Halimah Yacob
Singapore
“Thank you. I think that is certainly a very good idea and that is what we want to do and wish to do, to have the integration of the facilities. As the Member said, it is to encourage inter-generational bonding and support. In fact, we have already started one in Mr Seah Kian Peng's constituency.”
“I thank the Senior Parliamentary Secretary for the clarification, and for his information, I have written twice to LTA. The answers have been negative. My question is, what is the alternative because the purpose of the overhead pedestrian bridge is for people to cross over but the elderly has difficulty crossing over?”
“Mr Speaker, Sir, I am really happy to hear about the immense investment in helping households cope with the rising cost of energy. There will continue to be households that, despite these assistance measures, will face difficulty in paying for their electricity bills.”
“Sir, I would like to ask the Minister: if the problem in Japan is not resolved within the next few months, what measures will be in place to assist sectors that are affected, notably, sectors like electronics?”
“Madam, I have two concise clarifications. My first concise clarification is to ask the Minister about the very low unemployment rate. Given this very low unemployment rate, does MOM have strategies in place to help people who want to find jobs, not just those who are already displaced but those who are currently employed?”
“Madam, on behalf of the House, I would like to thank the Minister, the Minister of State and the Senior Parliamentary Secretary for the very comprehensive and detailed responses given. This year, the Ministry of Manpower did not have the highest number of cuts. That honour went to the Ministry of National Development.”
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“Yes, I am making the points. And we look forward to many more initiatives on the part of the Ministry to put the patient at the centre, as the Minister is saying. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $1,689,007,260 for Head O ordered to stand part of the Main Estimates. The sum of $102,490,200 for Head O ordered to stand part of the Development Estimates. Head K - Ministry of Education”
“Sir, first, I would like to thank the Minister, Senior Minister of State and Parliamentary Secretary for their extensive and comprehensive replies to this House. We have heard various initiatives and many changes which were introduced to our healthcare system. Many of these changes are good changes, and they will make our system more resilient and robust. In particular, we now have a more transparent system.”
“Sir, I think on the issue of manpower development and supply for the healthcare sector, we all agree that having an effective and adequate supply of manpower for the healthcare is extremely crucial for an effective delivery of healthcare services in Singapore. In this respect, there have been many developments, one of which has already been alluded to by the Minister when he spoke recently about the establishment of the second medical school and focusing on how to create greater specialisation and sub-specialisation for doctors. These developments will contribute towards developing better healthcare service through the doctors. The other development is, of course, the establishment or allowing nurses to continue to upgrade themselves through a degree in nursing through the second medical school that is being set up. For a long time, this has been the bugbear of nurses that they have no opportunity to do so to improve themselves. This is definitely a step in the right direction. I would like to ask the Ministry also to consider not only on the direct staff providing healthcare services, like nurses and doctors, but also to look at the para-professionals. Because to have an integrated, holistic healthcare delivery system, particularly with an ageing population, we do need para-professionals, ie, podiatrists, psychotherapists, to provide palliative care as well. There is some concern that this group probably has not been receiving enough attention, and there may also be a shortage of this category of para-professionals. So I would like to urge the Ministry to look into the needs of this group of people and also to ensure an adequate supply of such para-professionals in the public health service. Health Manpower”
“Sir, just a couple of clarifications that I would like to seek from the Minister. Firstly, could the Minister inform this House, in terms of the availability of "B2" and "C" class beds, what is the percentage now? What is the assessment with regard to whether they are sufficient to cater to the needs of people who demand these class "C" and "B2" wards? What is the policy of the Ministry on this? Secondly, when I spoke about opening the use of Medisave, I specifically mentioned about allowing Medisave to be used for treatment of chronic illnesses. Use of Medisave for chronic illnesses is different from outpatient use of Medisave for common cold, cough and fever. Chronic cases are those who suffer from long-term illnesses such as diabetes, high blood pressure, etc. I have come across quite a number of cases where people cannot afford to go through these treatments. Of course, the response would be that we can rely on Medifund. But there are those who are not within that category as well because of their salary and other reasons, and they really find that the regular treatment is expensive. Their concern is that they would drain their Medisave funds. There can be a limit imposed, but they need the treatment and they need to go for regular check-ups, tests, and so on. My third clarification is this. The Minister mentioned about the fact that the reimbursement system would also be retained side by side with the block grant system in the method of subvention for the public hospitals. My request for clarification is that the Ministry has stated, in conjunction with the introduction of the block grant system, that there would be an audit system that would be put in place, to ensure that people's concern would be allayed that they would not be getting treatment.”
