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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“MOH also regularly conducts training programmes to equip these hospital staff with the skills to communicate sensitively with the family members of donors, explaining the organ donation process, hearing the family's concerns and clarifying any related issues that they may have. We will continue to evolve our approach to engage Singaporeans about this important and emotive topic, so that the life-saving and life-changing benefits of organ transplantation can be better understood and embraced by family members and society at large.”
“Madam, the Human Organ Transplant Act (HOTA) facilitates Singapore Citizens and Permanent Residents (PRs) who reach 21 years of age, to donate their kidneys, livers, hearts and corneas in the event of death, for the purpose of transplantation to save lives. Every year, the National Organ Transplant Unit (NOTU), sends a HOTA notification letter to all citizens and PRs who are about to turn 21 years old. This Page: 41 letter clearly explains the requirements and implications of HOTA. We also organise on-going public education programmes such as the "Live On" campaign which started in 2008 to raise public awareness and understanding about organ donation. Last year, SingHealth Transplant organised the "Thanks a Million!" project. Around one million paper roses were folded by over 18,000 school students and healthcare professionals from various institutions in Singapore to show appreciation to the gift of life made by organ donors. This year, MOH has also planned a series of public education efforts including television commercials, newspaper advertisements, and roadshows to spread the message of organ donation and to encourage individuals to discuss their views and decisions on organ donation with family members and loved ones. Through this open sharing, we hope that the family members would then be more ready to honour the organ donation decisions of their loved ones when called upon to do so. In addition to these public education efforts on the ground, our hospitals have teams comprising senior clinicians, medical social workers, nurses and transplant coordinators to engage family members of donors during the organ donation process.”
“Mdm Speaker, may I seek your consent and the general assent of Members present to move that Question Time at this day's sitting be exempted from the provisions of Standing Order No 22 (1) so as to enable Questions for Oral Answer to be taken till 4.00 pm today?”
“Madam, that is why we have introduced Healthcare 2020 two years ago, having looked at the capacity planning and looking at the projection for our population, as well as the profile of our population and the pace of ageing. Healthcare 2020 will include capacity building that will meet the demand, going forward. It is not just about acute hospital beds; it is also about the entire healthcare system, as well as the model of care. Coming back to the waiting time that Mr Low has asked, as I have explained, the waiting time will depend on the situation from day to day. For a normal day, we should not expect the patient to wait more than a few hours. For patients who are more urgent, in fact, they will be warded immediately. They may be sent to ICU immediately, even before warding. What is more important is that even while they are waiting, their care and safety will not be compromised. We have in-patient teams that will be on hand, and even at the A&E, the observation ward, to keep watch over them, to provide them with necessary treatment. The treatment will start even before they were warded if the waiting is too long. We will have to assess the situation. When there is a spike in demand because of various factors, for short periods of time, the waiting time may be a little bit longer. So, I hope that Singaporeans will understand. Under normal circumstances, patients can expect a normal waiting time.”
“Madam, let me put it this way. I would suggest that for specific cases, if they have an extensive stay in our rehab hospitals or community hospitals, we will encourage them to discuss with the hospital administration. If they need help with their out-of-pocket payment, we have schemes including MediFund that would be made available to help them, especially for the low-income who are not able to afford the out-of-pocket expenses, rather than to adjust overall caps. The overall cap on claims has an impact on the premiums. For specific cases, if we raise the overall caps, it may impact the premiums that will affect everyone. On a case-by-case basis, if the patients are needy, we will be happy to look at it. I encourage Mrs Chiam to encourage the patients to discuss with the hospital or let me know specifically, and we will look into it on a case-by-case basis.”
“We are currently reviewing both ElderShield as well as IDAPE. As I explained in my reply, the review is rather complex because it involves deciding what kind of benefits ElderShield should provide and every benefit that we want to provide has an impact on the premiums. We have to ensure that the premiums remain affordable. As much as we have done for MediShield, as you can see, it is quite an elaborate exercise. Currently, we are reviewing ElderShield, together with IDAPE. In due course, we will share with Members the status of the review. On drugs that are not covered: from time to time, we will include standard drugs that are covered under subsidy for chemotherapy. But for drugs that are not covered, there is a Medication Assistance Fund that we have provided. Even if it is not a standard drug that is included, you can still have access to the Medication Assistance Fund, if the doctor determines that this is the drug that you need to use for your specific treatment, whether it is for cancer or any other illnesses and that you are not able to afford the drug. The key is for patients to discuss with the doctor. If the drug or treatment is necessary and you cannot afford it, we would encourage you to discuss with your doctor and the Page: 143 institutions will then apply for Medication Assistance Funds where necessary.”
“Madam, it is right that, today, we have a free choice of beds and, of course, given that the public hospitals are subsidised, many patients still come to the public hospital. And because the quality of our public hospitals is very good, the choice is, therefore, quite obvious. But going forward, even currently, we do have collaboration with the private hospitals to see how we can better spread the load and we have, as I mentioned in my reply, collaborations with Parkway Hospital and West Point Hospital to tap on their capacity. I think this is also one way of spreading the load but, eventually, I think the key is to ensure that it is not just the acute hospitals but also different settings that we need to continue to develop and also encourage patients to opt for step-down facilities for them to recover better.”
“And the monitoring of compliance to medication is one area that we are exploring to see whether we can step up on medication compliance. But, very often, we find that it is not just a single issue. When patients have compliance issues, they tend to be associated with other social issues as well. So, telehealth will also have to be done together with a suite of services to ensure that the patients will be looked after well at home.”
“Madam, let me just clarify with Mr Giam on the IP coverage. If you are covered today by the Integrated Plans and if you develop any disease, the Integrated Plan must continue to cover you. So, what I was talking about is, if you already have exclusions, you will still be covered by Page: 141 MediShield Life. So, I hope that clarifies. The second question that he asked is about MediSave coverage for CDMP, or the Chronic Disease Management Programme. Currently, we cover 15 diseases. We continue to review them. I think we just added five recently. So, we will continue to review them and we will add additional diseases when the Review Committee thinks that it is appropriate. Even with the current 15 diseases under the CDMP, we have already covered more than 90% of the chronic diseases. So, I think it is adequate. In addition to that, because we are going to introduce flexi-MediSave, it will also be able to cover additional expenses that one does incur because of diseases not covered by CDMP. I hope that answers his second question. On his third question, he asked about the Changi General Hospital's home visit programme. These programmes are conducted by CGH and they will assess the needs of the patients. As far as I understand, there are no charges, but I have to verify that. But even if there are charges, if the patients are not able to afford, there will be schemes that will provide the necessary assistance to ensure that affordability is not an issue for the patients, if they need to access these home visits. But for home therapy, of course, there will be therapists' charges. These therapies will be subject to the normal subsidies that already are in existence. For telehealth, I have mentioned in my reply that we are exploring various models.”
