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 organ transplant rate of Singapore was about 35 per million population (pmp) in 2004. The rate was about the same at 34 pmp in 2012, lower compared to Hong Kong (at 63 pmp), Republic of Korea (at 72 pmp) and Australia (at 151 pmp). The main reasons for the low organ transplant rates are the low numbers of available transplantable organs from the small pool of suitable brain dead donors in the intensive care units as well as the low numbers of living organ donations in Singapore. Over the past decade, MOH has ramped up public education to raise awareness on how organ donations under the Human Organ Transplant Act (HOTA) help to save lives. The budget for public education increased from about $120,000 to about $1 million per year over the last 10 years, with more platforms being used to reach out to more Singaporeans. In 2008, the Ministry launched the "Live On" campaign to raise public awareness about organ transplant. The campaign, lasting three years, adopted a creative approach of analogising a human organ to a pair of treasured jeans that is long-lasting and passed on, just as organ donation is a gift to help Page: 121 someone live on. The coordinated campaign leveraged on print, broadcast, online, mailers to 21-year-olds and outdoor channels to further spread this message. Similarly, MOH has planned a series of measures in the next two years to improve the organ transplantation rates for both deceased as well as living organ donors.”
“This year, we expanded the Seniors' Mobility and Enabling Fund to provide more support for seniors to remain mobile and live independently in the community. The recent study visit to Japan was a useful one. Today, one in five Japanese are over the age of 65. By 2030, Singapore will be as old as Japan today. The visit validates many of the strategies of the MCA, such as the importance of promoting active ageing, including giving options for the elderly to remain in the workforce. One key lesson that stood out for us is the need to build up home care services early to facilitate ageing in place, even as we build up nursing home capacity. The Japanese shared with us that they face an urgent need to build up the home care sector to help meet the demand for long-term care. The Japanese also shared with us that more than 60% of respondents to a survey of Japanese seniors indicated that they preferred to receive care at home. Earlier this year, MOH set up a Home Care Workgroup to review strategies for developing home care in Singapore. The Workgroup is developing a roadmap to enhance the home care sector in Singapore, and it is expected to complete its review by early next year. Page: 114”
“By the end of this year, we would have added around 1,000 more nursing home (NH) beds to the stock of 9,000 NH beds in 2011. We are on track to meet our target of 15,600 NH beds by 2020. We have also opened three new Senior Care Centres (SCCs) which added 170 daycare places to the 2,100 places that we had. Three more SCCs will open within the next six months, and we are on track to meet our target of 6,200 SCC places by 2020. We are also working to add capacity to the home care sector, to serve an additional 1,100 new home healthcare clients and 1,300 new social home care clients by the end of this year, up from 3,400 and 2,200 respectively. We are on track to meet our target of up to 10,000 home healthcare Page: 113 clients and 7,500 social home care clients by 2020. Second, we are also working to improve the quality of aged care. In 2012, we set up a nursing home work group to review existing standards and identify areas that could be enhanced. They have commenced their industry consult, and we hope to introduce the enhanced standards by 2015. Meanwhile, industry-led work groups have also been set up to similarly review the community care and home care sector. In parallel, we are working to develop new models of integrated and people-centred care that cater to seniors' health and social needs. For example, social and health services are now integrated at SCCs, where seniors can receive day rehabilitation services and day care services. Third, we are also working to address seniors' concerns regarding the affordability of healthcare and aged care. Last year, we expanded the Intermediate and Long Term Care (ILTC) subsidy framework to cover two-thirds of resident households.”
“The Ministerial Committee on Ageing (MCA)'s vision is to enable seniors to age-in-place gracefully. We aim to achieve this in two ways – first, to keep seniors healthy, active and safe in the community and second, to provide good aged care. On the first focal area of keeping seniors healthy, active and safe, the Wellness Programme has been rolled out to all constituencies as of end-2012. The programme reaches out to seniors and encourages them to participate in physical and social activities. In the past year, MSF has set-up eleven new Senior Activity Centres (SACs) at rental flats and studio apartments, bringing the total number to 56 SACs today. These centres provide convenient nodes within the community where seniors can drop in to interact and participate in regular social activities. HDB also introduced the Enhancement for Active Seniors (EASE) programme to provide subsidised home modification services, such as slip-resistant treatment to toilet and bathroom flooring and the installation of grab bars and ramps where technically feasible, to keep seniors safe at home. As of 30 September 2013, about 14,300 households had successfully signed up for EASE. At the community level, 11 constituencies have introduced the City For All Ages (CFAA) Project to make their communities senior-friendly. Under this project, community leaders and residents in various communities come together to promote health screening and exercises, suggest hardware improvements around the town and introduce new befriending programmes to make their communities senior-friendly. Let me now move on to the second area of the MCA's focus, that is, to enhance aged care in terms of better accessibility, quality and affordability. First, we are ramping up the capacity for aged care services.”
“MediShield is a self-sustaining and not-for-profit insurance scheme. This requires setting aside sufficient reserves in the MediShield Fund to meet its liabilities, expected risks and target Capital Adequacy Ratio (CAR). Between 2005 and 2012, on average, about 65% of the MediShield Fund comprised reserves to fund the expected scheme liabilities. Scheme liabilities include policyholders' claims as well as premium rebates to help policyholders with old-age premium affordability. The remaining portion of the Fund, which is what Mr Giam has referred to in his question as "net assets", is capital from which the MAS-based risk requirements are financed. CAR is computed as the ratio of these "net assets" to the MAS-based risk requirements. The Member also asked about the CAR that the MediShield Fund targets to maintain. While the minimum CAR is 100%, MAS requires funds to meet a minimum threshold CAR of 120%, below which a "financial resources warning event" is triggered and the regulator may intervene. No prudent insurance fund operates by holding only the absolute minimum requirement, otherwise a small variation in claims would immediately cause a breach. Reserves and capital numbers change from year to year as claims payout changes and the Fund's assets are marked-to-market. As at end 2012, the CAR of MediShield Fund is about 165%. The MediShield Fund has set a target CAR of 200% to ensure that the Fund is able to meet its liabilities to policyholders even in adverse scenarios. This target is in line with industry best practices. MediShield liabilities and reserves are reviewed on an annual basis in line with actuarial principles.”
