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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Every one of 3,841 lines we hold for Gan Kim Yong, in date order, each linked to its source. Free to read, in full, without an account. Page 55 of 77.
“Mdm Speaker, I would hesitate to say that the haze is over for this year as I think Dr Vivian Balakrishnan has reminded us all that the Page: 56 dry season is not yet over so we have to remain vigilant and to be well prepared. So, for the time being, the scheme will still remain in place and will be reviewed again at the end of the dry season to see whether it is necessary to be continued, whether we will re-introduce it next year or we could refine the scheme to make it a better scheme when the haze does return. We hope it does not, but in the event that it does return – whether we will need the scheme or whether we need a different scheme – we will look at the situation at that point in time but for the time being – this being the dry season – the scheme will remain in place.”
“Mdm Speaker, MOH will continue to explore the different masks available in the market and to see which of them would be suitable for use by our children. At the same time, we would also consult relevant authorities worldwide, including the Food and Drug Administration (FDA) in United States, to see which of the masks would be suitable. As I have explained, some of the children who are older, who may be bigger in size, the small-sized mask would be suitable for them, and this is on a case-by-case basis. For haze, as Dr Vivian Balakrishnan has explained, is unlike a virus attack. For children who are outdoors for short-term exposure, it is not required that they wear the mask for as long as the exposure is limited to a short period of time. For children during a heavy haze period, the real advice is to stay at home, which is what we had given to the parents, to encourage them to keep the children at home – minimise exposure in the open air when the haze levels have reached unhealthy levels – rather than to rely on the masks. But we noticed that some parents are asking their children to wear the N95 mask and therefore, we reminded them that the N95 masks are not certified for use by children. It is much better for them to keep their children at home rather than to rely on masks. But for children who need to travel to schools or to tuition centres, when they need to take a bus or when they need to commute short distances, they really do not need to wear a mask in any case unless the haze has reached very, very unhealthy or hazardous levels. Then please refer to the advisory provided by NEA jointly with MOH and we will advise the children and parents accordingly.”
“Mdm Speaker, I would like to thank Dr Lam for raising this question; in fact, it is a very important question. MOH officials have been working with grassroots organisations not only to distribute masks to needy residents but also to take the opportunity to explain to residents the proper usage of the mask and we have also distributed pamphlets and posters to explain how to use the mask properly. The Member is right that the masks ought to be used properly to provide adequate protection. And for patients who are suffering from chronic diseases, the use of the mask may not be appropriate. For these patients, we advised them to consult their doctors if they find that wearing the masks create problems for them, especially in their breathing. So, it is important for the masks to be used in an appropriate manner.”
“We have stepped up efforts to transfer stable patients from the hospitals into community hospitals and nursing homes to free up acute bed capacity. Should the haze worsen and there is a need to free up bed capacity further, non-urgent services and elective cases at the hospitals may be scaled back. Secondly, we will take care of the patients in our public sector hospitals and healthcare institutions so that they are not adversely affected by the haze. If the haze situation is bad, these institutions will close their windows and doors to reduce the inflow of dust particles. And if necessary, air coolers and fans will also be used to improve the ventilation for patients in non air-conditioned wards. For especially vulnerable patients, we will put in place air purifiers to help reduce the impact of the haze on these patients during significant haze. We will also facilitate home delivery of medication for chronic patients – if necessary – so that they can get their needed medication without having to visit Page: 54 our clinics. Third, our hospitals and polyclinics have adequate equipment and supplies, including adequate medication stocks, on standby to support the continuation of critical services. Our hospitals also have plans in place to ensure adequate manpower to staff critical services such as the A&E, Intensive Care Unit and operating theatres. At the national level, we are re-building our stockpile of N95 masks so that we will be ready, should there be a disease outbreak during this period.”
“When haze reaches unhealthy levels, children should really be kept indoors as much as possible. This has been communicated to the public through various platforms including the mass media and online media. Since schools reopened last week, MOH has been working with MOE and schools on the various Page: 53 mitigation measures, based on the health advisory of the day. Dr Lam and Mr Giam asked about long-term measures to protect the health of Singaporeans. MOH has worked with our healthcare institutions to put in place plans in three areas, to ensure that we are "haze ready". First, managing the expected surge of patients at our polyclinics and hospitals for haze-related conditions. The Ministry has already implemented a special scheme where those who suffer from respiratory problems or conjunctivitis because of the haze need only pay $10 when they seek treatment at participating general practitioners (GPs). The scheme applies to Singaporeans aged 18 years and below, or 65 years and above, and those in low-income groups. The scheme will enhance the accessibility and affordability of primary care for haze-related conditions. There are now more than 600 GP clinics participating in this scheme. Information on the participating GP clinics is on the MOH website, and also shared through community organisations. The Agency of Integrated Care (AIC) has been actively reaching out to individual GP clinics to encourage them to sign on. To increase awareness amongst members of the public, posters have been distributed to GPs so that the participating clinics can be easily identified. MOH had also earlier worked with the hospitals to retrofit suitable spaces within the hospital campuses to ready additional bed capacity in the event of a demand surge due to an increase in dengue cases.”
“Madam, Dr Lam asked about the short- and long-term effects of air pollution. For healthy individuals, short-term exposure to haze may cause temporary minor irritation of the eyes, nose, throat and skin. Such irritation typically resolves on its own in most cases. However, the haze particles can aggravate lung diseases, cause asthma attacks and acute bronchitis in people who already have chronic lung diseases, and trigger off heart attacks and irregular heartbeat in people with heart problems. Thus far, there has been no clear evidence of long-term health effects of short-term haze, like that we have experienced. Mr Gerald Giam asked about the impact of the haze on healthcare services. So far, the impact has been manageable. When the haze was more severe in the week of 17 to 23 June, we saw a 16% increase in polyclinic attendances for relevant conditions compared to the week before, but attendances at hospitals' accident and emergency (A&E) department did not show any significant increase. The air quality improved in the last week of June and polyclinic attendances correspondingly decreased to just 4% higher than the level before the onset of haze. Attendance at A&E departments for the relevant conditions actually decreased by 23% in the last week of June. Ms Lee asked about N95 masks. The N95 masks are not specifically designed for use by children, nor have they been certified for effectiveness for such use. To be effective, N95 masks need to maintain a well-fitted seal at all times, which may be difficult to achieve in young children who are smaller and of varying sizes. It is possible for the older children who may be able to fit smaller sized N95 masks for adults. Parents who wish to buy these masks for their children should ensure proper fit and usage of the mask.”