“They think that MediShield will cover all hospital bills and they get quite shocked when they find that when they get hospitalised, MediShield does not cover them. I think there is a need to embark on a public education programme to educate people on what is covered, how to make their claims and how it benefits them. This is also to avoid confusion as to how the scheme works. I urge the Ministry to look into this.”
“MediShield Firstly, Sir, I note that there is nothing in the current MediShield scheme to incentivise people to stay healthy. If we believe that everyone must take personal responsibility for his own health, then we should incentivise people to stay healthy. I would therefore like to suggest that the Ministry of Health consider giving discounts on the MediShield premiums for those who stay healthy and have not made any claims from MediShield for a certain period. This is very much like the no-claim bonuses of insurance companies, like insurance for cars and other kinds of insurance. Although human bodies are not like cars, for those who attempt to make it as good as cars and keep them in good shape, I think at least some incentive is due to them in terms of discounts on their premiums. Secondly, Sir, Basic MediShield is pegged to "B2" and "C" class. If means testing is introduced and there are no subsidies for the middle-income, there will be an impact on them as it may result in under-insurance for them. If they were to purchase a rider at that point of time when the means testing comes in, they will be subject to underwriting and this may cause hardship to them. I would therefore like to ask MOH to look into the concerns of this group of Singaporeans. Thirdly, Sir, there is also a lot of misunderstanding and ignorance about MediShield and how it works. Many people remember about the increase in the premiums and the deductibles but they forget about the increase in the coverage and how this will help to reduce their burden on big hospital bills. Many more do not understand the role of MediShield, which is to cover catastrophic illnesses.”
“Sir, currently, once Medisave has reached a certain limit, any amount exceeding that will be transferred to the Ordinary Account. With the increase in healthcare cost and the increase in the premiums and the deductibles, it is better for people to save as much as possible in their Medisave accounts. Also, as MediShield covers only the bigger hospital bills, the small and medium-sized bills will have to be paid through Medisave or by cash. We will therefore need a lot more money in our Medisave account to pay for these bills. I would like to ask MOH whether it would review the existing policy. Instead of transferring the amount in excess of the limit to the Ordinary Account, consider retaining the full amount of the monthly Medisave contribution in the Medisave account. Secondly, Sir, I would like to ask MOH to review the outpatient treatments for which Medisave can be used. Currently, most employers pay for the medical benefits of their employees, but this is not extended to the spouse and children. Hence, the out-of-pocket payments can be high and if they do not have enough savings, it can cause hardship. In particular, I would like to ask that MOH consider including the treatment of chronic diseases as one of the illnesses for which Medisave can be used. If there is a worry that the Medisave fund will be depleted, MOH can consider imposing a maximum withdrawal limit for this purpose. This is important because chronic diseases accounted for 60% of deaths in 2003 in Singapore. It is critical, Sir, that those suffering from chronic illnesses attend regular check-ups and undergo treatments. If giving access to Medisave will achieve this purpose, then we would, in fact, be saving costs and saving lives too.”
