Singaporeans to keep MediShield Life premiums affordable in four ways: (a) Premium subsidies of up to 50% for the lower- and middle-income; (b) Special premium subsidies of up to 60% and Medisave top-ups of up to $800 for the Pioneer Generation; (c) Transitional subsidies for all Singaporeans, to help ease the shift to MediShield Life over four years; and (d) Additional Premium Support for needy Singaporeans. As I explained during the debate on MediShield Life, the premium subsidies for the lower-to middle-income Singaporeans, Pioneer Generation and the Additional Premium Support for the needy are permanent features of MediShield Life. This means that a significant proportion of Singaporeans will continue to enjoy MediShield Life subsidies for life, even after the transitional subsidies have ended in 2019. The Member asked how inactive Central Provident Fund (CPF) members with no or little Medisave savings would pay for their premiums. Currently, about nine in 10 of adult inactive CPF members have sufficient Medisave balances to pay for at least three years of their MediShield Life premium payable or are currently having their MediShield premiums paid for by family members. The Government also provides regular Medisave top-ups through schemes, such as the GST-Voucher, which can be used to help to pay the premiums. With substantial Government support, most families will be able to fully cover MediShield Life premiums from their Medisave.”
“MediShield Life is an insurance scheme targeted at protecting Singaporeans against large medical bills in public institutions. Premiums are actuarially set based on the expected claims as well as other scheme’s liabilities. Any discount for those who undergo regular health screenings will therefore need to be funded through higher premiums for other policyholders. It is therefore better to encourage appropriate health screening through other means. The Ministry of Health (MOH) will continue to make efforts to enhance the accessibility and affordability of health promotion efforts. Under the Health Promotion Board's Healthy Living Master Plan, a number of initiatives have been put in place, including community and workplace health screening and education programmes, initiatives to promote healthier food options in schools and in the community and initiatives to promote physical activity. We also enhanced the Community Health Assist Scheme (CHAS) this year to provide free screening tests under the Integrated Screening Programme (ISP) and subsidies for follow-up consultations for CHAS members aged 40 and above at any CHAS participating clinic. Since 1 September 2014, all Pioneers are able to enjoy even higher benefits for ISP screening. By encouraging more Singaporeans to undergo appropriate health screening and follow ups and to adhere to the course of treatment, we help more Singaporeans lead healthier lives.”
“Madam, as I said at the beginning of my reply, other than the Ng Teng Fong General Hospital, the other hospital projects under construction are currently on track.”
“I thank the Member. It is an important question. For the hospitals, whether it is Khoo Teck Puat Hospital or other public hospitals, they work very actively in the Emergency Department to manage the patients proactively. So, even while they are waiting for the allocation of beds, care is not compromised. The doctors work in teams to manage Page: 31 their condition and to deliver timely care and treatment. At the same time, many hospitals, including Khoo Teck Puat General Hospital, have also been working proactively with the community, with patients, especially those who are known to have frequent admissions, to manage them in the community so as to reduce the need for attendance at the Emergency Department as well as to reduce the need for admission. We need to work at this issue with a multi-prong approach, not just creating more beds, but also to improve the process and minimise the need for admission and for hospital beds. If we are able to keep our patients healthy, for a start, if not, even with conditions, we try to minimise the progression of their conditions so that their conditions are better managed to reduce the need for admission. For some patients who have fall risks, we will also work with the community and the therapists to make sure that these patients are trained to be able to manage themselves to minimise the fall risks. And with the Enhancement for Active Seniors (EASE) programme introduced by HDB, we are able to modify the homes to render the home safer for some of these patients who are recovering from illnesses to minimise the need for admission.”
“This is to ensure that the private sector service providers will continue to play an important role in delivering healthcare as part of a national system. Although we have a public healthcare system and a private sector system, at the end of the day, it is one integrated system. We do intend to continue to find ways to tap on the capacity that is available in the private sector. With regard to the Member's question about availability of manpower resources, this is a factor that we will take into consideration as well when we develop collaborations with the private sector to see where there is available capacity in the private sector, and we will tap on them. In some collaborative framework, we tap primarily on their bed capacity and the public hospitals provide the manpower. In other collaborations, we also tap on the manpower resources of the private hospitals. So, these models are quite flexible and adaptable, and we will look at the resources available to optimise the balance. Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, in the Minister's reply just now, he did not mention anything about Khoo Teck Puat General Hospital. I would like to ask whether there is anything that can be done to reduce the waiting time for those patients waiting for a bed. According to my residents' feedback, some of them have to wait for more than 24 hours and some waited for more than 48 hours to have a bed. So, is there anything that can be done in a shorter time while waiting for the building of new hospitals?”