“Mdm Speaker, may I have your permission to take Question Nos 21 to 23 together?”
“The Chairman of the Tribunal is drawn from a select panel appointed by the Minister consisting of senior medical practitioners of not less than 20 years' standing, past Judges or Judicial Commissioners of the Supreme Court, advocates or solicitors of not less than 15 years' standing, or officers in the Singapore Legal Service with an aggregate of not less than 15 years of full-time employment in the Singapore Legal Service. Most of the medical members of this select panel are also members of the Complaints Panel. The other members of the Tribunal are drawn from the Complaints Panel. In certain cases where it is necessary to appoint a Legal Service Officer (LSO) as a member of the Disciplinary Tribunal, the Medical Council may choose a legal officer from the select panel appointed by the Minister. The members of the Complaints Panel and medical members of the select panel appointed by the Minister attend training sessions on the complaints and disciplinary processes which are conducted by SMC's panel of legal assessors who are senior lawyers. If requested by the Complaints Committees, a legal assessor can be appointed to advise the committee should they require guidance regarding any questions of law. If the Tribunal does not have a lawyer as its chair or as one of its members, a Legal Assessor is appointed to assist the Disciplinary Tribunal.”
“Section 38 of the Medical Registration Act provides for the formation of a Complaints Panel from which members of the Complaints Committees and Disciplinary Tribunals are drawn. The Complaints Panel is headed by a Chairman, Assoc Prof Chen Fun Gee, and comprises 166 members. These members, in turn, comprise (a) 16 members from the Singapore Medical Council (SMC), (b) 100 registered medical practitioners of at least 10 years' standing who are not SMC members, and (c) 50 lay persons nominated by the Minister. The registered medical practitioners in the Complaints Panel are drawn from a list of nominees submitted by medical professional bodies, and public and private hospitals based on their professional standing in the medical community. Lay persons are drawn from professional bodies, for example, Accounting and Corporate Regulatory Authority, Board of Architects, Professional Engineers Board, Singapore Association of Social Workers, the Singapore Pharmacy Council, the Singapore Nursing Board and the Law Society of Singapore, and from academics nominated by our Universities. To look into complaints against medical practitioners, the Chairman of the Complaints Panel appoints a Complaints Committee of three persons from the Complaints Panel comprising a Council member as Chairman, a registered medical practitioner and a lay person as members of the Committee. Where a formal inquiry is determined to be necessary by the Complaints Committee, a Disciplinary Tribunal is appointed by the Medical Council. Neither the Chairman nor members of the Disciplinary Tribunal would have been in the Complaints Committee looking into the case.”
“A total of $172 million has been used for the implementation of NEHR Phase 1 so far. As NEHR is a 10-year programme, the total investment will depend on the needs of the healthcare sector. MOH is currently gathering feedback from the various stakeholders for the next phase. The annual maintenance costs of the system is about $20 million.”
“National health expenditure (NHE) covers not just basic healthcare services, such as inpatient and outpatient hospital care, visits to primary care doctors and long-term nursing care, but also includes consumption of health products, for example, pharmaceutical drugs, over-the-counter health supplements, Chinese herbs, consumables, such as dressings and appliances, such as mobility aids, as well as other healthcare services, for example, traditional and complementary medicine and therapy. It also includes spending by not just residents, but also foreigners. The table below shows Singapore's NHE in each of the last 10 years, and the main components – Government Health Expenditure (GHE) which includes Medifund assistance, Medisave withdrawals and MediShield claims. From 2002 to 2011, national healthcare spending increased by an average of 9% per annum, while Government healthcare spending grew faster, by more than 11% per annum. In 2011, ElderShield payouts amounted to $10 million and this is expected to increase over time as the population ages. In addition, Integrated Shield Plans paid out about $0.2 billion. The remainder includes other third-party payers, such as private medical insurance, employers' benefits for employees, Civil Service medical benefits, charitable donations, as well as out-of-pocket payments, including spending by foreign medical tourists.”
“From 2010 to 2012, an average of 650 MediShield policyholders aged 60 and above (or less than 1% of policyholders aged 60 and above) opted out of MediShield coverage each year. Policyholders do not indicate their reasons for cancelling their MediShield coverage. Following the recent MediShield enhancements, the MediSave withdrawal limits for medical insurance premiums were revised from 1 March 2013. The current limits are $800 for policyholders aged 75 years and below, $1,000 for policyholders aged 76 to 80 years and $1,200 for policyholders aged above 80 years. The revised withdrawal limits are sufficient to fully cover basic MediShield premiums of all policyholders. For elderly Singaporeans, the Government has put in place various measures to help them with the payment of premiums. A one-time MediSave top-up of up to $400 was provided to insured Singaporeans to help with the basic MediShield premium revisions. The Government provides annual MediSave top-ups of up to $450 to the majority of elderly Singaporeans through the GST Voucher Scheme. The Government also provides additional MediSave top-ups to Singaporeans from time to time when there are Budget surpluses, such as the recent one-off MediSave top-up of $200 for all Singaporeans aged 45 and above in Budget 2013.”
“In addition, NKF, in collaboration with some public hospitals and external vendors, has organised activities and seminars to provide continuous support and education to the dialysis patients, including PD patients, and their caregivers. One such effort was the seminar, "You Are Not Alone", held in December 2012 and attended by 85 PD patients and caregivers. MOH, together with the various VWOs, also provides subsidies to ease the financial burden of PD patients and their caregivers. Moving forward, MOH will continue to work closely with the VWOs and public hospitals to further enhance support to PD patients and their caregivers.”