“Between 1985 and 2004, a total of 2,232 Singaporeans were diagnosed as being infected with HIV. As at June last year, 62% of women with HIV in Singapore were married and widely believed to have caught the disease from their husbands. This points to the need to have better protection for married women. Will the MOH consider legislation to make it compulsory for spouses of HIV patients to be informed? While we want to protect the confidentiality of AIDS patients, we need to balance this against the interests of spouses who may unnecessarily expose themselves to risks if their husbands refuse to tell them about this condition. Will more be done to promote HIV/AIDS education at the workplace? One final point, Sir, on means testing. I would like to urge the Ministry, if means testing is to be introduced, please do it in a sensitive and humane manner and consider a sliding scale instead of just one income limit which cuts across one income level. Means testing, if not properly done, Sir, can result in high administrative cost and cause a lot of angst.”
“This means that more resources will have to be invested in preventive measures, including public education. However, the number of experts dealing with infectious diseases is not sufficient to deal with the growing problem. According to one report, there are only 11 experts at the Communicable Disease Centre dealing with all the different kinds of diseases. Also, the amount allocated to the Health Promotion Board has gone down for FY2005 when more should be put in to educate the public. Sir, let me now turn to the issue of management of chronic diseases where we need a holistic approach. This is where integration between the tertiary, secondary and primary care providers, as well as the VWOs, is important and is seen as lacking today. For example, if a person who suffers from stroke is discharged from the hospital and subsequently visits the polyclinic or his own GP, it is not clear whether there is sufficient information or follow-up on his case so that there is seamless service provided and the quality of care is not compromised. A lot more can also be done to educate sufferers of such chronic diseases and their families on how to better manage the disease on their own. This is where the Health Promotion Board can do a lot more, and cutting its budget will not help. I would like to ask the Ministry to address these concerns so as to strengthen the practice of preventive medicine in Singapore. Will the Ministry also put in place a more integrated holistic system for the management of chronic diseases by adopting a patient-centric perspective? Will the Ministry allocate more resources to public education, a very important strategy in dealing with prevention? On HIV, Sir, the numbers are increasing.”
“Polyclinics might not have the full range of specialist services that are provided in the hospitals or the outpatient specialist clinics, and not all GPs have specialist or sub-specialist knowledge and they do not have the economies of scale of the polyclinics and therefore cannot match the latter's relatively cheaper medication or have paramedical facilities like X-rays and services like podiatry, dietetic advice and the rest. So, the concern, Sir, is that we should not put the cart before the horse. Also, now that the MOH wants better right siting of healthcare services, there are some who feel that a more efficient structure compared to the existing one, where there are two hospital clusters with their own network of polyclinics, is useful. One suggestion is to have all the polyclinics under one integrated system. This makes sense, as it will ensure a better vertical and horizontal integration in the provision of healthcare services. Sir, I would like to ask the Minister for Health to address these concerns about right siting. This is necessary in order to generate greater public confidence, as right now the confidence level is not so high that polyclinics and the GPs can replace the services of the hospitals. Also, will the Ministry consider merging all the polyclinics under one structure for a more efficient delivery of services and in line with the Ministry of Health's policy on right siting. Sir, my fourth point is on preventive medicine. There are two aspects to this. The first is on the management of infectious diseases, and the second concerns the management of chronic diseases. Worldwide incidence of chronic diseases, including HIV/AIDS, has increased. A most important strategy in dealing with infectious diseases is prevention.”
“I hope that the Minister for Health will address these concerns and ensure that healthcare remains affordable. [Mr Deputy Speaker (Mr S Iswaran) in the Chair] 4.48 pm Sir, let me now come to hospital funding. The MOH has announced its decision to move funding based on piece rate reimbursement to block grants for the two clusters. The intention is that block grants will encourage hospitals to cut waste and look closer at whether a patient needs to be warded as an outpatient or sent to a polyclinic or a family doctor. Singaporeans are concerned that this may have a reverse effect. Hospitals may under-treat patients or allow queues unnecessarily long or push them to the outpatient clinics when they actually need hospitalisation. This is because the fewer patients the hospital treats, the more funds they get to keep, and this will affect the quality of healthcare. MOH has said that, to prevent this from happening, it will put in place an auditing system. Can the Ministry give details of this auditing system? Will it be published before the new funding system starts? How can Singaporeans access this auditing system, and what steps would be taken to educate them on it? Who will be monitoring the system? I hope not the hospitals, Sir. My third point, Sir, is on the delivery of healthcare services. One way in which the MOH hopes to contain healthcare costs is through right siting of healthcare services, so as not to overload the hospitals providing tertiary care and allow primary care doctors to do more. While the objective is good, the concern is that the polyclinics and the private GPs may not be adequately prepared for this change.”