“Madam, during my speech in the Committee of Supply (COS) debate, I had mentioned that we are in the process of developing a collaborative framework with the private sector. This takes several forms. With regard to the GPs, we have enhanced Community Health Assist Schemes (CHAS) over a period of time progressively and now, the GPs are participating very actively in our CHAS programme. On the hospital side, we are also collaborating with several private hospitals. We are still in discussion with some private hospitals. Therefore, because we are still in discussion, I Page: 30 will not be able to share some of the details of the discussions. But I can share with Members some of the collaborations that are already ongoing. For example, the National University Hospital has a collaboration with the West Point Hospital to provide additional beds for patients who are stable and are recovering from their illnesses and may require rehabilitation. So, they are now located in the West Point Hospital. Tan Tock Seng Hospital has also been working with a private hospital to explore the possibility of managing some of the patients. Changi General Hospital has a collaboration with Parkway East Hospital to look after some of its patients to provide additional bed capacity to Changi General Hospital. We are, as I have said, continuing our discussion with various private-sector operators on additional collaboration. These are pilot in nature for the time being because we are venturing into a new collaboration. Once the details are worked out, once they are able to be sustainable, we do intend to see how we can work out a longer term relationship.”
“Over 400 patients have benefited from this service since January this year. In addition, some 800 homecare places have been added since the beginning of this year and we will also be adding new nursing home capacity in the next few years. We have also stepped up efforts to encourage patients to visit general practitioners (GPs) for non-emergency conditions, so that Emergency Departments can focus on those who really need emergency care. For example, the Eastern Health Alliance (EHA) launched the GPFirst initiative in January this year, where EHA works with GPs in the east to encourage the public to tap on GPs to manage non-emergency cases. Almost 160 GP clinics are now participating in the scheme. The MOH will actively work to ensure that the overall capacity in the national system is adequate to meet our needs.”
“Since the start of the year, a task force led by Assoc Prof Benjamin Ong, our Director of Medical Services (DMS), has been working with public health clusters to actively manage the demand and supply of hospital beds nation-wide. To mitigate the impact of the delay, I have asked DMS and his task force to ensure that our bed capacity is sufficient to meet our needs, especially during this period of delay. Several measures have been implemented. Firstly, Jurong Health Services will continue to operate the 330-bed Alexandra Hospital until the new hospital is ready. In addition, another 150 beds from National University Hospital and Singapore General Hospital will be added to cope with any surge in acute care demand. The new Changi General Hospital-St Andrew's Community Hospital Integrated Building will also progressively open from December this year, as scheduled. These measures, along with other ongoing capacity-related initiatives, will add about 400 acute and community hospital beds to the system this Page: 29 year. Separately, MOH continues to work with the hospitals to improve the processes of care delivery to facilitate timely discharge of patients to return home or to other appropriate care settings, including community hospitals or nursing homes. For example, the short-stay observation wards at Emergency Departments allow suitable patients to be managed and safely discharged once their condition stabilises, without the need for admission. We have also put in place programmes to provide support for patients post discharge, such as the Interim Caregiver Service (ICS), which provides temporary help for patients who are fit to go home but whose discharge may be delayed because their families need time to work out their long-term caregiving arrangements.”
“Madam, first, let me assure Members that besides Ng Teng Fong General Hospital, the other hospital projects under construction are currently on track. The key reason for the delay of the Ng Teng Fong General Hospital was due to a delay in the building's exterior works. Let me explain. The building's exterior works, or referred to as the façade, comprise the functional elements such as windows, glass panels, air vents and cladding. These functional elements need to be installed so that the building is protected from the wind and the rain to allow internal building works and installation of critical equipment to proceed without the risk of damage by weather. The Ministry of Health (MOH) and Jurong Health Services, which are overseeing the project, have been monitoring its progress since construction of the hospital started in 2012. Earlier this year, they detected that the progress of the exterior works had fallen behind schedule. The façade subcontractor had experienced problems with the production of façade components in its factory in Thailand. Jurong Health Services initiated discussions with the subcontractor to address these problems. Unfortunately, the curfews imposed in Thailand in June this year, did not help. This has created further disruption to the production and installation of the facade. To put the construction back on track, Jurong Health Services had worked with the main contractor and façade subcontractor to assess the production status, and made plans for the contractors to re-schedule their production to meet the project timeline. Unfortunately, despite the additional measures taken, the overall construction programme has been delayed and this has affected the progress and delivery of the project.”