“Peritoneal dialysis (PD) is a dialysis modality that provides more convenience and independence to renal failure patients as it can be self-administered and largely home-based. However, some of the older PD patients and those with multiple complications do rely on assistance from their carers and family to help them on the dialysis treatment, such as connecting to the PD machine, drug regimen, diet and activities of daily living. To better support these patients, Voluntary Welfare Organisations (VWOs), such as National Kidney Foundation (NKF), collaborate with public hospital medical teams to provide close community support to the patients and their caregivers in a few ways. First, the PD patients and their caregivers are provided with three to five days of training by nurses and physicians in the hospitals before they carry out PD independently. The patients and caregivers are also encouraged to contact the PD nurses on-duty at the PD centres to seek assistance if they encounter any PD-related difficulties. Second, NKF has a Home Visit Programme in collaboration with the public hospitals, where home visits are conducted by a team of trained and experienced PD nurses from NKF, Tan Tock Seng Hospital (TTSH), and other hospitals. These home visits are carried out every three months, or more frequently if required, to provide training and guidance to the patients and their caregivers in the management of the patients and to allow early intervention by PD nurses and physicians if problems occur. Third, in circumstances when the patient's family members require further social support, the Medical Social Workers (MSWs) from the hospital will provide assistance.”
“Of the expected increase of 20,000 healthcare professionals between 2011 and 2020, as announced in the Healthcare 2020 Masterplan, about 3,600 will be positions for doctors. Most of the positions will be filled by graduates of the three local medical schools and Singaporeans returning from overseas with recognised medical qualifications. We are expanding our local medical training capacity. In 2012, the Yong Loo Lin School of Medicine and the Duke-NUS Graduate Medical School graduated a total of 290 new doctors. With the Lee Kong Chian School of Medicine admitting its first intake from 2013, total local output of medical graduates will rise to 500 in the longer term. In addition, 92 overseas trained Singaporean doctors returned and were registered in 2012. MOH will continue its efforts to attract overseas Singaporeans with recognised medical qualifications to return. Any remaining demand in specific areas is then filled by overseas-trained foreign doctors. Some of them may be temporarily registered, and will be in Singapore for a limited period to help alleviate our immediate clinical service needs.”
“While most patients and their family members are appreciative of the hard work and good care provided by our public healthcare staff, the number of cases of physical and verbal abuse towards healthcare staff has risen in recent years. Based on available data from the public hospitals, the number of cases which were reported to the Police increased from 16 in 201012 to 33 in 2012. Our public hospitals take a serious view of this and have measures in place to protect healthcare staff from abuse. Signs are displayed prominently to remind visitors to treat healthcare staff with respect. Healthcare staff are also trained to assess and de-escalate potential conflicts and manage abusive situations. They are empowered to alert security officers for immediate assistance. If necessary, police intervention may be further sought and charges may be pressed against individuals who continue to behave abusively. MOH does not condone any abusive behaviour towards our healthcare staff. While it is understandable that patients and their family members may face stress and anxiety, we would like to remind the public that our healthcare staff are doing their best to provide good care for patients and they should be treated with respect under all circumstances.”
“The Medication Assistance Fund (MAF) helps Singaporeans better afford selected high cost drugs in our public hospitals. We enhanced the MAF in October 2011 and increased the subsidy from 50% to up to 75%. We also expanded the scheme to cover non-standard drugs that doctors have assessed to be clinically necessary and appropriate for the treatment of the patient's condition. As of December 2012, more than 6,000 MAF applications have been approved, amounting to $6 million in assistance to patients. Through subsidies for drugs on the Standard Drug List (SDL) and the MAF, we help to keep the cost of drugs affordable for Singaporeans. We regularly review the SDL and MAF, and on 1 April this year, we added another 17 new drugs into the SDL and MAF, including second-generation insulin products and insulin penfills, to lower the cost of medication to diabetic patients. The Member also asked about subsidies for medical implants. Currently, subsidised patients at our public hospitals enjoy a 50% subsidy on medical implants, up to a dollar cap of $1,000. This subsidy cap is sufficient to cover almost 90% of implants used in public hospitals. MOH will continue to regularly review the subsidy caps to keep the cost of implants affordable. Over and above the subsidy schemes, patients who require additional help with their bills can approach the hospitals' medical social workers for financial assistance.”
“Wherever possible, our doctors accommodate a family's request for some additional time to grief and to address their concerns. We need ongoing efforts for the life-saving and life-changing benefits of organ transplantation to be better understood and embraced by our people. The Live On campaign was first launched in 2008 to increase public awareness. Over the past five years, we have had periodic campaigns and publicity to spread awareness about organ donation. We will continue to evolve our approach to engage Singaporeans about this important topic. My Ministry will work with the community to strengthen outreach and engagement efforts to enhance public awareness on organ donation.”
“Certification of brain death is done by two independent doctors, neither of whom has been involved in the care and treatment of the patient or in the subsequent transplant. This independence ensures that the diagnosis is made on the basis of professional criteria benchmarked to international best practice. After brain death has been certified, the patient's status as an organ donor would be verified against the Organ Donor Registry. If the patient has not objected to organ donation previously, in accordance to HOTA, the wishes of the patient to donate his or her organ after death must be upheld. The transplant coordinator from the National Organ Transplant Unit and physician in-charge would approach the family, as sensitively as they could, to share with them about the patient's decision as an organ donor and also explain the process. In situations where families have concerns about the donation of organs by the deceased, the transplant coordinators, social workers and medical team would give the family more time. The doctors in the hospital have been trained to communicate empathetically and sensitively with the family members on issues related to organ donation. They would meet up with the family to listen to their concerns, clarify any related issues that they may have, explain the legal requirements under HOTA and the process involved, as well as provide emotional support and active counselling to the family. Due to potential instability in the brain dead patient, the process is extremely time-sensitive, and we aim to recover the donor organs within 24 hours after certification of brain death. Beyond a certain timeframe, the organs may no longer be suitable for transplantation.”