“Many of my residents, patients or Singaporeans whom I come across ask me, "Why do we only give subsidy to patients who have been referred by polyclinics to Specialist Outpatient Clinics, and not walk-in patients to Specialist Outpatient Clinics?" One of the key reasons is because of right siting. We want patients to be assessed by a primary physician and if the doctor assesses that a patient requires specialist attention, he will then be referred to the SOC and he will benefit from the subsidies. Therefore, this is one way for us to encourage our patients to be assessed before they access a higher level of care. In this way, we ensure that they are provided with the appropriate level of care without over-consuming healthcare services.”
“Madam, first on the MediShield rebate for achieving certain health indicators or targets. First, MOH is quite keen to encourage healthy living and to encourage Singaporeans to stay healthy, adopt a healthy lifestyle, and we will continue to evolve incentives and programmes to encourage Singaporeans to maintain a healthy lifestyle and maintain good health. But to provide a rebate for MediShield would mean that we would have to take the funds from the MediShield pool, which means the premiums will have to go up in order to be able to pay the rebate. So, it is better for us to think about other ways to encourage healthy living, and MOH is quite happy to look at alternative programmes and to provide necessary funding, if need be, to incentivise healthy living. On right siting, it is an issue that the Ministry has been discussing over the last few years; how do we ensure that patients are given the appropriate level of care. If they do not need higher level, more expensive care, they should not be using the more expensive care because that will drive up healthcare costs. But right siting is something that we will continue to do, and all our public hospitals are very mindful of that. Whenever they prescribe certain treatment, Page: 140 they will always be very mindful of the cost involved and what is appropriate for the patient clinically. And there are regular reviews among the peers within the hospital, as well as within our polyclinics, to ensure that there are certain guidelines and protocols that they will follow, in terms of right siting. Let me give Members one example.”
“Overall, I think the key is that whatever we do, whatever responses that we introduce, we must ensure that the patient's safety and interest are looked after. When a patient arrives in the A&E, they will be triaged and assessed and, for the urgent cases, they will be attended to immediately. Even for warding, there is also prioritisation. For patients who are more urgent and require earlier warding, they will be admitted earlier, and allocated a ward earlier. So, the A&E departments in the hospitals manage patients actively. On the ground, they respond to situations when they warrant.”
“Having said that, I think the important thing for us now is in looking at hospital capacity, to at the same time look at how we can transform the care model to rely less on acute hospital capacity which is very expensive, very intensive and it is actually not in the interests of patients to remain in hospitals when they no longer need to. Many patients require some time to recover after an acute episode. It would be better for them to recover in the step-down facilities like community hospitals, nursing homes or even at home. That is why this afternoon, we spent a lot of effort talking about how we can expand home care capacity to address this issue. Looking ahead, other than building hospital capacity, we also need to continue to transform our care model. We need to continue to build community and home care so that, collectively, as a system, we would then be able to meet our healthcare demand going forward. Mr Low also asked whether waiting at hospitals will still happen and whether there will still be queues at our acute hospitals. I think I also mentioned in my reply that hospitals not only need to cater to our long-term underlying demand needs for healthcare services, they also need to be able to respond to emergency situations when there is a surge in bed demand. This could be because of some emerging diseases, or dengue, or it so happens that, for a particular period, there are more people going to the A&E and, therefore, more hospital beds are needed. So, the hospital has ways and means to adjust itself to be able to respond to demand surges. We have seen some of these and we Page: 139 have shared with the House what are the measures the hospitals have put in place to respond to the surge in demand from time to time.”
“Thank you, Madam. First, let me explain that hospital bed projections had been done in the past, and we review it regularly, taking into account population projection, the pace of ageing, as well as the potential Page: 138 changes in disease patterns. But there are many, many variables that would determine the demand for healthcare services. Ageing is one, but lifestyle changes are also another factor that we have to take into consideration. Lifestyle changes are a lot harder to predict. What kind of diseases would occur as a result of lifestyle changes? Family structure is also another factor that we have to take into account – whether family members are more able to take care of their elderly, their frail, and their patients, or whether they would rely a lot more on the acute hospitals' facilities. There are many factors involved and it is not only about the direct impact on demand of hospital beds, but also about how we can discharge patients from hospitals, including to step-down care facilities, and whether we are able to create sufficient capacity for the step-down care facilities or whether patients are willing to be transferred to these recovery and rehab facilities rather than to stay in hospital. It also has to do with the cost to patients. With the subsidies in hospitals, some patients may prefer to remain in the hospital rather than in a step-down facility. And we have, therefore, enhanced the intermediate and long-term care subsidies in 2012 in order to provide greater support for step-down care.”
“These additional benefits may still be subject to exclusion, depending on the commercial terms that the IP providers will work out. For Singaporeans, the assurance is that all will be covered under MediShield Life.”
“Madam, I would like to thank Dr Lam for the questions. Firstly, on the polyclinic, it will take some time for us to identify the site, to prepare the site and, at the same time, to also consult the advisers involved and to prepare the ground. At the same time, to also train the people, making sure that we have sufficient manpower to staff the polyclinic. Although the polyclinic will only be ready in 2017, in the meantime, we are also working on how we can enhance access to primary care for residents in the eastern and northern area, particularly through the CHAS scheme that we have just enhanced. Through CHAS, up to middle-income Singaporean patients will be able to access private GPs with the Government's subsidy support. When they go to the private GPs, they do not have to join the queue. This is something that we are working on. We are also working with several possible GP groups as well as individual GPs to set up additional new FMCs in different parts of Singapore. Hopefully, with additional FMCs being set up, it will also enhance access to primary care in different locations. With regard to the integrated Shield plans, Dr Lam has asked about what will happen to those who are currently excluded under IP plans. When MediShield Life comes into effect, how does that work out? When MediShield Life comes into effect in 2015, it will cover all Singaporeans and all the integrated plans will then ride on MediShield Life's basic coverage. Since basic coverage covers everyone, even those who are excluded today under the IP plans will become covered under MediShield Life – but only for the basic benefits that MediShield Life will provide. Whereas the IP plans will cover additional benefits, additional coverage, additional payouts for higher wards.”
“To provide additional transparency on the bill component attributed to doctors' charges, MOH is working towards publishing information on the amounts charged at our public sector hospitals under this component for common procedures. This enhanced transparency will provide more information to help patients make informed decisions. On an individual level, we still need to preserve the focus on personal responsibility. Staying healthy is the best way to keep healthcare cost down. I also agree with Mr Laurence Lien that while seeking to enhance affordability, we still need to guard against over-consumption, by focusing on providing basic and essential healthcare for all Singaporeans. Even as we shift towards greater collective responsibility, co-payment will remain a very important cornerstone of our healthcare financing framework. 2.30 pm The transformation of our healthcare financing system through higher Government subsidies, greater MediSave flexibility and MediShield Life will help reduce the burden of healthcare cost on the patients and keep healthcare affordable for all. But beyond the numbers and the schemes, more importantly, this shift reflects the Government's commitment to help Singaporeans, Page: 77 especially those who are more needy and vulnerable, and build an even more inclusive and caring society. It is the Government's assurance that we will keep healthcare affordable for all Singaporeans. I am confident that with all stakeholders playing their part, we will be able to forge a closer social compact. We will be better able to cope with future challenges and strengthen the foundations of our healthcare system for generations of future Singaporeans to come. This way, we can help Singaporeans not only to live long, but to live well and with peace of mind.”