“MOH, through the Agency for Integrated Care (AIC), has been working with public and private sector unions and increasing our engagement of employers to promote awareness of the Community Health Assist Scheme (CHAS). As the Public Service is a large employer, AIC engaged different Government agencies, as well as relevant unions, and tailored the outreach to their employees or members. Their outreach includes conducting talks and roadshows, distributing mailers and CHAS application forms, featuring CHAS in organisation newsletters, and displaying CHAS posters in common areas. We will continue to reach out to and encourage more Singaporeans to sign up for the scheme and would like to encourage employers to help spread awareness of CHAS in their organisations so that their employees can benefit. MOH also encourages employers to recognise medical certificates issued by any registered doctor for the purpose of being absent from work due to illness.”
“The Healthier Ingredients Subsidy Scheme was introduced in 2011 by the Health Promotion Board (HPB). This helped bridge the price differential between regular and healthier food ingredients. Besides cooking oil, the same scheme already covers brown rice and whole-grain noodles. To improve the scheme's reach and effectiveness, it was extended this year from a small number of hawker centres to wholesalers that distribute healthier ingredients directly to multiple clients in the food service sector, food operators with central kitchens, and volume caterers. This approach helps Singaporeans who have their meals outside the home. The feedback HPB received thus far has been encouraging. We will review this programme regularly to benefit more Singaporeans. In addition, to encourage the shift towards healthier eating habits, HPB has put in place a public education and marketing campaign. A major restaurant chain has, for instance, introduced brown rice as the default option for one of its signature dishes. My Ministry welcomes and will continue to explore innovative ideas that encourage healthier eating.”
“Madam, I do not have in my hand the exact quantity of outsourced services. If the Member is interested, he could file a separate Parliamentary Question and we could try to answer. But I would say that MOH outsources quite a lot of services, for example, hospital services actually are carried out by the corporatised restructured hospitals and the Government provides subvention in a similar way to an outsourced service. For nursing homes, for example, we have adopted a Build-Own-Lease (BOL) model, where we build the infrastructure but we outsource the operation to operators. So, we have quite extensive outsourcing activities. I agree with the Member that we will continue to find ways to strengthen our outsourcing framework to ensure compliance and strengthen the governance so as to make sure that those who need help will get the help.”
“MOH acknowledges the concerns raised by the Auditor-General's Office (AGO) with regard to the over-payment of $64,000 in relation to financial assistance given to Singaporeans under the Interim Disability Assistance Programme for the Elderly (IDAPE). The support given should have ceased upon Page: 22 beneficiaries' death. MOH has since 2002 engaged an external vendor to administer IDAPE. The errors arose mainly due to the administrators' migration of its IT processing system, resulting in the demised list not being updated in certain months. This has since been rectified. MOH has also required the administrator to make improvements in data processing to prevent similar errors from recurring. This includes system enhancements to trigger alerts when there are errors in data processing or uploading. MOH has also sought full reimbursement of the over-payments from the administrator, as provided for under the terms of the IDAPE contract. MOH views all AGO findings seriously and instituted measures through changes in operating procedures or establishing new Standard Operating Procedures to ensure similar mistakes are prevented in future.”
“The MediShield Fund's reserves were at $1.7 billion as at 31 December 2013. The reserves support scheme liabilities that include policyholders' claims as well as premium rebates to help policyholders with their premiums in their older ages. Of the total reserves set aside, currently about two-thirds support ongoing and future claims while the rest support future premium rebates. The portion of the reserves that support premium rebates is expected to rise in future with the move to distribute premiums more evenly over policyholders' lifetimes under MediShield Life, so that net premiums after the premium rebates rise less steeply in old age. MediShield liabilities and reserves are reviewed annually in line with established actuarial principles. The MediShield Fund accounts are audited annually by an independent auditor. Page: 128”
“MOH has also ramped up services in the long-term care sector to support patients recuperating in the community. For example, in addition to CHs, Senior Care Centres also offer active rehabilitation services for patients in the community. The Government also provides subsidies for home-based rehabilitation services to keep them affordable.”