“POSD bans, as implemented overseas, are aimed at decreasing exposure of non-smokers, in particular, vulnerable populations, such as youths, to the advertising effect of POSD; and it is another means of denormalising the use of tobacco products. This, together with other tobacco control measures that are already in place, will potentially lead to a decrease in smoking initiation rates. In addition, it would help to reduce impulse purchases among smokers who are trying to quit. The public consultation on the POSD ban was completed on 30 June 2013. HPB and HSA also conducted trade engagement sessions with retailers and associations in July 2013. We are studying the results of the consultation and more details will be shared in due course. Page: 98”
“Graphic health warnings are part of a comprehensive suite of tobacco control measures in Singapore that include public education campaigns, smoking cessation programmes, taxes and bans on advertising, sale to minors and smoking in public places. The World Health Organization (WHO) recommends the use of graphic health warning labels on cigarette packages as it is more effective than text-only labels. In 2005, the Health Promotion Board (HPB) evaluated the impact of the introduction of graphic health warning labels and found that seven in 10 (71%) smokers said they knew more about the health effects of smoking, and more than 50% of the smokers were more concerned about their health after seeing the graphic health warnings. 25% of smokers were motivated to quit as a result and made efforts to abstain from smoking. The effect on non-smokers was equally significant; more than half of them advised their friends and loved ones to quit smoking as a result of seeing the graphic health warnings. To prevent desensitisation, as Dr Janil Puthucheary has pointed out, graphic health warnings are changed every few years to ensure they remain effective. This year, we introduced a ban on misleading descriptors, and added new text warnings.1 Besides the enhanced use of graphic health warnings on tobacco packaging, my Ministry is also concerned with the prominent displays of tobacco products functioning as a form of advertisement for smoking. Research studies have shown that the Point-of-Sale display (POSD) of tobacco products is not only attractive but also influences purchasing behaviours. In Canada, Iceland and Ireland, implementation of a POSD ban was associated with a decrease in smoking.”
“We plan to provide additional capacity to serve an additional 240 seniors, by the end of FY13. By FY20, we plan to develop approximately 60 new SCCs to serve an additional 5,500 seniors. Page: 132”
“Today, we have a network of about 60 eldercare day centres providing day services, such as day care and day rehabilitation services. This network of centres has a total capacity to serve 2,800 seniors. To better serve our seniors who may have different needs, the Government has launched Senior Care Centres (SCCs) last year. SCCs are part of the Page: 131 Government's efforts to provide aged care and support facilities within the community so that more seniors can age within the community and close to their loved ones. SCCs are new integrated day eldercare facilities that provide a range of aged care services, such as day care, dementia day care, day rehabilitation and basic nursing services, to holistically meet the needs of seniors needing care. This integration of services under one roof at the SCCs reduces the need for seniors to travel to different day centres to access different services. In the past year, we have developed three new SCCs7 − one each in the Central, Eastern and Northern regions, which can serve about 230 seniors in total. Currently, there are still vacancies available at these SCCs, as well as in the network of day care centres and day rehabilitative centres. However, as clients generally prefer centres near their residential locations, there are about 350 seniors who are currently on the wait list for various centre-based care services, and the average waiting time to placement is between 20 to 50 days depending on the location. To enhance the geographical distribution of services and in anticipation of an increase in demand for day care services that will come with an ageing population, we will be developing more SCCs across the island in the heartlands to make care more accessible to seniors.”
“In an effort to help Singaporeans better cope with medical ailments that may arise as a result of the haze, MOH introduced a haze subsidy scheme on 21 June 2013. Under this scheme, Singaporeans who are elderly, children or in the lower income group are eligible for a subsidised fee of $10 if they are seen at participating General Practitioner (GP) clinics, or at the polyclinics, for respiratory or eye conditions due to the haze. The rest of the bill will be subsidised by the Government. The utilisation of the haze subsidy scheme was tracked by number of claims made by each participating clinic. Thus far, under the scheme, participating GP clinics have seen around 8,200 attendances for haze-related conditions, with another 2,600 attendances at the polyclinics. The number of participating GP clinics has steadily increased, from 200 clinics at the inception of the scheme, to more than 650 clinics today.”
“As of 7 September 2013, MOH has been notified of 15,774 cases of dengue fever. All medical practitioners have been advised to remain vigilant for dengue cases and to order tests for dengue if deemed appropriate. To facilitate the early diagnosis of dengue during this epidemic, the Ministry increased the subsidies for dengue NS1 testing at the emergency departments of public hospitals so that patients who are clinically assessed to require the test will not pay more than $10 per test. This has been in place since 17 June 2013. As of 16 August 2013, more than 6,600 subsidised tests were done. This year's dengue epidemic led to a corresponding increase in the number of patients treated for dengue or suspected dengue at polyclinics and public hospital EDs, compared to the last two years. Polyclinic attendance for dengue or suspected dengue increased 6.5 times, from an average of 931 cases for the first six months of 2011 and 2012, to 6,065 cases for the first six months of 2013 (see table below). However, these comprised less than 0.3% of the total number of polyclinic attendances. Page: 129 There were 6,880 ED attendances for dengue or suspected dengue at acute public sector hospitals in the first six months of this year, comprising 1.3% of total ED attendances. In comparison, there were only 2,523 ED attendances for dengue or suspected dengue for the whole of 2012 (see table below). To cope with the extra workload at EDs, and to reduce the waiting time to consultation, our hospitals have increased manpower and streamlined processes to enhance efficiency. Such measures include adjusting the work shifts of doctors and nurses based on anticipated patient load, deploying nurses from other work areas that are less busy to assist at the ED, and providing support services.”