“Death, whether from an accident or from illness, is a tragedy for the family. We empathise with families who lose their loved ones and are undergoing an emotionally draining time. The interests and well-being of our patients and their families are assured through stringent processes laid out in HOTA and the procedures adopted by each hospital. While our doctors and medical team, counsellors and transplant coordinators try their best in every case, we understand that we can always do better to engage each family. As a society, we forged a consensus in the provision of HOTA to provide for an opt-out organ donation system that allows for the removal of kidneys, livers, hearts and corneas from Singapore Citizens and Permanent Residents who have died, for the sole purpose of transplantation. Organs retrieved are transplanted to bring new lease of life to patients suffering from end-stage organ failure. Currently, there are more than 500 organ failure patients on the waiting list for various organs. With the help of HOTA, cadaveric donations have benefitted more than 850 patients between 1987 and end 2012. Under HOTA, the issue of organ donation is only considered and brought up for the family's attention after the patient is certified as brain dead. Brain death is diagnosed only when there is catastrophic irreversible brain injury and is determined according to strict clinical criteria, similar to those adopted in countries, such as the United Kingdom and Australia. When brain death has occurred, blood flow and oxygen delivery to the brain ceases irreversibly and all brain functions are lost and will never return again.”
“ElderShield is an insurance scheme that provides basic protection against the costs of long-term care arising from severe old-age disability. The scheme provides cash payouts of $400 a month for up to six years to help defray the cost of caring for a severely disabled elderly at home or in nursing homes. As at end 2012, there were 1 million basic ElderShield policyholders, or about 59% of the resident population aged 40 to 80. Those aged 80 and above would have passed the qualifying age for ElderShield when it was introduced in 2002. Hence, they are not eligible for coverage under ElderShield but they may apply for coverage under the Government-funded Interim Disability Assistance Programme for the Elderly (IDAPE) instead if they meet the qualifying criteria. The enrolment rate for ElderShield has been improving with each cohort. In 2012, more than 92% of those who turned 40 years enrolled. Of the one million ElderShield policyholders, 26% have purchased additional coverage through ElderShield Supplements. Between 2008 and 2012, the number of claims rose from 3,900 to 4,900, while the amount of claims rose from $23 million to $58 million. Claims are expected to grow significantly in future, as the scheme matures and more policyholders move into the older age groups, when they are more likely to make claims. As part of MOH's ongoing overall review of the healthcare financing system, we will study possible enhancements to ElderShield to ensure that Singaporeans can continue to be adequately protected against long-term care costs.”
“In 2012, 38% of the doctors on Temporary Registration for service provision had been given extension and had practised in Singapore beyond their initial two-year licence. These doctors need to demonstrate good performance and be recommended by their departments to enroll into training programmes in order to renew their licences beyond the initial two years. Further extension will be contingent upon the doctor being accepted into a specialist traineeship by the fourth year of their Temporary Registration. In 2012, the Temporary Registrations of 66 doctors were not extended.”
“As at 31 December 2012, there were 10,225 doctors registered with the Singapore Medical Council. Sixty percent, or 6,131, worked in the public sector, and 34%, or 3,515, worked in the private sector. The remaining doctors were not professionally active. In the public sector, 72% were on Full Registration, 23% were on Conditional Registration, and 5% were on Temporary Registration9. In the private sector, 97% were on Full Registration, 3% were on Conditional Registration, and less than 1% was on Temporary Registration. There is a larger proportion of doctors on Conditional and Temporary Registrations in our restructured hospitals as training, supervision and education are part of their work. There are currently 308 doctors on Temporary Registration brought in primarily for service provision, which make up 3% of our medical workforce. These doctors do not have the recognised basic medical qualifications listed in the Second Schedule of the Medical Registration Act. However, they have relevant experience in specific fields and specialties and are recruited to temporarily meet the clinical service needs in our healthcare institutions. They work with other doctors to provide general clinical services and patient care and assist senior doctors in meeting the medical needs of patients, particularly in departments facing tight workloads, such as the Emergency Medicine and Geriatric Medicine departments. There are regulations and measures in place to ensure that these doctors are properly supervised and work only in the departments where their clinical experience is relevant. Their performance is also closely monitored to ensure that the doctors meet Singapore's standards and are adapting well to local practice.”
“Since the expansion of the Community Health Assist Scheme (CHAS) in January 2012, the number of participating General Practitioner (GP) and dental clinics has increased to 541 and 295 respectively. We aim to have a good geographical spread of these clinics, especially in areas less well-served by polyclinics. All HDB towns have at least 40% of their clinics on CHAS, with the exception of Bishan and Kallang/Whampoa. There are 16 and 39 CHAS clinics in Bishan and Kallang/Whampoa respectively and residents in these two HDB towns also have access to subsidised care at polyclinics in the neighbouring towns of Ang Mo Kio, Toa Payoh and Geylang, which are located less than 2 km away. We will continue to improve the distribution of CHAS clinics across the island. At the same time, we will also explore further improvements to CHAS, so that not only would more clinics be interested to participate, but more eligible Singaporeans would sign up and benefit from the scheme. We aim to reach out to another 100 GP clinics and 50 dental clinics by year-end. This would bring the number of CHAS clinics to close to half of all GP and dental clinics. Through our outreach and engagement with GPs, we have also received valuable feedback on the features of the scheme and how we can further improve on administrative processes to enhance efficiency. To reduce possible entry errors, we have included a summary page, to allow GPs to verify their entries before the actual submission of claims. Later this year, we will be introducing further IT enhancements, to facilitate entry of diagnoses. We will constantly review and explore ways to reduce barriers and encourage more GP and dental clinics to participate in CHAS.”