“Currently, five Community Hospitals (CHs), with a total capacity of 831 beds, receive Government subvention. The Ministry of Health (MOH) is building more CH capacity under the Healthcare 2020 Masterplan. New CHs at Jurong, Yishun, Sengkang and Outram are expected to open progressively in 2015, 2016, 2018 and 2020 respectively and these four CHs are estimated to add over 1,600 CH beds in total. In addition, current CHs, such as Ang Mo Kio-Thye Hua Kwan Hospital and St Andrew's CH, are also adding beds and these will be progressively available by the end of this year. In addition to transferring to CHs, public acute hospitals have also put in place various transitional care programmes to facilitate the transition of patients back to their homes. This involves multidisciplinary care teams, comprising doctors, nurses and allied health Page: 127 professionals, who provide periodic medical follow-ups at the homes of patients. These patients are well enough to be discharged from the acute hospitals but require more support and caregiver training while recuperating at home after discharge. Patients and caregivers may also receive caregiver training with acute hospitals' rehabilitation collaborators and be discharged back to home. For example, NUH's Early Supportive Discharge Programme involves sending therapists to patients' homes to assist in providing physical and occupational therapy for a period of time. For patients medically fit for discharge from hospitals but requiring post-discharge support at home while waiting for permanent care arrangements, MOH has also put in place the Interim Caregiver Service which provides a caregiver who can support the patients at home in their activities of daily living for up to two weeks.”
“Only then would we be able to generate the growth and revenue for us to continue enhancing and strengthening our healthcare financing framework, including making MediShield Life a reality. It is not just MOH making things work, but a whole-of-Government team, with all Singaporeans playing their parts. Let me once again urge Members to support the Motion and give Singaporeans better protection, for all, for life. Page: 90 [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, (proc text)] [(proc text) "That this House endorses Paper Cmd 4 of 2014 on 'MediShield Life Review Committee Report' as the basis for designing MediShield Life, to provide every Singaporean with better lifelong protection against large medical bills through better collective support, in a scheme that is financially sustainable, affordable to all, and strengthens our social safety net." (proc text)] Page: 91”
“My Senior Minister of State has earlier elaborated on our efforts. Dr Lam Pin Min, Ms Ellen Lee, Er Dr Lee Bee Wah and Dr Lily Neo have all highlighted the importance of ensuring that Singaporeans have a good understanding of our healthcare financing system and how MediShield Life works, so that they can better plan and prepare for their healthcare needs. I agree, and we will step up our engagement and outreach efforts on MediShield Life as well as the Pioneer Generation Package and other healthcare financing changes, so that Singaporeans can better understand and benefit from these changes. Madam, we have covered a very wide range of issues in this debate, from the broad changes in our healthcare financing framework to the detailed design and implementation of MediShield Life. I would like to thank Members for their many thoughtful comments and useful suggestions. I am glad that Members agree on our key objectives of building a healthcare system that achieves quality outcomes, while being cost-effective, accessible to all and sustainable for current and future generations. But to turn the ideas into reality requires a blend of three important things: Listening with our Hearts – to know what worries Singaporeans; Thinking with clear Heads – to balance among competing needs and objectives; and Being Hands-on in implementation and delivery. As Mr Christopher de Souza and many other Members have highlighted, we need to ensure that our healthcare system is sustainable and effective, not just for the next five or 10 years, but for generations ahead. This requires good governance, long-term policy planning and a strong economy, with good jobs for Singaporeans.”