“Patients with any of the 10 conditions under the Chronic Disease Management Programme (CDMP) can tap on Medisave to pay for their treatments. In addition, those who qualify for CHAS can receive subsidised care at GP clinics. Five more conditions will be added to CDMP from 1 January 2014 and these are anxiety, osteoarthritis, benign prostatic hyperplasia (BPH), nephritis/nephrosis and Parkinson’s disease. We will consider the possible inclusion of more chronic conditions, including conditions such as epilepsy, into CDMP as we continue to review the expansion of Medisave use. Meanwhile, patients who require treatment for epilepsy will continue to enjoy subsidies at the polyclinics.”
“As Singaporeans live longer, and with better, more advanced but more expensive treatment being available and accepted as a mainstream treatment approach, healthcare costs will rise over time. In the public healthcare sector, the management of the various institutions monitor their operating costs closely and constantly strive to innovate and find new and more cost effective ways to deliver their services. We also monitor the doctors' fees and the overall bill sizes closely to ensure that basic healthcare services provided by our public institutions remain affordable, especially for the lower- and middle-income patients. We are also working towards empowering patients in making decisions on healthcare services. For this reason, MOH has been publishing total hospital bill sizes for both the public and private sector on its website since 2003. Greater transparency of healthcare charges will allow market forces to work more efficiently and help patients make informed decisions. MOH is studying the proposal to make professional fees more transparent by publishing information on fees that our public sector doctors have charged for their services. Page: 108 At this year's National Day Rally, Prime Minister Lee announced the Government's plans to provide more subsidies for lower- and middle-income Singaporeans who require specialist outpatient care at our public hospitals, so that they will pay less. We are currently working on the details and will share more information in the first quarter of 2014.”
“To help parents defray the cost of childhood vaccinations, the use of Medisave was extended to cover the cost of all vaccinations in the National Childhood Immunisation Schedule (NCIS), up to $400 per account per year from June 2013. The Government has also provided a MediSave Grant of $3,000 for all newborn Singaporeans which can be used to pay for these vaccinations. In addition, vaccinations under the NCIS that confer strong herd immunity against the respective diseases for the whole population are offered free for citizens at the polyclinics. In doing so, we hope to encourage a higher uptake of these vaccinations and achieve adequate coverage for the population. Parents are required to produce records of their child's immunisation certificates at Primary 1 registration, for BCG, diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella and hepatitis B, all of which are free for citizens at the polyclinics. MOH will continue to regularly review the financing framework of the NCIS to ensure its relevance and affordability to Singaporeans.”
“To increase public awareness of mental health issues, the Health Promotion Board (HPB) conducts public education programmes regularly to promote mental well-being among children, adults and seniors. These programmes include workshops at the workplace where young employees pick up skills to manage stress and build their resilience. A workplace mental health promotion grant was put in place from 2011 to support employers in carrying out mental health promotion activities. Page: 97”
“HPB also has a peer support training programme which trains selected tertiary students on mental health issues, including suicide prevention, and equips them with peer support skills to reach out to their fellow schoolmates in need. The Community Health Assessment Team (CHAT), launched in 2010 and led by IMH, is another programme that includes efforts to reach out to distressed youths from Post-Secondary Education Institutions (PSEIs), such as Polytechnics or ITEs. For the elderly, social support is a key element in the prevention of suicides, and this is provided through community services, such as active ageing programmes and wellness centres managed by the People's Association that encourage socialisation and promote an active lifestyle. For elderly persons who live alone, there are befriending programmes and Senior Activity Centres that offer support through centre-based activities and home visits. There are a variety of professional services to support persons who are at risk. Family Service Centres (FSCs) provide professional intervention and support to help families and individuals resolve their social and emotional difficulties and to regain stability and independence. FSCs will also help to pool together community resources and services to help them as necessary. Hospitals provide crisis interventions for patients who have attempted suicide. They act to reduce the risk of identified suicide attempters through (i) elimination of acute suicide danger, for example, hospitalisation, sedation, crisis-intervention; (ii) adequate treatment, for example, pharmacotherapy, psychotherapy; (iii) provision of follow-up care for those with high suicide risk; and (iv) counselling and support groups for patients both within the hospital and in the community.”
“According to Police records, the number of attempted suicides increased from 1,009 in 2011 to 1,090 in 2012, or an increase from 19.5 to 20.5 per 100,000 total population. The number of deaths arising from suicide rose from 8.1 per 100,000 population in 2011 to 10.3 per 100,000 in 2012. However, year-to-year fluctuations may not be representative of longer-term trends. Suicidal behaviour has a large number of complex underlying factors, including family, social, economic and mental health issues. A local study based on Singapore's suicide statistics from 2000-2004 had reported that relationship problems were associated with one-third of all suicides, and financial or employment issues were associated with a further one-third. For suicides amongst the elderly, gradual physical disability and suffering were important risk factors, especially if coupled with a lack of adequate community and family support. However, it is important to note that it is often not just one factor but a combination of several factors interacting with each other which may trigger suicidal behaviour. We adopt a multi-pronged strategy to prevent suicide. These include collaborative efforts among different Ministries, such as MSF, MOE, MHA and MOH and stakeholders in the social sectors. The broad approaches involve i) building greater resilience in the population; ii) developing targeted interventions for high-risk individuals, and; iii) increasing public awareness of mental health issues. Building resilience takes place at many levels. In schools, students are taught to set realistic and achievable goals for themselves, build positive and Page: 96 healthy relationships with others, and to seek help when necessary.”