“Singaporeans who face difficulty with their healthcare bills can approach the medical social workers at our public healthcare institutions for financial assistance such as MediFund or MediFund Silver, which is a targeted assistance scheme for elderly Singaporeans. The Government also provides MediSave top-ups to Singaporeans from time to time, to boost their MediSave savings for their future healthcare needs. As part of the review of healthcare financing, we are also reviewing how we can further help Singaporeans who were unable to obtain insurance coverage due to pre-existing conditions with their healthcare expenses.”
“MediShield currently covers 92% of the resident population. Over the years, my Ministry has worked with the CPF Board to introduce various auto-cover points, including when one starts work and at birth, to bring Singaporeans under MediShield protection as early as possible, before they develop pre-existing health conditions. The number of residents who have applied but were unable to obtain MediShield coverage due to pre-existing conditions is, generally, very low, at less than 0.5% of residents aged 60 and below and about 1% to 2% of residents above age 60. The Member also asked about the use of Medisave and Special Account balances for commercial insurance plans. Medisave may be used for private health insurance plans that comply with MOH requirements, such as plans that are integrated with MediShield and provide guaranteed renewals, regardless of conditions that develop after coverage begins. However, Singaporeans who are unable to obtain MediShield coverage due to pre-existing health conditions will most likely be subject to similar underwriting requirements under the commercial insurance plans, and may be unable to obtain coverage, or required to pay substantial premium loadings. The use of MediSave for approved private insurance plans is also subject to the usual withdrawal rules as there is a need to safeguard Singaporeans' interests and ensure effective use of MediSave monies that should be preserved for future healthcare needs. Likewise, the CPF Special Account is meant for retirement needs and should continue to be preserved for this purpose. For those who do not have MediShield or private insurance coverage, heavy Government subsidies and MediSave will continue to be available to help them with their healthcare expenses.”
“Voluntary Welfare Organisations (VWOs) play a key role in the provision of dialysis services in the community. MOH has been assisting the VWOs such as the National Kidney Foundation (NKF) in identifying suitable sites in areas where there is a need for such services and in facilitating discussions with relevant authorities to secure these sites. My Ministry will continue to monitor the demand for dialysis centres, including in new towns such as Punggol. Besides ensuring sufficient capacity for haemodialysis, we are also working with the VWOs and renal physicians to improve the access of peritoneal dialysis for suitable patients who can enjoy a more active lifestyle with this modality of dialysis. The Government also supports VWO providers' efforts to raise funds so as to help reduce patient bills. For example, the $1 billion Community Silver Trust (CST) provides dollar-for-dollar matching grants for funds raised by VWOs providing intermediate and long-term care services, such as NKF. In addition to the CST, Government also provides operating subvention to help defray VWOs' operating costs for providing dialysis service and lower the cost to patients. We have recently increased our subvention to enhance the support for VWO providers. We are also adding primary care capacity to cater to the future healthcare needs of an older population, especially those with chronic conditions, including dialysis patients. Specifically, two new polyclinics will be built in the new towns of Punggol and Pioneer by 2017.”
“MediShield, the national basic medical insurance scheme, provides portable insurance coverage for Singaporeans. The scheme covers policyholders' needs not only in employment but also in-between employment and after retirement. As MediShield offers guaranteed renewal, policyholders enjoy continuous coverage even if they develop new health conditions after coverage has started. This ensures that Singaporeans are able to retain their medical insurance coverage regardless of their employment or health status. As at June 2012, 94% of the population aged 21 to 65 was insured under MediShield. Two-thirds of the insured were also covered under the private Integrated Shield Plans. As part of the review of healthcare financing, we will also be reviewing MediShield to ensure that it remains relevant and effective. We encourage employers who wish to provide medical benefits for their employees to do so in the form of portable medical benefits, so that they can remain covered even after retirement, when their healthcare needs are likely to increase. They can do so either through additional MediSave contributions to employees or through purchasing such plans on behalf of their employees.”
“Mdm Speaker, in fact. MOH has been working with the various Government agencies, including our own Health Promotion Board (HPB), National Environment Agency (NEA), as well as AVA, on outreach and public education. We want to raise the awareness of the threat of infectious diseases. During peace time, or without the immediate threat of infectious diseases, our focus has been on non-communicable diseases associated mainly with ageing and so on. But we are very much aware that infectious diseases continue to be a threat, given today's globalised world. There is now a much higher volume of international travellers and infectious diseases will continue to be a threat to many countries in the world. This is an area that MOH will continue to work on with our various organisations and agencies to reach out to not just our residents at the community level but also the professionals, such as doctors and the healthcare institutions, so as to raise their awareness and to enhance their preparedness should a crisis arise.”
“Madam, I want to thank the Member for another very important question. In fact, with our experience in SARS, we are now much better prepared than 10 years ago. However, with each new infectious disease, it will bring in new experiences, new challenges, new threats. It is a continuing journey of learning so our healthcare professionals and institutions are working together, preparing ourselves for the possibility of the arrival of H7N9 or novel coronavirus patients in Singapore. Our institutions are ready and we will be able to manage them.”
“Madam, up to today, the knowledge of the actual transmission mechanism of novel coronavirus is still very limited. We are watching and monitoring very closely. Reports are coming out from WHO on the knowledge that they have gained in the investigation into the various cases. So far, WHO has not recommended any travel restrictions because from their investigations, transmission is limited to very close and prolonged contact, primarily, within the same family or where they are housed together within the same hospital ward. We would follow the advice from WHO in terms of travel advisory. For us in Singapore, we have introduced several measures including notices to our travellers who are arriving in Singapore, that should they develop symptoms or fall ill and if they have the travel history to affected areas, we encourage them to see our doctors immediately so that we can provide the necessary treatment as well as, if necessary, to isolate them. For the outbound travellers, we have given general travel advice to encourage them to stay away from crowded areas, and to exercise and maintain a high level of personal hygiene. These measures will help to mitigate the potential risks. Finally, on sustained transmission: when we look at the current cases of transmission, transmission tends to be between one or two persons when they are in close contact. Transmission after the second person tends to be attenuated. Sustained transmission means there is a sustained transmission beyond the immediate contact. From WHO's contact tracing, out of the 2,000 that they have followed up on, very few of them have developed these symptoms, other than the clusters I mentioned in my reply.”