“We will study the Committee's recommendations and suggestions to strengthen the current regulatory and accountability framework for IP insurers, while being mindful not to over-regulate the IPs, as imposing requirements which are too onerous could limit choice or result in higher premiums for policyholders. I am heartened that many Members, including Mr Ang and Mr Sitoh, have welcomed the proposed standard IPs providing coverage based on B1 charges. Members have raised many useful points and suggestions, which we will take into account when we design the B1 plan. We will release more details after studying this carefully. Many Members expressed support for the idea of portable medical benefits. As I had mentioned yesterday, the Government encourages employers and unions to work together to move towards portable medical benefits, and tap on MediShield Life's national risk-pool to provide lifetime medical coverage for workers beyond retirement. Incentives are already in place today for employers with portable medical benefits, as they receive an additional tax deduction of up to 1% of their expenses on the portable medical benefits scheme. I thank Mr Teo Siong Seng for his suggestion on working with the business community to reach out to more employers. The tripartite work group, which held its first meeting last Friday, will study this in greater detail, and see how we can better Page: 89 support companies and workers in making this shift. Madam, even as we conclude our debate on MediShield Life, there is still a lot of work to be done from now until the end of 2015 when MediShield Life will go live. My Ministry and the CPF Board will work hard to implement MediShield Life smoothly. The engagement of fellow citizens will not stop, but will continue in many forms.”
“I am keenly aware of the impact on premiums, but I would rather have sufficient reserves in MediShield Life and provide the necessary premium support and subsidies, than to put Singaporeans' healthcare protection at risk. Page: 88 MOH and CPF Board will continue to ensure that the MediShield Fund adheres to actuarial principles with premiums priced on a sound and sustainable financial basis. Members can then be assured of the Fund's ability to honour claims in the future. We have also heard concerns from Members such as Mr Ang Wei Neng and Mr Gan Thiam Poh about the capacity in the public hospitals if more people turn to subsidised care, especially with the introduction of MediShield Life. As part of our Healthcare 2020 Master Plan, we have laid the groundwork to add significantly more capacity to improve access and meet the long-term demand for healthcare services, including subsidised beds. Beyond building more acute beds, we need to transform the model of care, as Dr Lily Neo has noted, to one that is less reliant on acute hospital care, closer to the community, and allows our elders to age in place and live their golden years with or close to their families. This means providing appropriate care to patients in the right setting, through primary care and community-based long-term care providers. We are also expanding capacity and capability in these areas. Altogether, from now until the end of 2020, we will add over 11,000 more acute hospital, community hospital and nursing home beds. Let me now turn to Integrated Shield Plans. A number of Members also spoke about the need to better regulate the IP insurers.”
“Apart from reserves held for expected future claims, insurance schemes also need to set aside capital to ensure sufficient buffer against adverse scenarios beyond projected claims. Mr Giam asked about the rationale for the Capital Adequacy Ratio, or CAR, of 200% that the MediShield Fund targets to maintain. The CAR compares an insurance fund's financial resources with the capital that is required to hold under regulations set by the Monetary Authority of Singapore (MAS). MAS requires funds to meet a minimum threshold CAR of 120%. Below this threshold, regulatory intervention may be taken against the Fund. Most commercial insurers therefore typically aim for 200% or higher as a result of this risk. No prudent insurance fund operates by holding only the absolute minimum requirement, as otherwise any small variation in claims would immediately cause a breach. A target CAR of 200% is broadly in line with industry practice and was recommended by MediShield's appointed actuary to ensure that the Fund is able to meet its liabilities to policyholders even in adverse scenarios. MediShield Life CAR is currently 157% as of end of 2013. The Member also asked about adverse scenarios that the Fund is expected to cope with. Adverse scenarios include worse than expected claims experience or a sharp drop in investment returns. In 2008, for example, the CAR fell to148%, and if the economic crisis then worsened further, we could have breached the minimum requirement. The capital gives peace of mind that MediShield can continue paying out on benefits during adverse scenarios without having to make sudden adjustments to premiums. This provides more certainty to the public.”