“Sir, I beg to move, That the total sum to be allocated for Head O of the Estimates be reduced by $100. Sir, the Ministry of Health has recently introduced many useful changes to our healthcare system. The recent MediShield review is one such example. However, revamping MediShield is but one facet of controlling healthcare costs in Singapore. Singaporeans, particularly the elderly, continue to be concerned over whether healthcare will remain affordable. There is also a concern whether the Government is spending enough on healthcare. According to the WHO's 2004 report, Singapore's per capita Government expenditure on health at average exchange rate has been falling gradually from US$365 in 1997 to US$274 in 2001. In general, Government expenditure on health, as a percentage of total expenditure on health, also fell gradually from 39% in 1997 to 33.5% in 2001. The other concern, Sir, is that only the services covered under the Basic Medical Package will attract subsidies, and this is determined by the Ministry of Health. Even medicines are subject to restrictions, as not all medicines are covered under the Basic Medical Package. So, if the criteria of what is covered under the Basic Medical Package are stringently prescribed, then less healthcare service will be subsidised. And the concern is not only with in-patient cost but also with outpatient treatment since, although consultation fees at polyclinics are low, the medicines prescribed can be expensive because they are non-standard and, therefore, not subsidised. Sir, more should be done to contain healthcare costs and, as the elderly need healthcare the most and financially they are the weakest, subsidies will continue to play a significant role in our healthcare financing.”
“Sir, I would like to thank the Minister for the explanation. But I think the Minister has described the scheme, which appears to be somewhat an ad hoc scheme to cater for a particular need when we had the economic downturn, and it is somewhat restricted in its scope. Can the Minister consider reviewing this, and perhaps expand it to include other areas, instead of a very confined area? The feedback to me is that it is too confined and, therefore, it is not of very much practical use. Assoc. Prof. Dr Yaacob Ibrahim: Sir, I agree with the Member. In fact, we are looking into the success of this scheme. We have allocated 500 licences. I think the take-up rate is less than 50. We are looking into how to make this a bit more attractive to the low income so that they can actually run the stalls with a reasonable profit to make a living.”
“The scheme was introduced in recognition of the economic downturn and these are ways in which we can help, especially the low income, to get some formal employment.”
“Sir, in the old days, to help poor and needy Singaporeans, the Ministry set aside a number of hawker stalls in order for them to run so that if they could not find employment or another source of income, at least this provided some income for them. We are faced now with a segment of the population who are not able to find employment. They also do not have enough resources to tender for the hawker stalls that are provided because there are more than the numbers which are allowed. People have to tender for it, and that depends on the amount that is tendered. If the tendering fees go up, it becomes difficult. It is hard for those who cannot afford it to be able to tender and run those stalls. So will the Ministry consider reintroducing this, at least allocate a certain percentage of hawker stalls for the poor and needy in Singapore, as part of our efforts to help them to be self-sustaining and independent? Assoc. Prof. Dr Yaacob Ibrahim: I thank the Member for the information. In fact, there are two schemes by NEA. One is, of course, the itinerant ice-cream seller's licence that we give out, and the other scheme is for us to help the needy and the low-income, ie, those who are out of job to run stalls in fixed locations. This is done through the CDCs. We allow the CDCs to make an evaluation and assessment of the applicants. If they fit certain criteria, we will assist them. So the schemes are in place. We would like to encourage, people who need assistance to go to the CDCs and work together with the CDCs on this matter. But it is not at the existing hawker stalls because we have moved our hawker stalls and wet markets towards a different regime.”