“The framework is also used to help assess the providers' own performance and prioritise their quality improvement efforts. The Government also provides additional support for Regional Health Systems initiatives that involve the management of patients outside of acute care in the hospital setting. An example is Alexandra Health System's (AHS) Ageing-in-Place initiative, as I had shared earlier. We will carefully study how various funding approaches can be adapted to these new care models to drive cost-effectiveness. Page: 76 We will continue to maintain strong clinical protocols among public-sector healthcare providers. Drugs are subsidised if their clinical efficacy and cost-effectiveness are proven. We are also introducing Health Technology Assessment for medical devices and implants to ensure they are cost-effective. MOH also has in place a framework to assess new costly technologies, based on their track record in terms of treatment outcome and cost-effectiveness. Mr Heng Chee How had also asked about drug procurement. To lower costs, our public health institutions procure standard drugs as a group. This has resulted in savings of $180 million since 2001, which have been passed on to patients. We will study how to build on this to achieve even lower drug prices for Singaporeans. Mr Low Thia Khiang asked whether we can increase transparency in doctors' charges. I agree that this is essential in order to empower patients and allow market forces to work more efficiently. All clinics are required to display their charges, and hospitals must provide financial counselling at the point of admission to help patients make informed decisions. The MOH website also provides comparisons of total hospital bill sizes.”
“To ensure that healthcare remains affordable in the long term, we need to carefully manage healthcare costs, as Mr Heng Chee How and Mr Low Thia Khiang have noted. I am glad that in the MediShield Life Review Committee's consultations, many Singaporeans have also recognised the risk of driving up overall healthcare costs as we expand the role of MediSave and MediShield. We must continue to ensure we pay for quality and effectiveness, bearing in mind that spending more does not necessarily bring better health outcomes. As Mr Laurence Lien and Mr Gerald Giam have suggested, we need to spend each healthcare dollar smartly, and pay providers to deliver quality care. Our current funding approach is designed to drive providers to adopt a patient- and outcome-centric approach in delivering care. In the home care sector, we are, in fact, piloting the idea of providing a fixed amount of funding per elderly per month, and Senior Minister of State Amy Khor will touch on this further. For inpatient admissions, the public hospitals are funded to deliver a bundle of services required for a patient and a particular condition. This is then aggregated and provided as a block budget, which encourages the clusters to improve productivity, and provide high-quality and cost-effective treatments to improve outcomes. A blend of aggregated block funding and some fee-for-service component achieves a balance of incentives – managing overall costs while retaining incentives for higher productivity. To complement the funding approach, MOH drives quality improvement using the National Standards for Healthcare (NSHC) framework. This ensures that healthcare services are appropriate for patients' needs, based on current evidence and clinical knowledge.”
“This includes Grandma Tan, who was not insurable due to kidney failure, but can now look forward to benefiting from MediShield Life coverage. Overall, with these new initiatives, the Tan family can expect to receive more than $500 in additional subsidies a year off their medical bills, and close to $2,000, if one of them requires long-term care. More flexible MediSave use will further reduce their cash outlay. With MediShield Life and premium subsidies, the family would enjoy even more savings, together with enhanced coverage under MediShield Life. As part of this shift in healthcare financing, we have committed to increasing the Government's share of healthcare spending and also increasing collective responsibility for one another's healthcare costs. Government's direct spending on healthcare is projected to increase to $7.5 billion in FY2014, up from $4 billion in FY2011 – almost doubling in a short span of three years. If we include MediSave top-ups into Singaporeans' MediSave accounts to help with their future healthcare needs, Government's total expenditure this year is estimated to be about $8 billion, and will continue to increase in future. As a proportion of national healthcare expenditure, Government's share will increase, from 33% in 2012 to 40% or more going forward, depending on the pace of increase of healthcare costs at the national level. With rising life expectancy, we will also need to set aside more MediSave for our old age needs. To support this, we will increase employer MediSave contribution rates by one percentage point, as announced at the Budget. This will help ensure that current and future generations of working adults have Page: 75 sufficient MediSave for their future healthcare needs, and also support more flexible use of MediSave.”
“Take Mr and Mrs Tan, a middle-aged couple, both working and supporting two school-going children and Mr Tan's elderly parents. As Blue Health Assist card holders, the couple now enjoy free screening tests at their neighbourhood CHAS GP clinic and subsidies for their screening follow-up consultations. The Tan children are also now able to enjoy the same CHAS benefits that their parents and grandparents already enjoy. These changes will potentially save the family more than $200 each year, assuming one follow-up consultation for each adult and four visits to the CHAS GP for each child. For Grandpa Tan who suffers from chronic back pain, the higher subsidies will greatly help with his out-of–pocket costs for his visits to his orthopaedic Page: 74 specialist in the public hospitals, his medication and when more expensive tests like an MRI scan need to be done. He would first see his annual subsidised bill reduced by about 40%, from $460 to $280. As a Pioneer Generation elderly, he will see a further 50% reduction in his bill to $140 – a saving of $320. He can use his MediSave to further reduce the co-payment for his MRI scan which further reduces his overall out-of-pocket payment from $140 to $35. If Grandma Tan unfortunately becomes disabled and requires long-term care at home, she will receive monthly payments of $300 from insurance, or $3,600 a year, if she is covered by ElderShield. With the new Pioneer Generation Disability Assistance Scheme, she will receive an additional $1,200 per year which will help the family pay for the long-term care arrangements. When MediShield Life is introduced, this will mean that the entire Tan family is covered for life.”
“The flexibility allows the elderly and their families to opt for the type of care that best suits their circumstances, including ageing-in-place at home, as well as informal Page: 73 caregiving. As part of our overall long-term care review, we are looking at the key design parameters of ElderShield to provide greater protection and support for Singaporeans. This is a complex exercise as enhancements to ElderShield will affect premiums for policyholders. We, therefore, need to study and weigh carefully the benefits of any enhancements and how much they will cost to policyholders before making any major changes. In the meantime, the PG Disability Assistance Programme will complement the existing ElderShield and provide immediate help even as we review ElderShield. We have also taken steps to enhance affordability for long-term care in recent years. Members will recall that subsidies for the intermediate and long-term care patients will increase across the board in 2012, with all lower- to middle-income households now eligible for subsidies. Mrs Lina Chiam and Mr David Ong have also called for the 3Ms to cover long-term care and to be more flexible. We have expanded MediFund since 2012 to cover non-residential long-term care services, in addition to nursing homes and community hospitals where MediFund was already available. But we must be careful in extending MediSave to long-term care as it may risk rapidly depleting our MediSave accounts which are still needed for MediShield premiums and acute hospital stays. What do all these changes I announce today mean to Singaporeans? They will help many lower- to middle-income Singaporean families reduce their healthcare expenses. Let me illustrate.”