“Use of Medisave for outpatient treatment under the Chronic Disease Management Programme (CDMP) is subject to an annual limit per Medisave account, which was raised from $300 to $400 on 1 January 2012. The annual limit is reviewed regularly to help Singaporeans pay for basic healthcare needs. The number of patients benefiting from Medisave use for CDMP conditions grew from 97,000 in 2009 to 149,000. Close to 90% of them were subsidised patients, of which 20% or about 26,000 patients fully utilised the annual limit in 2012. This was lower than the average of about 28% from 2009 to 2011. The proportion of patients who fully utilised the limit was similar across the ages. Patients who visited the polyclinics for treatment of CDMP conditions incurred an annual bill of $200 on average, well within the annual withdrawal limit. Patients whose conditions are more complex may need specialist outpatient care and incur higher bills. Patients can also tap up to 10 Medisave accounts of their immediate family members if their annual bill exceeds the withdrawal limit. For subsidised patients with financial difficulties, they can also apply for assistance under Medifund. To further help this group of patients better afford their treatment, MOH will be increasing the subsidies at the Specialist Outpatient Clinics for the lower- and middle-income. More details will be released in the first quarter of 2014. Page: 95”
“The short answer is yes, we will try our best to keep the premiums low and affordable. The Government will pay particular attention to those who are in the lower income group and those who are elderly who may no longer be working, and also may not have accumulated sufficient savings because they might have started work many, many years ago. And during those years, their incomes were limited. These people belong to the group we call the Pioneer Generation. We will look after them and make sure that the premiums will be affordable to them, so that they will be covered by MediShield Life. As I have said, MediShield Life is meant to cover all and to cover for life. If there are people who cannot afford it and drop out of the scheme, it will not be MediShield Life. An important feature of MediShield Life is to ensure that all of us are covered.”
“Mdm Speaker, let me just explain that we have conducted a few rounds of public consultation on healthcare. In fact, the consultation is ongoing. So, we consult the public on many issues including Medisave, MediShield, as well as how we can help them with the medical costs in general. This coming public consultation is aimed specifically at MediShield Life and what the features are, and how do we make sure that it is practical and meaningful to the man in the street, to the patients who need help, and what are the features and the costs involved. There are several aspects to be dealt with in the consultation. We will produce a consultation paper shortly before the consultation exercise starts, to outline what are the key things that we are consulting the public about. I will again urge the Member to be patient and it will be out soon. As to when MediShield Life will be implemented, this is quite a major shift and, therefore, we will need to take a bit of time to work out the details and consult the public as well. I think it will take some time. We do not think it will be completed within a year. We hope to be able to implement MediShield Life by 2015. Page: 23 In the meantime, I am very conscious that the Member has asked what about those who need help who are not covered. For now, until we implement MediShield Life, for those who are excluded currently, if they still need help in terms of financial support, they can approach our hospitals or public health institutions and we have schemes to help them, especially for the lower income and, for the older Singaporeans. So, help is available even before MediShield Life comes into being, but with MediShield Life, they will have greater assurance that their healthcare bills will be covered by insurance.”
“As for the other features, for example, how we can enhance the payouts, how we can help to reduce the co-payment especially for the larger bills, these are the details that the Ministry is working on now. During the public consultation, we will share more details. And we hope to be able to give even more details and the broad shape of the scheme by the next Committee of Supply (COS) debate.”
“Mdm Speaker, first let me explain that today, the Government already indirectly subsidises MediShield because the Government provides top-ups into MediSave, and MediSave is being used to pay for the premium for MediShield. So, indirectly there is Government subsidy for MediShield, particularly for the lower income. Going forward, with MediShield Life, as the Member has rightly pointed out, with enhanced benefits, the pay-outs will increase and that is the objective of enhancing the benefits, and therefore the premium has to go up as well. The Government is very conscious about the impact of higher premiums and, therefore, we have already made the commitment that we will make sure that the lower income as well as older Singaporeans who may not have sufficient savings, will be looked after. We will make sure that the premiums, with Government subsidies, will be affordable for them. That is the first question. The Member also asked about the Pioneer Generation Package. The details are being worked out now. In due course, we will reveal more details on who will qualify for Pioneer Generation Package and what is provided for in the Pioneer Generation Package. I urge the Member to be patient. We will reveal that in time. Last question is about the details of MediShield Life. We will have a public consultation. We are still working on MediShield Life and what form it will take. But the key parameter is that we want to make sure that all Singaporeans will be included and they will also be included throughout their lives. Therefore, we Page: 22 will remove the age limit on MediShield Life.”
“Mdm Speaker, as part of the overall healthcare financing review to ensure that healthcare remains affordable for all Singaporeans, MOH is studying the introduction of better coverage for large bills and moving to life-long MediShield coverage for all Singaporeans. As the move to MediShield Life is a major policy shift, we will have a public consultation exercise later this year to seek Singaporeans' views on the proposed MediShield Life. The details and costs of the MediShield Life, including the likely impact on the payouts from MediShield Life if all pre-existing conditions and all residents are covered for life, are currently under Page: 21 study. More details will be shared during the public consultation exercise.”
“First, let me explain the CHAS was conceptualised primarily to take care of chronic diseases. Therefore, if we are going to see the GPs for chronic diseases which are covered under the Chronic Disease Management Programme (CDMP), treatment for the diseases would be covered by CHAS. Other conditions will not be included, but we also cover outpatient acute conditions for the blue card as well. For the CDMP, we recently announced that we are going to expand the list from 10 conditions to 15 conditions. We will continue to review whether there is a need to further expand the CDMP as we go on and as we gain more experience with the five new diseases.”