“I hope Mr Png is now assured that pensioners will not be worse off and he will help us to reach out to these pensioners and assure them that they will not be worse off. Let me now turn to the long-term sustainability of MediShield Life, which Dr Janil Puthucheary, Mr Yeo and Mr Giam spoke on. MediShield and MediShield Life as long-term health insurance schemes ensure sustainability by setting aside sufficient reserves. The reserves enable MediShield to honour not just current-year claims but also long-term commitments such as continuing claims for dialysis and cancer treatments, and premium rebates for the older age groups. It would not be responsible to all Singaporeans and policyholders if yearly premiums for MediShield just exactly balanced yearly payouts, for this would mean that it cannot meet any continuing commitments for long-term dialysis patients or premium rebates. I am glad to note that Mr Giam agrees that MediShield Life should be Page: 87 financially sustainable and have adequate reserves. In assessing premium adequacy, we cannot consider only claims incurred in the current year. This looks only at current cash flow without considering the long-term claim liabilities, for example, for conditions which are already receiving payouts, leading to the misconception that MediShield is collecting more premiums than needed. As Dr Puthucheary has explained, the incurred loss ratio is a more appropriate measure, as it compares total premiums to the total monies required to ensure that the Fund is able to meet both current-year claims and also its liabilities into the future. MediShield Fund's incurred loss ratio over the last five years was 96%, as Dr Puthucheary pointed out – just sufficient to ensure sustainability of benefits but not excessive.”
“We do not plan to raise taxes for the purpose of paying for these MediShield subsidies. Whether taxes have to be raised in future depends on our overall spending and our overall revenues in Government. The Minister for Finance has stated during this year's Budget debate that over the next decade, total healthcare spending will go up significantly. The Government will work with the healthcare providers to contain healthcare cost increases. It will also ensure it has the revenues over the next decade to fund this increase. Even with MediShield Life taking on a larger share of Singaporeans' healthcare expenses, I would like to assure Members that the Government will not cut down on Medifund assistance. There will still be some who will need extra help. The amount that the Government has set aside for Medifund assistance will continue to be available to help any Singaporean who falls into difficulties with their healthcare expenses, including for outpatient care and intermediate and long-term care. Let me now touch on pensioners. Mr Png Eng Huat gave the impression that pensioners will be worse off by being included in MediShield Life mandatorily and gave several examples of how that is the case. In the press release on Friday, 4 July, as well as in the reply in Parliament yesterday, Deputy Prime Minister Teo has made it quite clear that pensioners will not be worse off in their medical benefits. In addition, the spouse will now receive MediShield Life coverage. Under the current pension scheme, a pensioner's spouse will lose coverage when the pensioner passes away. But going forward, the spouse will now be covered under MediShield Life for life, even after the pensioner has passed away.”
“Madam, subsidies have to be targeted at those in greater need. Hence, MediShield Life premium subsidies are provided based on per capita monthly household income and annual value of homes. Annual value is a relevant consideration, as among those with the same income, those who live in homes with a higher AV would generally be better off than those who live in homes with a lower AV. While this approach is not perfect, it strikes a balance between being more precise in assessing applicants' means, while keeping the process simpler for most applicants. The $21,000 threshold for annual value covers all HDB flats and some lower value private properties. Those genuinely needy but living in homes with AVs beyond the eligibility criteria for Premium Subsidies can appeal and they will be assessed on a case-by-case basis, taking into account specific family circumstances. If they are Pioneers, they will still be eligible for Pioneer Generation Package regardless of income or AVs. Mr Gerald Giam called for the Government to consider automatically extending Premium Subsidies to those who are known to be needy and already on Government help schemes. Indeed, this is our intention. Assessment for Premium Subsidies will be done in as simple and convenient a way as possible. We will share the details when ready. For those who are unable to afford their premiums after Premium Subsidies, the Government will also provide additional premium support, similar to how Medifund helps Singaporeans with medical expenses in the public healthcare institutions today. No Page: 86 Singaporean will drop out of MediShield Life because of inability to pay for premiums. The Government has planned its budget to include higher subsidies under MediShield Life.”
“This helps to cushion the impact of future premium increases during their own retirement years. This is quite different from what some have suggested – to cap premiums for the elderly or have flat premiums across all age groups. Because this means that the older generation will be contributing less than the payout from MediShield Life and the deficit will have to be paid for by the younger generation. Given our ageing population, this is not advisable as it entrenches an inter-generational cross-subsidy, where the young carries the burden to pay for the premiums of the old. With a growing number of elderly being supported by a Page: 85 shrinking number of younger policyholders, premiums of the younger generation will keep escalating, imposing an increasing burden on our children's generation. This will not be sustainable. Instead, what we have done is to determine the premium on an actuarial basis, as recommended by the Committee, while putting in place Government subsidies and additional support to help the older generation and the needy with their premiums. Some Members, including Mrs Lina Chiam, have also voiced concerns about premium affordability and asked whether Government support could be extended beyond the first four years of transitional subsidies. Let me reiterate and clarify that Premium Subsidies for the lower to middle income, covering up to two-thirds of the population, are a permanent feature of MediShield Life and will continue to be provided, beyond the first four years. Pioneers will also enjoy the special Pioneer Generation premium subsidies for MediShield Life, for life. Some Members, such as Assoc Prof Fatimah Lateef, have questioned the use of annual value (AV) in assessing eligibility for premium subsidies.”