“The Government's intent is to help PGs aged 80 and above today fully cover their premiums, through a combination of premium subsidies and MediSave top-ups. For the younger PGs who are on MediShield today, the aim is to help them through premium subsidies and MediSave top-ups, so that their share of MediShield Life premiums will be about half of their current MediShield premiums. For the younger PGs who are not on MediShield today, they should pay less than the current premiums. For PG elderly with moderate to severe functional disabilities, we will provide more support through a new Pioneer Generation Disability Assistance Scheme from September 2014 onwards. Under this scheme, the elderly with moderate to severe disabilities or their nominated caregivers will receive additional cash assistance of $1,200 a year. This is in addition to the payouts from existing schemes, including ElderShield insurance, Interim Disability Assistance Programme for Elderly (IDAPE) and the Foreign Domestic Worker Grant. This package will help not just the Pioneer Generation but also younger Singaporeans who support their elderly parents. More than financial benefits, this package reflects the Government's intention to recognise our pioneers. I hope that this will encourage a whole-of-nation effort to celebrate the Pioneer Generation and all that they have done for us. In addition to addressing acute care needs, we also need to continue strengthening long-term care financing to prepare for the future. Ms Lee Li Lian, Mr Heng Chee How asked about the review of ElderShield. We introduce ElderShield to help those who are severely disabled and need long-term care. The cash payouts from ElderShield can be used to pay for caregivers' support or formal care services, such as nursing home bills.”
“The Prime Minister and Deputy Prime Minister have also announced the special healthcare package for our Pioneer Generation who are a special group that built Singapore at a time where there were fewer social safety nets. They may not have had sufficient income, nor time to save up adequately for their healthcare in old age. The Pioneer Generation Package (PGP) will help to ensure that they are well covered and need not worry about healthcare during their old age. The PGP is comprehensive. In the subsidised SOCs and polyclinics, they will receive a further 50% off their subsidised bills, on top of the enhanced subsidies that I mentioned earlier for SOC services, and standard drugs. What this means for a lower- to middle-income PG elderly is a subsidy of over 80% in the SOCs and polyclinics. All PGs will also be placed on CHAS. As Deputy Prime Minister has mentioned, we have brought forward the CHAS benefits for the Pioneer Generation to September this year. PGs who are already on CHAS will enjoy additional subsidies above what they receive today for each visit. Page: 72 Altogether, subsidy enhancements at the SOCs will benefit some 500,000 subsidised patients, including 200,000 Pioneer Generation patients. The enhancements at the polyclinics, together with the CHAS benefits for the Pioneer Generation, will benefit over 600,000 patients. These initiatives will cost the Government over $200 million in the first year. With MediShield Life, the Government will help the Pioneer Generation with their premiums through a special premium subsidy, starting from 40% at age 65 and rising to 60% at age 90. They will also receive additional MediSave top-ups from July 2014 onwards.”
“In fact, for such typical households in the lower- to middle-income groups, we aim to keep their net premiums to the current level or lower, after taking into account the permanent subsidies that the Government will provide, additional MediSave contributions and the top-ups. For older individual Singaporeans aged 55 to 64, and currently on MediShield, those up to median income will see no net premium increase, taking into account permanent subsidies and MediSave top-ups. For those aged 65 and above this year, the Pioneer Generation Package announced earlier will Page: 71 provide sufficient support for MediShield Life. There could still be those very needy, who are unable to pay the remaining share of premiums even after the permanent subsidies and MediSave top-ups, I would like to reassure them they will be provided additional financial assistance, such as through MediFund. Our intent is that no Singaporeans will drop out of MediShield Life because of their inability to pay for the premiums. However, Government support is necessarily targeted at those groups who need help with premium payments. Those who have the means should still pay our own share. In this way, we look after one another. 2.15 pm Nonetheless, to further help with the shift to MediShield Life and cushion the impact on premiums, the Government will provide additional transitional premium subsidies for all Singaporeans, regardless of income. Details on the finalised parameters of MediShield Life benefits, premiums and subsidies will be announced after my Ministry has studied the final recommendations from the Committee. The Committee is expected to complete its review and submit the recommendations to the Government in the middle of the year. Let me now move to the Pioneer Generation Package.”
“Let me now focus on the issue of MediShield Life premium affordability which some Members have expressed concerns about. With better coverage and benefits under MediShield Life, premiums will also need to increase. With this shift to MediShield Life, I want to assure Singaporeans that the Government will ensure that premiums remain affordable, especially for the low-income and the elderly, as suggested by the Committee. The cost of bringing in the currently uninsured should be shared across those with pre-existing conditions, the existing insured policy holders and the Government. Therefore, as suggested by the Committee, this cost of bringing those who are currently not covered into the MediShield Life should be shared among those who are currently uninsured as well as those who are existing insured policy holders and the Government. However, the Government intends to support most of the initial cost of universal coverage under MediShield Life. We will also introduce permanent subsidies for the lower- to middle-income groups. The Review Committee is still discussing the key features of MediShield Life and studying the impact on premiums. But let me just share with the House the approach we intend to take to keep premium increases affordable when we shift from MediShield to MediShield Life, as follows. Firstly, for a typical Singaporean household – comprising a working-age couple with two school-going children – MediShield Life premiums will take up no more than half of their annual MediSave inflows, including top-ups and Workfare, where applicable.”
“With the move towards universal coverage under MediShield Life, all Singaporeans with pre-existing conditions, including those who have cancer or who have just recovered from cancer, will be covered under the scheme. The private insurance schemes, such as Integrated Shield Plans (IPs), are different from MediShield. They provide options for better benefits above the basic protection offered by MediShield. Those who are covered by IPs will still be covered by MediShield. But the additional coverage is over and above the MediShield coverage. As insurance is about risk-pooling across members, members have to be in good health at the point of joining insurance schemes. To protect policyholders, we require insurers offering IPs to guarantee renewals so that once policyholders take up the plan, they cannot drop them from coverage, even if they develop illnesses and incur higher claims subsequently. But should they not be able to be insured by the private shield plans, they will continue to be insured by MediShield and MediShield Life when it comes into effect. More generally, as insurance buyers, we need to plan for our Page: 70 healthcare coverage wisely and purchase an appropriate plan that is affordable, not just when we are young, but also in old age, because in private plans, the premiums will rise as you grow older. And it will rise significantly. If you plan to seek treatment at public hospitals, a more expensive insurance plan covering the cost of care in private hospitals may not be necessary. Both the Committee and MOH have received feedback on the affordability of Integrated Plans (IPs) and will be reviewing to see how we can provide appropriate options for upgrading coverage beyond MediShield Life.”
“As this is a major step in transforming our healthcare financing framework, we have appointed the MediShield Life Review Committee to review and recommend the key parameters for MediShield Life, such as benefits, claim limits and co-payments – issues which Mr Giam mentioned – taking into account feedback from the Page: 69 public and key stakeholders. Two weeks ago, the Committee shared their preliminary recommendations on how to improve benefits under MediShield Life, including removing the lifetime claim limit, and enhancing payouts through raising claim limits and lowering co-insurance rates. We welcome these recommendations as they will help to reduce the patients' share of larger bills to address their concerns about affordability, as highlighted by Dr Lam. Dr Lam had also asked if we would consider pre-funding for MediShield Life. Many have supported the idea of pre-funding at the Committee's focus group discussions. With pre-funding, policy holders pay more premiums when they are working and earning income, which are set aside to provide premium rebates when they grow old. This improves the premium affordability at their old age. Pre-funding is not about the younger generation cross-subsidising the older generation, because such cross-subsidy across generations would be unsustainable as our population ages. The Committee is currently reviewing the extent of pre-funding in MediShield and will provide an update when ready. Mr Png Eng Huat and Mrs Chiam have also asked about the insurance coverage for patients suffering from pre-existing conditions or who have recently recovered from cancer.”