“Mdm Speaker, we are already progressively seeing more and more GPs signing on and we want to continue to reach out to them. In fact, through our Agency for Integrated Care (AIC), we have been engaging the private GPs to explain to them what the scheme is about and how they can benefit from this scheme as well as help us to reach out and benefit the needy patients. More and more GPs and dental clinics are coming on board. We will continue to step up our efforts to reach out to them to encourage them to sign Page: 20 up. Assoc Prof Fatimah Lateef (Marine Parade): Mdm Speaker, can I just ask the Minister: for clinics that are displaying the CHAS logo, both dental and medical clinics, are there only specific procedures that are applicable to CHAS subsidy? I have got lots of residents who are now coming forward to say that when they go for certain procedures, they are told that these are not covered under CHAS.”
“The answer is yes. Please apply and we will review on a case-by-case basis. If the income has indeed dropped, we will give you an upgrade to the blue card. The idea is that this card eventually aims to help the low-income and the middle income and if you need help, we will try our best to help.”
“Mdm Speaker, from 1 January 2014, the qualifying age for the Community Health Assist Scheme (CHAS) will be removed. This will allow Singaporeans of all ages in lower and middle income households to access subsidised care at private General Practitioner (GP) clinics and dental clinics near their homes. Page: 19 For existing Health Assist cardholders who have family members in their household who are 40 years and below, we will automatically include their family members into the scheme with effect from 1January 2014. They will receive their Health Assist cards from 26 December 2013 onwards. For younger households who only meet the revised criteria now, they can already start to apply for the scheme now and each household will only need to submit one application form, which is available at the Restructured Hospitals, Polyclinics, Community Centres and Clubs (CCs) or Community Development Councils (CDCs) and they can also download the forms from the CHAS website. We will also work with grassroots organisations to reach out to needy households in the community to help them apply for the scheme.”
“In 2012, about 4,600 CPF members aged 60 years old and above withdrew an average of $2,000 from their MediSave accounts to pay for their parents' treatment. This represents about 2% of the total number of members in this age group who withdrew from their MediSave accounts. The use of MediSave for family members' healthcare expenses enables children to better care for their parents in old age, including financially. However, we are mindful to calibrate this to ensure that they have sufficient savings for their own healthcare needs. Thus, the Government has provided MediSave top-ups for the elderly under the GST Voucher scheme, to help relieve the burden on their children. Those from low-income families with insufficient MediSave balances can also apply for financial assistance, including MediFund.”
“For stable patients who are unable to be cared for in the home setting, the Agency for Integrated Care (AIC) works closely with our hospitals to facilitate their transfer to step-down care facilities, such as nursing homes. As a result of the collective efforts by the hospitals, AIC, MOH and nursing home providers, the number of patients who have been successfully matched to a nursing home has nearly doubled from 1,185 in 2010 to 2,100 in 2012. MOH is building more nursing homes and community hospitals to meet the increase in demand. By the end of this year, 700 more nursing home beds will come on-stream, with another about 3,000 nursing home beds being added by 2016. By 2020, the number of community hospital beds will increase by 1,900 beds, more than tripling the 800 community hospital beds today.”
“As of 19 July 2013, there are 645 patients in the restructured hospitals who have stayed for more than 21 days. These patients currently occupy approximately 10% of the beds in service in the hospitals. Of these 645 patients, 364 (or 56%) are not yet fit for discharge and still need to receive medical care in the acute hospitals. Of the remaining 281 patients, about two out of three are awaiting placement or transfer to nursing homes or community hospitals for further care, and the rest would include patients who are awaiting care-giver arrangement and training before their discharge. MOH works closely with the hospitals to provide the necessary support, so that patients can be discharged and recuperate in the comfort of their own Page: 134 homes. For example, we have recently introduced a pilot interim caregiver service by the Thye Hua Kwan Moral Society for patients of Changi General Hospital and Tan Tock Seng Hospital earlier this year. This service provides temporary help of two weeks for patients who are fit to go home but whose discharge may be delayed while they work out their long-term caregiving arrangements, for example, waiting for the foreign domestic worker to arrive. In addition, there are also Aged Care TransitION (ACTION) care coordinators in each hospital to help newly discharged patients and families who may need help adjusting to the new care needs of the patients. Changi General Hospital, Khoo Teck Puat Hospital and Tan Tock Seng Hospital have also started a transitional care service where doctors and nurses visit the patients at their home in the immediate post-discharge period for those who may need medical follow-up.”
“MediShield is a basic health insurance scheme designed to help Singaporeans with the costs of subsidised Class B2/C bills at public hospitals. MediShield premiums can be paid through MediSave. The current MediSave withdrawal limits can fully cover basic MediShield premiums for policyholders across all age groups. MOH will continue to regularly review the MediShield and MediSave schemes, to ensure that healthcare remains affordable for Singaporeans.”
“As at end 2012, 92% of the resident population, or 3.5 million members, were covered under MediShield, compared to 78% as at end 2007. The significant increase is due to several factors, including the introduction of more auto-cover points, including at birth. The recent enhancements to cover congenital and neonatal conditions from birth and to extend the maximum coverage age from 85 to 90 will improve the population coverage further. For the remaining 8% who are not covered under MediShield, most opted out, lapsed in their coverage, or never applied for coverage for those who were not auto-covered. Less than 0.5% of the population was unable to obtain MediShield coverage when they applied, due to serious pre-existing illnesses. Those with pre-existing conditions but who are otherwise in good health can be covered for medical treatment not related to their conditions. We have received feedback about extending MediShield coverage to Singaporeans with pre-existing illnesses from the Government Parliamentary Committee for Health, and Singaporeans whom we engaged during the Our Singapore Conversation. MOH will take into account such feedback in our review of healthcare financing.”