“Sir, a point of clarification. Apart from the issue of political democracy, a long-standing concern about Myanmar is forced labour. I would like to ask the Minister what influence do we have to try and transmit the message that forced labour is not desirable in Myanmar, and what role can we play in that respect, as we are an important member of the ASEAN community. There is international concern about the use of forced labour in Myanmar.”
“Perhaps, this is the problem: there are just too many schemes that people are confused. We need to take a different approach, to take stock. Even among the needy, there are different segments - the elderly poor who live with their family but there are others who live alone, the low income two-parent families and the single mothers, to name just a few of the segments of the needy and the poor. Each of these segments may have different needs and problems, and therefore different approaches may be required to reach out to them. We also need to take a long hard look at whether some of these schemes are indeed serving its purpose. If the criteria for some of these schemes are so stringent, for instance, they may not be meeting their objective, and yet they appear as just another item to clutter a long list of schemes to help the needy and the poor, but they may not have much impact. Therefore, I urge the Government to look into some of these issues and ensure that help reaches those who are in most need of it. In conclusion, Sir, we cannot avoid globalisation but we can choose a path that is inclusive, humane and fair. Let us show that we can do it in Singapore. On this note, Sir, I support the motion.”
“This being the case, there will continue to be big demands on Government services, particularly for social, community and job-related projects. I would like to seek a clarification from the Prime Minister whether taking these factors into account, will there be any impact on the level of services provided by the Government with this budget cap of 5%? My fourth point, Sir, is to commend the Government for making it easier for Singaporeans to top up the Medisave accounts of their spouses and parents. This is important as the statistics show that a high percentage of older Singaporeans depend on their children's Medisave to pay for their hospital bills. The percentage is higher among women, who either do not have Medisave savings or have insufficient amounts in their accounts, particularly the older women. But I feel that the Government could go even further if it wants to incentivise people to top up. Currently, there is no tax relief for topping up the Medisave accounts of spouses and parents. I would like to suggest that the Government consider giving tax exemption for such Medisave top-ups, as I understand that this scheme has not been well-received and not well-utilised. Therefore, we need to better incentivise people to make use of it, if you want to encourage people to actively top up the Medisave accounts of their spouses and parents because this is a very critical account, bearing in mind that our population is ageing very rapidly. Finally, Sir, I would like to urge the Government to continue to pay attention to the plight of needy Singaporeans. To be fair, the Government has done much to provide for our poor and needy. There are so many schemes available to take care of their needs.”
“So, the clarification I would like to seek is whether the Government has explored other ways of enhancing efficiency and increasing productivity in the public sector. Instead of outsourcing the functions, can the Government redesign jobs in these sectors so as to enhance their value and generate higher productivity? Will outsourcing these activities result in a deskilling of Singaporeans as core skills are no longer in their hands? I think for the private sector, there is no consideration, it is basically a question of what can be done efficiently at the lowest cost which they can buy from the market. But in the case of the public sector, one issue that I think we need to think about is by Best Sourcing. Are we not then withering down the core skills that our workers have, whether it is in the horticultural area, or other areas? We need to have people with the core skills, to be able to run the public sector services efficiently. Is it wise to outsource so many activities and will there be an impact on the level of service provided to the public? What steps are being taken in the public sector to prepare workers for these changes? Is there a systematic programme of training for workers, like the SRP, to target those in a certain age group and who are more vulnerable to prepare them for other jobs in the civil service or private sector? My third point, Sir, is on the budget caps. This year, there will be further budget caps of 5%, higher than last year's budget cap of 2%. My concern is that we have announced quite a number of programmes. At least, the Government has announced a number of programmes. In addition, although our economy has done very well last year, there is an expectation that this year the world economy will slow down and there will be an impact on us.”