“While we remain concerned about the depletion of MediSave balance, we can consider more flexibility, especially for the older Singaporeans. We plan to introduce a new flexi-MediSave scheme that will allow the elderly to use their MediSave more flexibly for outpatient medical treatments at our SOCs, polyclinics and CHAS clinics. This will enable elderly patients who see their CHAS GPs for cough and cold to tap on MediSave to reduce their out-of-pocket payments. Flexi-MediSave will also supplement the $400 annual limit for chronic disease treatment, which Assoc Prof Lateef mentioned. We intend to start by allowing up to $200 of Flexi-MediSave use per year. We will work out the details over the next few months and share more in due course. We hope to have this ready by the first half of next year. Madam, beyond enhancing subsidies and MediSave, we also need to step up risk-pooling to share the burden. This brings me to MediShield. We will be enhancing MediShield to become MediShield Life to provide lifetime peace of mind and better benefits for all Singaporeans, regardless of how their life and health circumstances may change. This includes extending coverage to the very elderly and those with pre-existing conditions. I am glad that many Singaporeans support the shift to provide lifetime coverage and better benefits under MediShield Life for all Singaporeans. MediShield Life is as much about giving all Singaporeans greater peace of mind as it is about us forging a new social compact – with everyone chipping in to better protect one another from having to face life's uncertainties alone.”
“Assoc Prof Fatimah Lateef asked about the co-payment for chronic disease MediSave claims. As I mentioned earlier, co-payment is important to encourage prudent consumption. Nevertheless, to reduce cash outlay and encourage timely treatment, we will remove the $30 deductible from July 2014. With this change, patients no longer need to pay the first $30 of each bill in cash. They can tap on MediSave from the first dollar, reducing their cash outlay. Ms Lee Li Lian asked how we can help cancer patients who need newer types of treatment, such as tyrosine kinase inhibitors (TKIs). MediSave and MediShield can already be used for such treatments. For patients who still face difficulty paying for the remaining costs, targeted subsidies are also available through the Medication Assistance Fund, if they do not respond to less costly alternatives. Patients can also use MediSave to pay for scans needed in the course of their cancer treatment today already. However, many Singaporeans have given Page: 68 feedback that scans needed for other illnesses can also be costly. Therefore, from the first quarter of next year, we will allow MediSave use of up to $300 a year to cover non-cancer related scans that are deemed necessary for diagnoses and treatment. With the enhanced SOC subsidies and MediSave coverage, scans will be significantly more affordable. Dr Lam Pin Min and Mr Gerald Giam had also suggested allowing more use of MediSave for outpatient treatment. Many elderly Singaporeans who need outpatient care have shared with me their worries over depleting their cash savings and burdening their children financially. Many of them want to be self-reliant and have asked to tap on their MediSave more easily, and we hear them.”
“The subsidies will be enhanced for the lower to the middle-income and span services from the consultation to the scans, tests and allied health services, such as physiotherapy, that are needed to diagnose and manage their conditions. They will enjoy higher subsidies of 70% and 60% Page: 67 respectively, and may see their bill reduced by up to 40%. For the convenience of patients, the means-testing framework will be aligned with that of CHAS, which means that current subsidised SOC patients who already have the CHAS blue or orange cards, will automatically enjoy these higher subsidies. We will reach out to the remaining subsidised patients in the SOCs to be means-tested so that those eligible can also enjoy the higher subsidies. SOC patients who are higher income, and those who decline to be means-tested for a variety of reasons, will continue to receive the current subsidy and will not be worse off. These changes will be implemented in September 2014. To further improve affordability of outpatient care, my Ministry will also enhance subsidies for drugs in the SOCs and polyclinics. Currently, MOH provides subsidies for standard drugs that have been assessed to be cost-effective and essential. They are mostly capped at the price of $1.40 per week or subsidised at 50% of the retail price. From January 2015, all lower to middle income patients will enjoy a 75% subsidy for all standard drugs so that they pay less for their medication, a reduction of up to half. Dr Lam will be pleased to note that we will also extend subsidies to more drugs. From April 2014, we will add another 13 drugs to the Medication Assistance Fund and the Standard Drugs List. Let me now move to MediSave and how we will allow greater flexibility for patients.”
“00 pm To address these concerns, my Ministry outlined three major shifts as part of the fundamental review of our healthcare financing approach which started last year. First, increase the Government's share of national healthcare expenditure. Second, gradually expand MediSave use. Third, increase risk-pooling. These shifts will improve healthcare affordability and give Singaporeans better peace of mind by reducing their cash outlay for healthcare. Today, I will provide an update of this review, covering the changes that we have made and will be making in the coming year and beyond. Let me start with outpatient care. Many welcomed the significant changes to the Community Health Assist Scheme (CHAS) I announced last year. We expanded the coverage of CHAS to more chronic diseases and recommended screenings. We removed the age floor so that younger Singaporeans can now enrol in CHAS and enjoy its benefits. Since October 2013, close to 260,000 more cards have been issued, bringing the total CHAS membership near 600,000 currently. CHAS will be further enhanced for the Pioneer Generation, which I will talk about later. As announced at the Budget, my Ministry will be enhancing subsidies or services in the Specialist Outpatient Clinics (SOCs) in public hospitals. Let me elaborate. Today, subsidised patients in the public hospital SOCs enjoy 50% subsidy on average for SOC services. These patients are able to enjoy these subsidies after they have been assessed to require specialist care and are referred to the subsidised SOCs by a polyclinic doctor or, if they hold a CHAS card, by a CHAS GP.”
“Madam, over the years, we have done well in ensuring quality care and keeping the population generally in good health. Our healthcare financing system, comprising subsidies and the 3Ms – MediSave, MediShield and MediFund – has helped us keep healthcare affordable, especially for the lower- and middle-income Singaporeans, while ensuring long-term sustainability. As our population ages rapidly and life expectancy continues to rise, our healthcare needs and expenditure will inevitably grow. This is why we have looked ahead to restructure our healthcare financing system to ensure that it continues to meet Singaporeans' needs and is even more robust than what we have today. Sustainability is important, not just for today's Singaporeans, but also for our children and future generations. The key to this is to encourage individuals to take charge of their own health. The concept of co-payment reinforces this discipline, but this also needs to be carefully calibrated to ensure affordability. We can never foresee when we might be struck by illness and require medical care, but when we do, the cost can be highly variable and uncertain, depending on the illness and the treatments. To ensure that we do not need to face life's uncertainties alone, we need to better share such risks within the family and across our community, even as we continue to encourage personal Page: 66 responsibility for our own health. I had the opportunity to talk to many Singaporeans during last year's Our Singapore Conversation sessions. They had reflected their concerns about healthcare affordability. I was also heartened that this stemmed from a strong desire for self-reliance as well as a sense of responsibility of taking care of their loved ones. 2.”