“Mdm Speaker, I am very heartened by the concern that our Member has for the needy patients and we too are concerned about their needs. We do have schemes in place to help should they require financial assistance, whether it is for scans or outpatient treatment. I assure Er Dr Lee that the Ministry officials are working very hard to try to complete the financial review. But it is a complex issue as it covers all the 3Ms – MediFund, MediShield and MediSave – as well as the Government subsidy as part of it. There are various factors which we need to balance. We want to ensure that the healthcare services continue to remain affordable. At the same time, we want to encourage prudent use of the healthcare savings of our patients and Page: 45 we also want to find ways to encourage considered and calibrated decisions on treatment so as to prevent over-consumption. At the end of the day, it is important as we design our healthcare financing framework to continue to have the motivation and incentive for individuals to stay healthy and to strengthen their family support at the same time. There are many factors that we need to consider and we are working very hard and we will announce them as soon as we are ready. Some of these measures may be announced progressively over a period of time. It need not be a whole package, waiting for the last bit to fall in place. As and when we are ready, as and when the schemes are being worked out, we will announce them accordingly.”
“Mdm Speaker, currently, patients can use up to $600 of Medisave per year for outpatient scans required for cancer treatment, as well as up to $400 for outpatient treatment for chronic diseases under the Chronic Disease Management Programme (CDMP). Nevertheless, Singaporeans have shared with us, including through Our Singapore Conversation, that they are concerned with the cost of scans, as well as for outpatient treatments. As part of our healthcare financing review, we are exploring ways to reduce the cash outlay for outpatient treatments, especially for the elderly, including greater flexibility in the use of Medisave. However, in deciding on which procedures to allow for Medisave use, we need to strike a judicious balance between helping our people defray the out-of-pocket cost of outpatient treatment and preserving Medisave to help patients pay for larger hospitalisation bills. Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, I would like to ask the Minister when will the review be completed and the results be known because scanning costs quite a lot and our residents feel that it is quite a strain on their pockets.”
“Hospitals have also been informed that suspect and confirmed cases of dengue who return to emergency departments within 24 to 48 hours should be appropriately prioritised for attention. Page: 150”
“Patients at the emergency departments (EDs) are prioritised and attended to based on the severity of their conditions. All life-threatening (P1) cases are attended to immediately. For emergency but non-life-threatening (P2) cases, the median waiting times across the EDs ranged between 14 and 49 minutes in 2008; and between 15 and 29 minutes in 2012. For patients who required admissions, the median waiting time for admission ranged between 0.3 and 2.2 hours in 2008; and between 0.1 and 3.1 hours in 2012. Even while patients wait at the EDs for admission, medical teams continue to monitor them and institute appropriate investigations and treatments. To reduce the waiting time to consultation, our hospitals increase manpower and improve processes to enhance efficiency. Such measures include calibrating the shifts of doctors and nurses based on anticipated patient load, deploying nurses from other work areas (for example, inpatient units) that are less busy to assist at the ED, and providing support services (for example. assisting with laboratory and radiological investigations). The waiting time to admission is dependent on the overall bed availability at any point in time. In anticipation of the increase in dengue cases, MOH has worked with hospitals to renovate suitable spaces within hospital campuses to inject new bed capacity, including temporary capacity, and deployed more nurses and doctors to staff the added capacity. Hospitals also actively review and work with the Agency for Integrated Care to discharge patients who are medically stable to long-term care facilities to free up hospital beds for those in need.”
“As for chickenpox, MOH is also unable to provide an age breakdown of the chickenpox cases as it is not a legally notifiable disease. Based on the nature of the disease and the clinical status of the child, doctors will make an assessment as to the appropriate number of days of medical leave to grant the child. A child who is diagnosed to have an infectious disease should only return to the preschool centre when the medical leave has expired and symptoms have resolved. This can take up to one to two weeks for dengue, chickenpox and HFMD. Page: 149”
“Hand, Foot and Mouth Disease (HFMD) is a common childhood disease. Children aged six years and under accounted for over 70% of the notified cases between 2010 and 2012. The table below shows the number and proportion of all HFMD cases who are children aged six years and under. HFMD can be transmitted from person to person directly through the faecal-oral route or contact with respiratory droplets, saliva, or vesicular fluid, or indirectly by articles contaminated by secretions. As children can acquire the infection from various modes of transmission, it is not possible to determine the specific source of their infection, whether from their siblings or from preschool centres. Of the HFMD cases notified among children below six, about half were in preschool centres. The key to Page: 148 controlling the spread of HFMD is to maintain high standards of personal and environmental hygiene. MOH also works closely with the Early Childhood Development Agency and the Ministry of Education to ensure that educational institutions, including childcare centres, remain vigilant and take measures to minimise the spread of this disease. Dengue is a mosquito-borne disease that is endemic in Singapore. The vast majority of dengue cases are adults. From 2010 to 2012, children aged six years and under accounted for 1.5% to 2% of all notified dengue cases. The table below shows the number and proportion of all dengue cases who are children aged six and under. As dengue infections are transmitted through the bite of infective female Aedes mosquitoes, it is not possible to conclusively determine the source of infection. MOH does not have data on the proportion of children with dengue who are in preschool centres.”