“I also note that in addition to no limit on the number that can be brought into Singapore, there are also no other safeguards, such as restriction only to workers from certain sources, such as the traditional sources, for instance. I hope to get a clarification on this point, particularly some assurance that this scheme will not end up as a backdoor through which more and more foreign workers will be brought in and thus undermining our job redesign efforts. I would like to know what safeguards will be put in place to prevent abuse. Secondly, Sir, I would like to touch on the proposal to market test 20% of the non-core activities. I can understand the need for the Government to remain lean and efficient, but I wonder whether outsourcing is the main strategy that should be adopted in order to achieve this objective. As it is today, the talk on the ground is that there is no job security even in the Government service. People somehow expect the Government to act differently from the private sector, which is primarily bottom line, profit driven. In the minds of public sector employees, the 3% reduction in manpower stipulated under the manpower management framework over three years is closely linked to market testing and subsequently outsourcing. I note that the suggestion is only to market test but, nevertheless, in the minds of public sector employees, this will invariably result in outsourcing, and 20% is indeed a significant number of public sector jobs. The older and less skilled employees are the most concerned. They fear that they will be targeted for retrenchment. Often the perception is also that outsourced activities end up in the hands of foreign workers.”
“Treat workers not as digits but as important contributors to your wealth and growth. Sir, since the Budget was announced, I have been asking our workers and unionists for their reactions, and most were happy with the Budget. They welcomed the $100 CPF top-up for Singaporeans above the age of 50 years. For the high income, this is an insignificant amount. But for the low income, this is an important contribution as it can amount to as much as one tenth of a month's salary for some of them. NTUC is also happy that the Government has heeded our call to top up the Medisave as this will help to lessen the burden on older and low income Singaporeans when MediShield premiums are increased this July. Sir, let me now touch on a few specific issues in the Budget. Firstly, I welcome the increase in the skilled foreign worker levy from $50 to $80 this year and to $100 next year. I think this is timely and necessary as the present rate is too low. At the same time, I note that the employers are now allowed to exceed the dependency ceiling if they pay a $500 levy. Some workers have asked me whether there is a contradiction here. On the one hand, we are trying to redesign jobs so that more Singaporeans can do the jobs which are currently done by foreign workers. On the other hand, we allow a free flow of foreign workers beyond the dependency ceiling. I am concerned that even the $500 levy will not be sufficient to deter an influx of foreign workers. And I worry that we may be working at cross purposes here. Employers can still bring in foreign workers cheaply by reducing their wages, particularly since there is no minimum wage prescribed for such workers that they bring in and they are not required to pay any CPF as well.”
“Indeed, Sir, I am glad that we are subscribing to a different globalisation process here - one which is inclusive, fair and humane with the Government firmly in the seat. The Prime Minister had also outlined the importance of helping people to work longer. A tripartite committee will be set up to look into this. But I would like to urge employers not to wait for the recommendations of this committee before they move. I urge them to think of creative ways to engage and retain older workers. If we were to look at the labour force participation rate among older workers, our rate is low, and this may not even capture the picture correctly as some may have given up looking for work and are therefore not reflected in the statistics. So employers need to go beyond lip service in supporting the employment of older workers and actually demonstrate their support through concrete action. I continue to receive complaints from unemployed workers who were told to their face that they would not be given jobs because they were too old and these are just Singaporeans in their 40s! Australia recently passed legislation prohibiting discrimination against older workers. While I am not suggesting that we do the same, if the situation does not improve and older workers continue to be discriminated in employment, then I am afraid that the pressure for legislation would intensify and this will restrict employer's flexibility in managing their affairs. Hence, it is better that employers adopt a proactive policy before they are forced to accept regulation on their right to recruit and manage older workers. So, I urge all employers to follow the Government - renew, strengthen and reinforce your social contract with the workers. Demonstrate your support through concrete action.”