“(In Mandarin): [Please refer to Vernacular Speech.] Madam, Dr Lam has just mentioned that an elder at home is a treasure for the family. I fully agree. I think we should now say that besides being a treasure for the family, the elders are also our national treasures. The pioneers among us are not only a treasure for the family, but also valuable assets to our country and people. They deserve to be cherished and honoured. (In English): Madam, collectively, we can shape societal mindsets about ageing. Through SG50-Seniors as well as many other programmes, I hope all of us can each play our part in our own way to celebrate ageing with our seniors and tell them that they are not a burden, tell them that they matter to us. Together, we can work to build Singapore to be a place where all of us, myself included, can look forward to our happy golden years, leading active, healthy and fulfilling lives. Together, we can make Singapore a Nation for All Ages. Healthcare for Seniors”
“In particular, we hope that through this "SG50-Seniors" initiative, we can engage businesses, organisations and the community to contribute programmes and privileges for seniors, such as by giving seniors discounts for entry to places of recreation and leisure and also to participate in sports and other learning activities. We hope that the special privileges will encourage seniors to go out with their families and friends and live life to the fullest. MOH, as the secretariat for MCA, will coordinate this effort. I agree with Dr Lam that we need to engage the public for many of our key initiatives and new changes, including this "SG50 Seniors" programme, PG Package as well as MediShield Life, which I will be talking about later on. Many of these are significant changes that require an extensive outreach effort to Singaporeans to help them understand the benefits available to them and, more importantly, how they can access these benefits. I welcome the community to help in the outreach – grassroots leaders, neighbours, voluntary organisations and employers – to help to spread the message. We will be forming an Inter-Ministry Task Force, led by Senior Ministers of State Josephine Teo and Dr Amy Page: 56 Khor, to take a whole-of-Government approach in communicating and reaching out to Singaporeans to help them understand these benefits. I thank Dr Lam for his suggestion to engage professional experts to help in the outreach. The Government will certainly consider his idea. Mdm Chair, all of us will grow old. But, in the process, we should keep ourselves healthy and active. And by doing so, ageing need not be a burden and can be a positive experience. I want to particularly thank Dr Lam for the beautiful poem that he has cited. Let me just respond briefly in Mandarin.”
“Even at their golden age, seniors can continue to grow as individuals, pick up new skills, pursue new interests that they did not have the time for when they were younger. Mr Yap Yee Tham is one such example. He retired from Building Construction Authority at the age of 55. Drawn by the opportunities to pick up new skills in the fun environment and expand his social circle, he signed up for YAH! (Young at Heart) Transformation Course and graduated in 2006. But he did not stop there. Several years later, he signed up for a Bachelor of Science programme in Construction Project Management. Mr Yap completed his programme in 2011, and now armed with a degree, he has since returned to the workforce and started a new career at the age of 65. He works full time at a construction consultancy firm as a Resident Technical Officer and is looking to contribute for many more years to come. Mr Yap demonstrates how we can continue to develop ourselves and contribute as we age. We want to enable more seniors to age positively like Mr Yap, and we have put in place programmes to support seniors in doing so. Senior Minister of State Heng Chee How will elaborate more on the ageing issues. We can celebrate ageing together as a nation. As announced by Deputy Prime Minister Tharman, the Ministerial Committee on Ageing (MCA) will reach out to businesses and organisations to coordinate an effort to celebrate and honour our seniors in the run-up to our 50th National Day Celebration next year.”
“However, as these diseases are highly influenced by lifestyle risk factors, including obesity, cigarette smoking and physical inactivity, we can reduce the impact of these risk factors by adopting healthier lifestyles. Healthy living starts with each one of us and we have to be responsible for our own health. To help Singaporeans adopt healthy living, my Ministry and the Health Promotion Board will work to help individuals and families to better take charge of their health and nudge all of us to make healthier lifestyle choices. In particular, we will focus on two key priorities, namely, obesity prevention and tobacco control, and target our strategies in three settings: in schools, at the workplace and within the community. These efforts will be complemented by preventive health initiatives to encourage early screening, detection and treatment of chronic diseases. My Parliamentary Secretary, Assoc Prof Dr Faishal, will be sharing more of our plans later on. Let me now move on to ageing. Madam, as we continue to work hard to ready ourselves and our healthcare system to meet the needs of an ageing population, we need to be careful that we do not associate ageing inadvertently with decline and obsolescence, nor sickness or disability. This is not the case today. Seniors today contribute actively in various ways – they are caregivers to their children and grandchildren at home, they are valued employees at the workplace or active volunteers in our community. As Mr Lien mentioned, they could also be bungee jumpers today. Page: 55 Ageing can be a happy and fulfilling journey. As a society, we can come together to celebrate longevity and encourage seniors to continue staying physically, socially and mentally active.”
“He is 79 years old and suffered from complications as a result of years of diabetes, and frequently visited his five different specialists at TTSH as a result. With a family physician, who focuses on his overall health and who coordinates his care amongst the various specialists, Mr Lim now only needs to see two specialists in TTSH and his frequency of seeing them has also decreased. His diabetes control has also improved. Beyond supporting and developing new ways to work with GPs, we will also be working with the College of Family Physicians to celebrate the role of our family doctors at the World Family Doctor Day in May 2014. This is an important tribute to the role of these critical medical professionals which we Page: 54 hope will raise the profile of GPs in Singapore and raise the awareness of their capabilities. Mdm Chair, I have outlined my Ministry's efforts to improve our healthcare delivery system to meet future needs. Improving healthcare is, however, only part of the strategy for better health. More importantly, we have to keep ourselves healthy so that we can continue to contribute positively to our community and families and enjoy a good quality of life, even as we age. 1.30 pm With the twin drivers of ageing and lifestyle changes, Singapore, like many other countries, is seeing an increasing number of people with chronic conditions and related diseases, such as heart disease, diabetes, stroke and cancer. These are major contributors to ill health and premature deaths in Singapore, and will likely continue to grow if current trends continue.”
“SingHealth also transfers stable chronic disease patients from Specialist Outpatient Clinics (SOCs) to their network GPs for continued management in Page: 53 the community, under the DOT (Delivering on Target) programme. We will continue to work with GPs to explore different models and collaborations to provide good care for our patients in the community. Secondly, MOH has been working with GPs and the private sector on introducing Community Health Centres and Family Medicine Clinics. Four Family Medicine Clinics (FMCs) have since been set up in partnership with private sector GPs – in Clementi, Ang Mo Kio, Jurong and Chinatown. At these clinics, Singaporeans enjoy a subsidy through CHAS, and they can look forward to seeing the same family physician for each visit. These clinics are well equipped and staffed by nurses and health care professionals to care for the chronic diseases holistically. Two more FMCs will be ready in June this year and we will continue to bring more on board over time. Beyond FMCs, our GPs are also doing good work in chronic disease management, supported by nearby Community Health Centres which provide allied health and nursing services for patients referred by the GPs. Three Community Health Centres will be opened this year, one in Bedok, another in Tiong Bahru and the third will be a mobile one, which enables it to cover a wider area, in Ang Mo Kio, Toa Payoh and Hougang. We are also encouraging our primary care physicians to continue to improve and upgrade themselves. With the establishment of the Register of Family Physicians in 2011, the majority of our GPs have upgraded themselves to be on the Register. A good family physician can help to manage patients' conditions within the community. Take Mr Lim, for example.”