“To facilitate the early diagnosis of dengue during this epidemic, the Ministry has also increased the subsidies for dengue NS1 testing at the emergency departments of public hospitals during the period of the epidemic so that patients will not pay more than $10 per test. This has already been in place since 17 June. Many private general practitioner (GP) clinics have existing arrangements for dengue testing, such as by sending samples to laboratories. NEA's Environmental Health Institute provides dengue NS1 antigen and antibody testing to all GPs and polyclinics at no cost, as part of NEA's efforts to promote early dengue diagnosis and prevent further transmission of the virus. We will continue to work with the private medical clinics to advise them on how they can access dengue testing services, if they do not already have existing arrangements to carry out such tests. Page: 147”
“Doctors are advised to monitor dengue patients closely, and to look out for warning signs and symptoms which may warrant a referral to hospital for Page: 146 further medical evaluation and management. Hospitals are also reminded to ensure that for suspect or confirmed dengue patients who are clinically assessed to not require admission at that point in time, there are outpatient monitoring systems to review them. In addition, hospitals have been informed that suspect and confirmed cases of dengue who return to emergency departments within 24 to 48 hours should be appropriately prioritised at triage. Doctors, usually, make a clinical diagnosis of dengue based on an overall assessment of the patients. Dengue tests can be ordered by doctors if deemed appropriate. The dengue tests which are commonly used are those which look for the presence of dengue NS1 antigen and dengue antibodies in the blood. NS1 antigen is a dengue virus protein and is usually present in the blood between day 2 and day 5 of infection, when the patient has a fever and the dengue virus is circulating in the blood. Dengue antibodies are usually detected only five to seven days after the fever has started. Thus, although dengue tests may help to support the diagnosis of dengue, a test that is done too early in the course of the illness may not give definitive results. For example, a negative dengue test on the first day of fever would not conclusively exclude the possibility of dengue. Dengue testing, therefore, has to be guided by the doctor's overall evaluation of the patient's clinical presentation. Dengue tests are available in our public hospitals.”
“He subsequently developed liver inflammation and confusion and was transferred to the intensive care unit (ICU) on 28 May. However, his condition continued to deteriorate despite maximal supportive therapy, including multiple blood transfusions, and he passed away on 29 May. The second death from DSS was notified to MOH on 9 June. The deceased, who had a history of diabetes and high blood pressure, presented at TTSH ED on 5 June with fever for one day, as well as left leg swelling and redness. He was clinically stable at the visit. He was diagnosed with cellulitis, discharged with antibiotics, and also advised to be monitored by a primary care provider for possible dengue. He was asked to return to the ED should his symptoms worsen. He next visited the ED on 7 June with weakness of his legs, with worsened swelling and redness of his left leg, and persistent fever. He was admitted for left leg cellulitis and probable dengue, which was confirmed by laboratory testing. He developed kidney failure and liver inflammation and was subsequently transferred to the ICU on 8 June. His condition continued to deteriorate and he passed away on 9 June despite maximal treatment. MOH sought independent expert opinion on the management of both cases. The experts have advised that the clinical management was consistent with accepted standard clinical practice in both cases. MOH and our public hospitals continually improve clinical management by sharing and learning good practices. MOH regularly issues circulars to our doctors and hospitals to provide updates on the dengue situation and reinforce advice about the clinical management of dengue or suspected dengue patients.”
“I wish to express once again our deepest condolences to the families of the two Singaporeans who passed away from Dengue Shock Syndrome. The clinical spectrum of dengue ranges from mild or asymptomatic infections to more severe forms of the disease. The vast majority of dengue patients have mild, self-limiting disease. However, a minority of patients develop more serious Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), which can result in life-threatening complications. As of 22 June 2013, MOH has been notified of 10,959 dengue cases. Of these, 46 (or 0.4%) had the more severe DHF. There is, currently, no specific antiviral medication to treat dengue. The key to managing dengue patients is, therefore, to ensure that they get sufficient rest and hydration while their body fights the virus, and to closely monitor their clinical status so that additional supportive therapy, such as platelet or blood Page: 145 transfusions, can be provided, if necessary. Unfortunately, despite the best efforts of our doctors, some cases of DHF or DSS will succumb to the disease. MOH was notified of the first death this year from DSS on 29 May 2013. The deceased presented at Tan Tock Seng Hospital (TTSH) emergency department (ED) on 23 May with fever and flu-like symptoms for one day, and was diagnosed with viral fever with possible early dengue. He was discharged as he was clinically stable and was keen to go home. He was advised to have his blood test repeated by a primary care doctor and asked to return to the ED if his symptoms worsened. He returned to the ED on 24 May but left, at his own request, without seeing the doctor. On 26 May, he visited TTSH ED with complaints of fever, headache and vomiting, and was admitted. He tested positive for acute dengue infection.”
“Doctors are advised to monitor dengue patients closely, and to look out for warning signs and symptoms which may warrant a referral to hospital for further medical evaluation and management. Hospitals are also reminded to ensure that for suspect or confirmed dengue patients who are clinically assessed to not require admission at that point in time, there are outpatient monitoring systems to review them. In addition, hospitals have been informed that suspect and confirmed cases of dengue who return to emergency departments within 24 to 48 hours should be appropriately prioritised at triage.”
“He subsequently developed liver inflammation and confusion and was transferred to the intensive care unit (ICU) on 28 May. However, his condition continued to deteriorate despite maximal supportive therapy, including multiple blood transfusions, and he passed away on 29 May. The second death from DSS was notified to MOH on 9 June. The deceased, who had a history of diabetes and high blood pressure, presented at TTSH ED on 5 June with fever for one day, as well as left leg swelling and redness. He was clinically stable at the visit. He was diagnosed with cellulitis, discharged with antibiotics, and also advised to be monitored by a primary care provider for possible dengue. He was asked to return to the ED should his symptoms worsen. He next visited the ED on 7 June with weakness of his legs, with worsened swelling and redness of his left leg, and persistent fever. He was admitted for left leg cellulitis and probable dengue, which was confirmed by laboratory testing. He developed kidney failure and liver inflammation and was subsequently transferred to the ICU on 8 June. His condition continued to deteriorate and he passed away on 9 June despite maximal treatment. MOH sought independent expert opinion on the management of both cases. The experts have advised that the clinical management was consistent with accepted standard clinical practice in both cases. MOH and our public hospitals continually improve clinical management by sharing and learning good practices. MOH regularly issues circulars to our Page: 144 doctors and hospitals to provide updates on the dengue situation and reinforce advice about the clinical management of dengue or suspected dengue patients.”