“Madam, I thank the Member for the question; it is a very important one. Our hospitals have been working together with MOH to look at how we can expand hospital capacity at short notice if there is a surge in demand. Some of this capacity could be temporary in nature in response to emergency cases due to, for example, the coronavirus or H7N9 should they land in Singapore. The hospitals are ready. One of the possible measures, for example, is to defer some of the elective surgery so that we can free up beds for emergency cases that come in. Another possible measure that we are looking at is to facilitate discharge of the medically stable patients, either to stepdown care or help them to be discharged home. We can provide home support for these patients so that additional beds can be freed up when necessary.”
“We continue to monitor the situation for evidence of community transmission of H7N9 or novel coronavirus. MOH has actively engaged other Government agencies to coordinate whole-of-Government measures to be ready for such a scenario. We have worked with hospitals and clinics to ensure that there is adequate surge capacity in healthcare infrastructure and beds. At the national level, we have sufficient personal protective equipment and antiviral stockpiles, which can be deployed, should the need arises. Possible control measures include isolation of cases, quarantine of close contacts, and social distancing measures to reduce community transmission, if necessary. We will continue to engage the WHO and our overseas counterparts to keep abreast of the most updated information. We are monitoring the situation closely as it evolves to ensure that public health is safeguarded. As of now, there is no indication that more drastic measures are required. Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, I would like to thank the Minister for the comprehensive answer. A lot of the residents are concerned about this mainly because they think that there may not be sufficient hospital beds, should the need arises. Based on their experience currently, they say that when they go to hospitals, sometimes they have to wait for the hospital beds. They are thinking, in case we need more hospital beds, how prepared are we and how fast can we react?”
“Our hospitals have put in place procedures to manage suspected cases of H7N9 and novel coronavirus. These include infection control measures for management of respiratory infections, and triaging and separating of suspect cases at emergency departments from non-suspect cases to minimise risk of transmission. When a confirmed index case is detected in Singapore, we stand ready to undertake contact tracing and phone surveillance of close contacts as an added precautionary measure, even in the absence of sustained human-to-human transmission. ICU isolation beds are available to manage severely ill patients. WHO, currently, does not advise special screening at points of entry, nor does it recommend any travel or trade restrictions for both H7N9 and novel coronavirus. MOH has advised travellers to affected areas on general precautions, such as practising frequent hand washing with soap and water, avoiding crowded areas and maintaining a high level of personal hygiene. In addition, H7N9-specific precautionary measures include avoiding direct contact with poultry, birds and their droppings, and consuming poultry and eggs that are thoroughly cooked. We have put up health advisory posters and issued health advisory notices to travellers at our airports to remind inbound travellers who have been in the affected areas to seek medical attention if they become unwell with fever and cough, and to inform their doctors of their travel history. As the June school holidays are approaching, we expect that Singaporeans will be making plans for overseas travel. We would like to remind them to be alert to the latest global disease situations for H7N9 and novel coronavirus, as well as updates to MOH's travel advisory.”
“However, we are monitoring the progress of investigations into the latest Saudi Arabian cluster closely. Madam, so long as there is no sustained human-to-human transmission for H7N9 or novel coronavirus, the risk of an outbreak in Singapore will remain low. Singapore does not import live poultry, birds or fresh frozen poultry meat from China. AVA has a comprehensive inspection and testing programme for imported poultry and birds to ensure that they are free from H7N9. The local chicken farms are under strict biosecurity and AVA conducts regular inspections at all pet shops that sell birds. AVA has a surveillance programme in place for chickens and birds in Singapore, including birds in the wetlands reserves and public parks, such as the Singapore Botanic Gardens. The H7 avian influenza virus has not been detected in tests on local and imported birds. A potential concern is transmission of H7N9 to Singapore via migratory birds carrying the virus. However, as the current H7N9 virus has not been detected in migratory birds in China, the risk of such transmission is currently low. AVA is vigilant against this possibility, and has stepped up surveillance testing on birds in Singapore, including migratory birds. Nevertheless, we need to be vigilant against the possibility of cases in travellers coming to Singapore. MOH has alerted all hospitals and doctors to look out for suspect cases with symptoms such as fever, cough and signs of pneumonia, and a travel history to affected areas for H7N9 and novel coronavirus. Suspect cases will be isolated and tested for H7N9 or novel coronavirus infection. To date, MOH has been notified of 11 cases who have been investigated for H7N9, and 24 who were investigated for novel coronavirus. None have been positive.”
“Madam, since the first reports from China on 31 March this year, there have been a total of 132 confirmed cases of avian influenza A (H7N9) infection, including 33 deaths. Affected areas in China include eight provinces and two municipalities: Zhejiang, Shanghai, Jiangsu, Anhui, Henan, Beijing, Shandong, Jiangxu, Fuijian and Hunan. Taiwan also reported one confirmed case who was likely to have been infected in Jiangsu, China. Infected poultry and contaminated live poultry markets are the most likely source of infection. Many of the cases had such exposure, and the virus has been isolated in chickens, ducks, pigeons and environmental samples from live poultry markets. Closure of the poultry markets in Shanghai has significantly reduced the number of cases there. There is no evidence of sustained person-to-person transmission so far. Despite close monitoring of more than 2,000 contacts, only three small family clusters have been identified so far, but these could be due to either common exposure to an animal source or limited person-to-person transmission. Besides the threat of H7N9, MOH is also closely monitoring another emerging infectious disease – the novel coronavirus infection first reported by the World Health Organization (WHO) in September last year. To date, there are a total of 34 confirmed cases of novel coronavirus worldwide, with 18 deaths. Countries which have reported cases include Jordan, Qatar, Saudi Arabia, the United Arab Emirates, the United Kingdom (UK) and France. The source of the novel coronavirus remains unclear. There have been several clusters suggestive of limited human-to-human transmission between close contacts, but there is no evidence of sustained human-to-human transmission of the infection so far.”