“We will continue to pilot new telehealth models and share successful experiences among our institutions. One critical piece in healthcare delivery is primary care. We need to further strengthen primary care so that residents can be better cared for in the community. To add on to the existing 18 polyclinics, we are constructing two new polyclinics in Pioneer and Punggol which will be ready by 2017. Beyond these, we have made plans to develop a further four new polyclinics by 2020 and another six to eight more by 2030. We will also develop new models to improve access to services by co-locating polyclinics with compatible community facilities where feasible. For instance, the redeveloped Bedok polyclinic will be situated within an integrated Community Hub. I note Mr Liang Eng Hwa's suggestion to speed up these polyclinic developments. MOH assesses primary care needs based on demographic trends and we will bear in mind Mr Liang's comments. Meanwhile, MOH has been introducing other initiatives to improve access to primary care. First and foremost, we have been continuing our efforts to tap on the capacity and capability of our GPs, in line with the Ministry's vision of one family physician for every Singaporean. Through the Community Health Assist Scheme or CHAS, over half a million Singaporeans are now able to receive subsidised care at about 1,000 GP and dental CHAS clinics around Singapore. Our clusters have been actively building their partnerships with GPs as well. Under the GPFirst initiative, for instance, Eastern Health Alliance works with GPs in the east to educate and encourage the public to tap on GPs to manage non-emergency cases.”
“We also need to think innovatively and find new ways to do things cheaper, better, faster, as my colleague Mr Lim Swee Say will say, but in our case, not just cheaper, better and faster, but also safer, including through telehealth initiatives, as mentioned by Mr Gerald Giam. Telehealth is a promising mode of care and, if done correctly, will improve outcomes and possibly, reduce costs. For telehealth to work well in the long run, two key conditions must be in place. First, we will need to adjust the way care delivery is organised and secondly, there must be a sustainable model to ensure that the service is affordable to patients. Already, we have a few telehealth projects in development. For example, Eastern Health Alliance Health Management Unit has been expanding their telecare system to monitor the progress of certain chronic and long-term disease patients. Starting out with diabetic patients from CGH in 2010, the programme was expanded to patients discharged from St Andrew's Community Hospital in 2011. In 2012, it was further expanded to include patients with chronic obstructive pulmonary disease (COPD) and heart failures. The programme has enabled its Page: 52 nurses to monitor over 3,200 patients today. This programme triggers telecarers to follow-up if a patient's test results show a worsening condition, when the patient visits the A&E, or misses a medical appointment. It also identifies needs and coordinate support services for the patient as part of his overall care management. Acute stroke patients who are presented at CGH and KTPH's A&E Department are also provided with timely diagnosis and treatment, where appropriate, by off-site neurologists at NNI via real-time video-conferencing and review of the patient's CT scan.”
“After three admissions into hospital within five months, he was placed on the AIP programme. When community nurses visited, they found that Mr Quek did not take his medications regularly and preferred food that tended to be quite salty and oily, and not suitable for a diabetic. Through regular visits and calls, the nurses guided him to a healthier diet and to take his medication regularly. They also worked with the doctors to reduce his medications from 19 different types to seven types when his conditions improved. Page: 51 To prevent him from falling, the community nurses helped to arrange for grab bars and ramps to be installed at his home and applied for a motorised scooter to help him move around more easily. Mr Quek has since been doing very well on the programme. He can now go out and meet his friends daily and his blood sugar level is also under control through a healthier diet and medication. He has not been re-admitted to the hospital for more than a year. We wish him well. More work has also been done upstream, to keep our population healthy by providing preventive health services for early detection and disease management where needed. For example, through our Eastern Health Alliance's (EHA) ECHO screening programme, one of our residents, Mr Liang, found he had extremely high blood pressure. After some persuasion by Mrs Liang, he went to see a GP and realised that the reading had in fact gone even higher. I am sure this was not caused by the GP. He was immediately put on medication for hypertension. If not for the ECHO programme, his condition would have gone unnoticed and could have resulted in very serious complications later on.”
“As highlighted by Dr Lam Pin Min, reforms and restructuring of the healthcare sector are needed to cater to the future healthcare needs of Singaporeans. Therefore, Healthcare2020 is not just about building capacity, but also about transforming our delivery of care and raising the quality of care for Singaporeans. Key to this strategy is the development of Regional Health Systems (RHS) to transform our model of care to be less reliant on acute hospitals, more integrated with primary care and more centred on the patient in the community and at home, as mentioned by Dr Lam Pin Min. Our healthcare delivery should allow patients to receive care that is more effective, less costly and in more appropriate settings. Our healthcare clusters are already embarking on some of these new programmes. One good example is KTPH's Ageing in Place (AIP) programme, which focuses on patients with three or more hospital admissions within a six-month period. Under this initiative, community nurses visit these patients regularly and develop holistic individual care plans to manage patients' health in their homes. During these visits, the nurses not only help to monitor the patients' medical conditions, they also conduct a home and social assessment to understand and manage the needs of the patients at home. In addition, the nurses help to advise the caregiver on how to provide proper care for the patient. By getting to know the patient better, the community nurses are also able to better motivate the patient to make lifestyle changes and reduce re-admission rates for the patients. Take Mr Quek Chiu Boy, for example. Mr Quek is 86 years old and has a long history of diabetes, high blood pressure, high cholesterol and heart problems.”
“This includes introducing new care models, which allow our elders to age in place and live their golden years with or close to their families. I agree with Dr Lily Neo that home care is important and it will be a priority area for MOH in the coming years. I visited Japan last September to better understand how they cope with an ageing challenge and what we learnt reaffirmed our strategy to strengthen community and home care. With an ageing profile that is about 15 years ahead of us, Japan officials told me at the very beginning of the meetings that they wished Japan had started building home-care capacity earlier. This reinforced our decision to build up our home-care capacity. This will allow us to support the different needs of our seniors and caregivers. Dr Amy Khor, Senior Minister of State for Health, will be talking more about our plans to develop our home-care services later on. Madam, as we develop our hardware infrastructure by building new facilities and adding beds, it is, ultimately, our healthcare professionals who are at the heart of our healthcare delivery system. We will continue to invest and grow our healthcare manpower pool and raise the capabilities of healthcare professionals. Dr Amy Khor will also be sharing more of our plans in this area. To meet our evolving healthcare needs, we cannot just continue to do more of the same. Increasing capacity alone cannot be sustainable in the long term. If left unchecked, demand will keep increasing and we will run up against the physical limits of space and manpower. A hospital-centric system is also not Page: 50 the best in meeting the needs of an ageing population, as patients' needs become more complex and require longer-term care.”