“I wish to express once again our deepest condolences to the families of the two Singaporeans who passed away from Dengue Shock Syndrome. The clinical spectrum of dengue ranges from mild or asymptomatic infections to more severe forms of the disease. The vast majority of dengue patients have mild, self-limiting disease. However, a minority of patients develop more serious Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), which can result in life-threatening complications. As of 22 June 2013, MOH has been notified of 10,959 dengue cases. Of these, 46 (or 0.4%) had the more severe DHF. Page: 143 There is, currently, no specific antiviral medication to treat dengue. The key to managing dengue patients is, therefore, to ensure that they get sufficient rest and hydration while their body fights the virus and to closely monitor their clinical status so that additional supportive therapy, such as platelet or blood transfusions, can be provided if necessary. Unfortunately, despite the best efforts of our doctors, some cases of DHF or DSS will succumb to the disease. MOH was notified of the first death this year from DSS on 29 May 2013. The deceased presented at Tan Tock Seng Hospital (TTSH) emergency department (ED) on 23 May with fever and flu-like symptoms for one day, and was diagnosed with viral fever with possible early dengue. He was discharged as he was clinically stable and was keen to go home. He was advised to have his blood test repeated by a primary care doctor and asked to return to the ED if his symptoms worsened. He returned to the ED on 24 May but left, at his own request, without seeing the doctor. On 26 May, he visited TTSH ED with complaints of fever, headache and vomiting, and was admitted. He tested positive for acute dengue infection.”
“1% of working adults smoke9, HPB has partnered the Singapore National Employers Federation (SNEF) to conduct sectoral studies among the workforce, such as employees from the hospitality sector. A survey, for instance, revealed that 31.5% of hotel employees smoke. Stress was indicated as a cause for smoking among this sub-group. The Workplace Smoking Control Programme (WSCP) was thus implemented in industries that have a higher number of employees who smoke, such as the manufacturing, hospitality and retail industries. The programme considers the unique work environments and creates convenient access to on-site quit consultants. Alternative stress management techniques (as opposed to Page: 142 smoking) are also introduced alongside Nicotine Replacement Therapy, as well as off-site support through QuitLine and the I Quit mobile phone application. My Ministry views the increase in smoking prevalence seriously. We will continue to monitor and review the effectiveness of our tobacco control measures, so as to provide a supportive environment for non-smoking as well as to de-normalise tobacco use.”
“According to the 2010 National Health Survey (NHS), the prevalence of smoking in Singapore has increased from 12.3% in 2004 to 14.3% in 2010, reversing a previous long-term decline. This trend is driven by significant increases in smoking among young adults aged 18 to 39. Social influencers, such as older peers and parents, have been cited as reasons for picking up smoking among the youths. The Student Health Survey conducted by the Health Promotion Board (HPB) found that 58% of youth smokers have at least one parent who smokes, compared to 27% of youth non-smokers. To de-normalise smoking, especially among the youths and young adults, my Ministry is considering the introduction of a Point-Of-Sale (POS) display ban, which aims to eliminate the advertising effects of tobacco product displays at retail outlets. A public consultation exercise was done to garner feedback on ways to strengthen our current tobacco control measures, including the proposed POS display ban. My Ministry has also introduced a wide range of anti-tobacco measures that includes school-based awareness programmes to prevent smoking initiation from an early age. We have also brought the Blue Ribbon Smoke-Free Movement to targeted settings, such as hawker centres, hotels, parks and mosques. Over 150 community-based touch-points have been established to facilitate convenient access to smoking cessation services. Three residential estates – Bukit Batok East, Hong Kah North, and Nee Soon South – were exemplary in their voluntary introduction of smoke-free zones in common community areas, such as void decks, corridors and neighbourhood parks8. As 16.”
“In 2012, a total of 15,733 caesarean operations were performed in Singapore. This was a slight increase from 2011 and 2010, with 14,583 and 13,674 caesarean operations performed each year respectively. In 2012, about one in three (or 37%) of all births in Singapore were delivered through caesarean operations and the rest were delivered through vaginal deliveries. This ratio has remained relatively stable since 2010. In 2012, elective caesarean operations formed slightly more than half (or 55%) of all caesarean operations in Singapore, which was similar to the proportions observed in 2011 and 2010, where they were 55% and 54% Page: 116 respectively.”
“Patients in need of Medifund assistance are first assessed by the Medical Social Workers and the amount of assistance is subject to the approval of the Medifund committees. Over the last three years, over 90% of the approved applications were provided full assistance. The processing time for each application varies. The assessment can be made within a week if the information provided is complete. Complex cases that require counselling, interviews with family or a more detailed assessment of the patient's medical condition will take longer. However, this does not affect patients who need urgent treatment. They would be provided the appropriate treatment, even as the application for Medifund is being processed. Similarly, the hospitals assess requests for downgrading from private to subsidised services according to the patient's financial need. After obtaining complete financial information, the assessment is generally completed within one to two days. Page: 98”
“Madam, I had explained that our original advisory was to encourage our children to stay at home when the haze was bad. We noticed, having issued the advisory, the parents were using the masks for the children and, therefore, we reminded the parents that the masks were not designed for children. Having said that, reiterating what Dr Vivian Balakrishnan has mentioned, that unlike the virus, the mask even if it is not 100% fitted provides some form of protection for the children. We wanted to make sure that parents understand that if the mask is not properly fitted, it does not provide 100% protection. So, it is still better for parents to keep their children at home. Therefore, we reminded the parents subsequently that the mask is not designed for children and to refer to our original advice that when the haze situation is bad, it is better for the children to minimise their exposure outdoors. So, I hope I have explained the sequence of events.”