“Mdm Speaker, may I have your permission to take Question Nos 1 to 4 together?”
“As at 31 December 2012, foreign nurses, excluding Malaysians, made up 26% (or around 4,950) of our public healthcare clusters' nursing workforce. While we have expanded local nursing intakes over time, we will continue to need foreign nurses to supplement the local workforce to meet the healthcare needs of Singaporeans. In addition to meeting registration requirements set by the Singapore Nursing Board, foreign nurses have to meet minimum standards in English proficiency before they are allowed to practise locally. Local assimilation programmes, which include basic conversational language courses, for example, Mandarin, Chinese dialects and Malay, are conducted to familiarise foreign staff with our local clinical practice, language and cultural context, to help them adapt more quickly to the local working environment and enable better patient-staff communication. Their language and communication skills are monitored closely during their induction period in our local system. Mentorship and supervision are also provided. In instances where the patient and the nurse do not speak the same language, other staff are called upon to help interpret. It is through such training, supervision and teamwork that our public healthcare workforce work together, regardless of nationality, to give our patients a good quality of care. The attrition rate of local nurses in our public healthcare clusters fell from about 13% in 2003 to about 8% in 2012. MOH will continue working with our public healthcare clusters to strengthen the retention of nurses. Page: 154”
“The statistics of abortions carried out in the first trimester (up to 12 weeks), second trimester (>12-24 weeks) and after 24 weeks of pregnancy are provided in Table 1. Table 2 provides the breakdown of abortions by Singapore Citizens, Permanent Residents and foreigners. Page: 153”
“Mandatory pre-abortion and post-abortion counselling was introduced in 1987 to provide information and support to women intending Page: 152 to undergo abortion. The criteria reflected the main concern then. Some of the criteria are no longer relevant and should be reviewed. The Ministry had commenced a review of this in early March this year and will consult the public in due course.”
“Half of CPF members aged 65 or older who passed on in 2012 had about $2,700 or less. About one-third of them had less than $1,000. Some of them may also have benefited from Government top-ups, as well as from the use of their children's MediSave either as a form of top-up or direct payment for healthcare expenses on their behalf. We need to help Singaporeans maintain adequate MediSave balances to help pay for their old-age healthcare expenses, as well as remain covered under MediShield, possibly up to age 90. Page: 140 Any unused MediSave balance forms part of the total CPF balances which are bequeathed to the deceased member's family.”
“Since last year, with consent, the Public Hospitals are able to tap into patients’ and their families' records of income at CPF, and Annual Value of residential property at IRAS, and use the information for financial counselling, means-testing for subsidies, and applications for MediFund or other assistance. Nevertheless, there is still room for improvement. For example, CPF data do not capture incomes above $5,000. We are currently working on tapping into IRAS records for full income data and we hope to implement it by early next year. We will continue to improve our processes and train our staff to minimise administrative hassle for patients and their families.”
“An example of this work would be the programmes for staff and volunteers at community centres and eldercare centres. These interventions couple the awareness of flu and other respiratory diseases with practical application of necessary skills like mask use and proper hand washing techniques. Infectious diseases continue to be a concern in Singapore. We will continue to educate and encourage Singaporeans to adopt good hygiene practices to prevent the spread of respiratory diseases in our community. In recent months, we see a rise in dengue cases in Singapore, MOH is supporting NEA's efforts in public education on dengue prevention.”
“Since the SARS crisis in 2003, the Health Promotion Board (HPB) has been putting out education campaigns regularly to emphasise the importance of good hygiene practices to prevent the spread of respiratory diseases. Several key strategies have been used. Firstly, HPB uses mass media, such as radio, TV commercials and print media, to increase the population's knowledge and awareness on how respiratory diseases are transmitted and can be prevented. Examples of this approach would include the flu campaigns that are rolled out twice a year, around May and November. Secondly, HPB proactively reaches out and educates the public on social responsibility and good hygiene practices through workplace programmes and community talks. Behaviours, such as hand washing and covering one's mouth and nose when sneezing or coughing, can help to prevent the spread of respiratory diseases. Individuals are also reminded to seek medical attention promptly if they have symptoms, such as fever and cough. These educational messages, while simple, will help to reduce the spread of diseases like influenza. Thirdly, educational outreach to schools is an important strategy in promoting personal and social hygiene. Interactive skits for primary school students as well as the "Health on Wheels" initiative that also targets pre-schoolers, ensure that these messages are delivered in a fun yet effective way. HPB also launched the "Let's Wash Hands" initiative in primary schools in 2012. This programme sets out to reach all Primary 1 and 2 students by 2015. Initiatives for relevant stakeholders, such as parents and teachers, have also Page: 127 been implemented. Finally, HPB works closely with community and business partners to roll out setting-specific programmes.”
“I do not have the data at hand but I would like to point out that from statistics – not just in Singapore but globally – the bulk of the medical expenses is incurred towards the end of life, most of the time within the last six months to 12 months. Even if our members today see that there is significant savings in their MediSave account, it is important to preserve these savings because as you grow older, as you become more frail, as you visit hospitals more often, you will need much of these MediSave monies. For those that are low income, I would encourage them to approach our medical social workers. It is better for us to help through the various help schemes, including MediFund which we have just expanded, and keep the savings for yourself because eventually you may still need it as part of your co-payment when you are hospitalised towards the end of your life. Some may need to also use it for other outpatient chronic disease management. I would, therefore, not take it too lightly in talking about the balances in our MediSave accounts. Again, I am sorry, I do not have the exact number of the MediSave balance of those who have passed away at this point in time.”