“As a Government, we must also ensure that our hospitals can meet the needs of all Singaporeans, both private and subsidised patients, and we need to strike a careful balance. When the subsidised beds are filled up, the hospitals will allow patients to be up-lodged into a higher bed class, if necessary. Hence, these private beds are already acting as potential capacity for subsidised patients when bed demand is high. 1.15 pm More importantly, we need to move beyond acute beds and provide appropriate care to patients in the right setting, especially in the Intermediate and Long-Term Care (ILTC) sector as well as the home care sector, as Mr Low Thia Khiang has also pointed out. We are already doing this by increasing the number of community hospital (CH) and nursing home beds. We agree with Dr Teo Ho Pin that community hospitals play an important role in step-down care and we are planning more community hospitals Page: 49 islandwide, including in the heartlands. These include Jurong Community Hospital in the west, Yishun Community Hospital in the north, Sengkang Community Hospital in the northeast, and Outram Community Hospital in the central part of Singapore. Altogether, from now until end 2020, we will add over 11,000 more acute hospital, community hospital and nursing home beds. Beyond 2020, we announced last year plans for four additional new acute hospitals. One of these will be the new integrated hospital development in Woodlands that Minister Khaw Boon Wan recently announced. Comprising an acute hospital, community hospital and a nursing home, this development will have about 1,800 beds in all and will open progressively from 2022. We are also expanding capacity and capability in the community and home-care services to complement efforts in adding beds.”
“When her 77-year-old mother was first discharged from CGH, Thye Hua Kwan Interim Care-giver Service helped to take care of her and Mrs Lee was able to leave home with peace of mind to work while she worked out the permanent care arrangements. Page: 48 At the A&E, protocols are in place to take care of the patients. Patients are prioritised based on the severity of their presenting conditions when they arrive at the A&E. I can assure Mr Dhinakaran that the A&E team attends immediately to urgent cases. As elderly patients can present with symptoms which are less obvious compared to the general adult population, the A&E doctors do spend more time with them. Our hospitals also deploy inpatient medical teams to initiate prompt medical assessment and definitive care at the A&E, even before patients are admitted, so that care will not be compromised. However, I would like to urge Singaporeans to visit GPs for non-emergency conditions, so that our Emergency Departments' resources can be focused on those who really need emergency services. Mr Low Thia Khiang asked if private beds can be converted into subsidised beds. I have previously explained in this House the constraints of this approach. In fact, National University Hospital (NUH) had converted some of its private beds into subsidised beds in 2013. It was not a straightforward process. NUH had to reconfigure the space and carry out renovations, such as rewiring and piping works for the addition of medical gas points, nurse substations and other supporting infrastructure. We actually lost the use of the wards for more than three months during the renovation.”
“Over the last 10 years between 2003 and 2013, we have increased public acute and community hospitals as well as nursing homes beds by over 30%. This includes the building of Khoo Teck Puat Hospital (KTPH). We also started planning for the new Ng Teng Fong General Hospital (NTFGH) even when Khoo Teck Puat Hospital was still under development. As part of Healthcare2020, we have put in place plans to add more capacity to meet the long-term demand for healthcare services – a point raised by Mr Dhinakaran. At the end of this year, we can look forward to the opening of the new Ng Teng Fong General Hospital and the new Integrated Building at Changi General Hospital (CGH). Sengkang General Hospital will be ready by 2018. We have also been expanding our Specialist Outpatient Clinic capacities – a point raised by Dr Lily Neo. We had recently completed the NUH Medical Centre last year and the new National Heart Centre (NHC) has just taken in its first patient a few days ago. While these facilities and services are being built, in the short term, our hospitals are actively managing the demand for hospital services. In 2013, we had added more than 300 beds to existing facilities. In addition, we have tapped into the capacity in the private sector. Mr Dhinakaran would be happy to note that we have some 50 beds from Parkway East Hospital and Westpoint Hospital and are exploring further collaborations with other private hospitals. We have also put in place programmes to facilitate the discharge of medically-fit patients, such as the Interim Care-giver Services (ICS), under which patients who are fit to go home are provided with temporary subsidised help while their family members work out their long-term care arrangements. Take Mrs Annah Lee, for example.”
“Overall, Singaporeans are enjoying longer and healthier lives. This can be attributed not just to better access to quality medical care and improvements in health technology, but also the efforts of individuals and the community in leading and promoting healthier lifestyles. Going ahead, we will need to work together to address the challenges of demographic and lifestyle changes so as to continue to improve the health of all Singaporeans. Two years ago, I shared with Parliament our "Healthcare2020 Masterplan" – to guide us in our preparation for the future. Focusing on three strategic objectives of enhancing accessibility, quality and affordability of healthcare for our people, Healthcare2020 provides the roadmap to a better and more inclusive healthcare system to cater to future needs and challenges, as mentioned by Dr Lam. Let me update the House on the progress of Healthcare2020 thus far. First, on accessibility. As our population grows and ages, demand for healthcare services will rise. Our hospitals are, indeed, seeing an increase in the number of older and frailer patients. These elderly patients tend to require longer stays in our hospitals as it takes more time for their conditions to be stabilised and to be prepared for discharge. Our family size is also becoming smaller over time. With less family support, family members may find it increasingly difficult to take the patients home in a timely manner. These factors contribute to an overall higher demand for Page: 47 healthcare services. In addition, as I have recently explained in the House, our hospitals have to manage periodic surges in demand, accentuated by outbreaks of diseases like dengue. Mr Low Thia Khiang asked about capacity planning. Building capacity has been a key focus of our healthcare policy.”
“Mdm Chair, I would like to first thank Members for all their comments and suggestions. With your permission, Mdm Chair, may I display some slides on the LED screens to facilitate the debate?”
“Mdm Speaker, MOH has highlighted in Healthcare 2020 Masterplan the trend of rising demand for healthcare services as our population grows and ages. We have already put in place plans to add capacity under the Masterplan to meet this long-term demand for healthcare services. While the new facilities are being developed, the demand for acute healthcare services remains high and the current capacity remains tight. From Page: 16 time to time, there may be peaks in demand due to various factors, such as an outbreak of diseases like dengue, as well as seasonal factors. Therefore, we have also put in place some buffer capacity to anticipate such surges in demand. Built in June 2013, the tent used for the Admission Transit Area Extension at Changi General Hospital is part of this buffer capacity to respond to unexpected surges in demand. This is a purpose-built facility for housing stable and conscious patients at the Emergency Department with less serious conditions. Changi General Hospital has also put in place appropriate clinical protocols and staffing to ensure that patients are cared for safely in the facility. This facility is closed in times when there is no surge in demand. In the next few months and years, new capacity will be injected steadily into the healthcare sector across various care settings. By the end of this year, more beds will be added from the various developments, such as the Integrated Block at Changi General Hospital and the new Ng Teng Fong General Hospital. Altogether, from now till 2020, we will add over 11,000 more acute hospital, community hospital and nursing home beds, and these new facilities will serve to meet the demand for healthcare services. 12.22 pm”