“Premium pricing takes into account several factors, including (a) the benefits and expected claims experience, which takes into account future changes in demographics, utilisation rates and costs of medical treatment; (b) provision for premium rebates for policyholders when they grow old is also included; and (c) provisions for reserves, capital and administrative costs for the scheme as well. Three main factors have led to higher MediShield Life premiums – better benefits, bringing everyone into MediShield Life and spreading MediShield Life premiums more evenly throughout one's lifetime. Let me explain each in turn. First, better benefits. With better protection, MediShield Life payouts will increase, premiums will have to increase, to support the higher payouts. Second, a small part of the premium increase goes towards bringing all Singaporeans, including those with pre-existing conditions, into MediShield Life, with Government supporting the bulk of the additional costs. Several Members have asked how the Committee decided on the additional premium of 30% for those with pre-existing conditions. Those with pre-existing conditions would need to pay more, in fact a lot more than 30%, to reflect their higher risks. However, the committee recommended a 30% additional premium so that it will not be overly onerous. The Ministry is currently reviewing the types of pre-existing medical conditions which will be subject to additional premiums, and will share more details when ready. Third, for the working-age groups, part of the increase is to pay for their own old-age premiums in advance, to achieve a more even distribution of premiums over one's lifetime, as highlighted by Ms Ellen Lee.”
“However, MediShield Life will not cover palliative care, which will continue to be affordable after Government subsidies and expanded use of Medisave, as recently announced. MediShield Life will also not cover long-term care such as nursing home and home care, which are covered separately by ElderShield and the Pioneer Generation Disability Assistance Scheme. My Ministry will review the scope of MediShield Life coverage from time to time taking into account changes in how medical care is delivered and new information on patient outcomes and effectiveness, while keeping an eye on premiums. Ms Mary Liew asked whether there could be an annual cap on out-of-pocket payments. MediShield Life will be paying out significantly more, but we should continue to be mindful of the need to manage costs, and a cap on out-of-pocket payments may encourage unnecessary consumption beyond the cap. Hence some level of co-payment will remain. For those who still face difficulties after subsidies, Medisave and MediShield Life, Medifund help will still be available. Page: 84 Let me now move on to address questions about premiums and premium affordability. Dr Lily Neo and Ms Tin Pei Ling asked how MediShield Life premiums are determined. Premiums are priced based on the established actuarial principles and approaches and they are done by an actuarial consultant, Deloitte Actuaries & Consultants in this case.”
“As suggested by Mr Teo Siong Seng, employers and other stakeholders can also play an active role in this, by promoting a healthy lifestyle and greater work-life balance at the workplace. As Ms Ellen Lee has mentioned, Singaporeans must ultimately be responsible for their own health. This includes going for recommended screenings regularly, and following the Page: 83 treatment for chronic conditions. This will avoid unnecessary costs by picking up and managing chronic conditions early and reducing the risk of progression to more serious complications that may require hospitalisation. Let me now turn to comments specifically on MediShield Life. Several Members have asked about the benefit features for MediShield Life, including the scope of what it covers. MediShield Life Review Committee decided that MediShield Life should continue to focus on large hospital bills, to maximise the benefits of risk-pooling while keeping premiums affordable. Costly outpatient treatments, like dialysis and cancer, are currently already covered by MediShield. The higher claim limits, lower co-insurance rate, and removal of the lifetime claim limit will further help cancer and dialysis patients with their bills. Dr Lam Pin Min and Mrs Lina Chiam asked about funding and affordability for community hospitals and palliative care. Members will recall that subsidies for community hospitals and long-term care services were increased across the board in 2012. With MediShield Life, the daily claim limit for community hospitals will increase from $250 a day to $350 a day. Medisave limits for community hospitals are generally adequate. For patients having difficulties, we can consider their bills on a case-by-case basis and we will exercise some flexibility.”