“For example, for urgent referral cases from polyclinics, we have an expedited route, especially for cardiac illnesses or suspected cancer cases, we have an accelerated programme to allow them to see a specialist quite quickly. We also look at the acuity of the conditions. If the patient needs urgent attention, he will be attended to at our SOC. If it is "urgent-urgent", then they ought to be in the emergency departments of hospitals. Once they are in the emergency department, they will be given immediate attention. If it is sudden cardiac arrest, for example, then they ought to go to the emergency departments. We have a protocol of referrals, depending on the acuity of the patients. For electives – electives refer to those cases where you decide when you want the operation to be done – time, in many cases, is not critical. We then have more flexibility in scheduling those electives for the various surgeries. We adopt a multi-pronged approach to address the queues in our specialist outpatient clinics. I also mentioned in my speech that we are developing a medical centre at NUH. With that, we will enhance the capacity for specialist outpatient clinics. So, we take a multi-pronged approach to address the queue issue at our specialist clinics.”
“The reason we do that is because when the CHAS clinics are accredited under CHAS, they would have a comprehensive system of managing the chronic diseases of these patients. The patients themselves are already means-tested through the CHAS system. To start with, the patient has to be a CHAS cardholder to be eligible for subsidy because they are means-tested. On the other hand, the referring GPs which work very closely with MOH and our tertiary institutions and our polyclinics in managing these patients are able to then assess the suitability of these patients for our specialist clinics. As a start, we are allowing our CHAS clinics to have access to the subsidised services in our SOC. For CHAS cardholders, they will go to our CHAS registered clinics. When they are referred to SOC, they will then automatically become subsidised patients. At our SOC, if you are referred by any other GPs, Page: 138 we will also look at it on a case-by-case basis, and depending on your income, we may do a means-testing at the SOC before we decide whether or not to allow you to downgrade to a subsidised patient. There is some flexibility at the SOC but we do encourage our patients to go through the CHAS clinics so that they are managed appropriately because when the SOC discharges these patients back to the community, it is also ideal for them to be discharged to the CHAS clinics so that they can follow up, and better manage the chronic diseases of these patients. We want to encourage a stronger partnership between CHAS clinics and our tertiary institutions as well as our polyclinics. On the waiting list for the specialist outpatient clinics, we have adopted several strategies. I had made a reply to an earlier PQ on this matter.”
“Compared to international standards, our level of computerisation has already achieved a certain milestone. Moving forward in the next phase, as I also explained in my speech, we will focus on developing and enhancing the functionalities of the NEHR so as to allow more useful features to be available to the users. Today, the basic NEHR is in place. It will take time for us to achieve buy-in from the individual physicians because habits are not easy to change. We do need a change management process to encourage our physicians, our nurses, and all our clinical users to change the way they have been working and move on to tap on the rich features that NEHR will provide. NEHR also serves as a very important tool for us to put together the healthcare data of the nation. Every single patient ought to have a single record so that we can share the data wherever you are, whichever setting that you go to. In addition to taking care of the patients' interest, it is also a tool to give us the ability to analyse national health data to understand the population's health trends so that we will be able to then develop policy instruments to address the key emerging trends. It is a multi-year project and our next step is to encourage buy-in, to encourage adoption, and this is not an easy task – I will acknowledge that – but it is something that we need to continue to work on. We will also be developing and enhancing the functionalities of the system. On the referral programme, I explained in my answer that for CHAS patients who go to the CHAS clinics – these CHAS cardholders – when they are referred by CHAS clinics, will be eligible for subsidy in our SOC.”
“At the same time, we also have to make sure that our remuneration system treats the doctors fairly. We pay them fairly and competitively so that their salaries are competitive versus the private sector. We probably will not be able to match the pay that the private sector can offer, but we cannot allow the gap to widen too much, otherwise there will be tension. Pay is not everything as far as the doctors are concerned, but it is an important factor. It also reflects our recognition of their contribution. The new pay scheme that is being worked out will take into account feedback from Members of Parliament as well as the professionals on how to balance between appropriate remuneration for the doctors versus interests of the patients so that we can shape the desirable behaviour. 5.15 pm With regard to the professional fees that I mentioned earlier, the intention is to look at whether we can take a portion of the professional fees, pool them together and then redistribute them to the individual physicians, taking into account their contribution to patient load, their contribution to education, their contribution to the management of the institution – maybe they are in leadership positions; they might not have a lot of time to see patients, but their contributions are equally important. All these factors have to be taken into consideration in the new framework. We will be able to share more once we finalise the framework. On the National Electronic Health Records (NEHR), Mr Low had asked the question before and, as I have explained, it is a multi-year project and we will move from stage to stage. We are actually in a very advanced stage of our Page: 137 computerisation.”
“Mdm Chair, if you would allow me, first let me explain that even as we focus on helping Singaporeans cope with their healthcare costs, it is still very important for us to continue to focus on managing overall cost. If overall healthcare cost goes up, even if the Government takes on a greater share, eventually the society will shoulder the cost. It is important, first and foremost, as explained in my main speech, that the starting point is to ensure that we manage overall healthcare costs. We do take many measures to achieve that. One area, for example, is that we want to ensure that we are productive and cost-effective in our treatment. We are very careful in selecting the appropriate treatments to make sure that we do not over-consume medical services. Right-siting is another area. We want to make sure that we do not keep patients in a high-cost setting. If they are better off to be cared for at home, then Page: 136 we want to care for them at home. If they can be cared for in a step-down care setting, then it is better to send them to step-down care. All these measures come together to manage overall costs to ensure that, as a society, as a nation, we manage overall healthcare costs. Even as we manage overall healthcare costs, we want to make sure that the Government's share will increase so as to keep the patient's share of the cost affordable to the patient. So, that is the major shift. Secondly, Mr Low asked about the new salary scheme. As I explained in my speech, the new scheme will be implemented in 2014. The working group is still working through the details of the scheme. The concept is this: first, we want to emphasise that the doctors' focus is always on the interest of the patients.”