“5 million Re-employment Assistance Programme (REAP), which will not only help to redesign jobs and retrain workers but also provide our workers with some financial incentives to help them stay on the job after they are trained, which is of particular importance to workers in low-paying jobs. Our workers, Sir, are not against economic restructuring or efforts to boost our competitiveness. They understand that companies invest millions of dollars in Singapore to set up factories and to install machines and equipment, and these companies need to recover from their investments. But what our workers are saying is that they need help to adapt to these changes, without which they will face tremendous hardship. They need support when they are in between jobs and they do not have any income. They need help to find new jobs and to be retrained for these jobs. They need to be given the opportunities so long as they are productive and not to be told that they are too old for the job. Hence, I am glad that our Government has given a very strong and important commitment to job creation and workers' training, particularly in the current climate where people are still feeling insecure. Again, in the Prime Minister's words, "this is to make sure that every vulnerable worker has adequate resources to retrain". Many foreign unionists had asked me why is it that there is little resistance to change in Singapore among the workers. And my answer to them is quite simple. It is not because the Government had muzzled us or that workers are ignorant of their rights. Workers are more willing to accept change because they know that if they are prepared to work hard, learn new skills and be adaptable, there will be help for them to move on to other opportunities.”
“For example, many structural adjustment programmes imposed by the World Bank and IMF on countries ran into problems because they insisted on a strict regime of economic reforms without balancing them with programmes to meet people's welfare. Sir, in many countries, globalisation has resulted in more precarious forms of employment, low wages and poor working conditions as competition intensified. Many governments seem to be helpless when faced with this relentless march of globalisation. And many more simply abdicate their responsibility to change this course of globalisation, citing lack of resources or other reasons, when the real culprit is the lack of political will to do anything. The real issue is not whether globalisation is good or bad, but whether we can make globalisation fair and inclusive so that everyone can benefit from it. The experience of workers in many countries shows that without strong government intervention, it is not possible to create a fair globalisation and there will be winners and losers. But we all know that a society where the benefits are enjoyed by only a few, while the majority is left behind, will never be able to enjoy lasting stability or prosperity. Sir, this Budget demonstrates that in Singapore, we can choose a different model of development - one that focuses on strong economic fundamentals but, at the same time, does not neglect people's welfare. So I am happy with the Prime Minister's statement that the Government "will prepare workers to meet the needs of the new economy". It will "invest in the workforce so that they hold productive and good jobs". In line with this, the Government will be topping up the Lifelong Learning Fund with $500 million this year. This will be strongly supplemented by the $34.”
“Mr Speaker, Sir, this year's Budget covers a wide spectrum of interest, spanning from the low income to the high income, the elderly and the young, the SMEs and the MNCs, sports and philanthropy. Of interest to me, Sir, is the policy underpinning of this Budget. What was the thinking behind this Budget? What message does it want to convey? Sir, over the last few years, Singaporeans have gone through several major crises. Many lost their jobs or had to endure shorter work-weeks or layoffs. Last year, the situation improved, but even then wage increases remained at a modest level for most workers. The shorter economic cycles had greatly added to the income and job instability that Singaporeans face. Unlike the situation in the past, good GDP growth alone will not solve all the unemployment problem. Structural unemployment has become a much more sticky problem and new solutions will have to be found. In such a situation, people look to the Government for leadership. And the Government, in leading the people, must do so with a firm hand, but it must also do so with compassion. In other words, it cannot only seek economic solutions without paying attention to how such policies and programmes will affect people during the implementation stage. Looking at this year's Budget, to me, what the Government is clearly saying is that changes will have to be made to ensure that our economy remains competitive, and these changes cannot be completely painless, but Singaporeans will not be left in the lurch. Indeed, this is not an easy balance to achieve.”
“Sir, can the Ministry try to expedite the process, particularly for foreign workers, although I understand the steps that are needed to be taken. Because of the hardship that it causes to the worker, he has to remain in Singapore without any means of sustenance. If at least the process is shortened and more efforts are made to try and process their claim much faster, I think that will reduce their hardship. Mr Hawazi Daipi: Sir, I can assure the hon. Member that the Ministry officers always do that. They will try their best to expedite. There is no reason to delay the compensation or settlement of the claim. But we will do more than that. The entire process, we understand, takes a long time, and it is quite tedious. The Ministry is reviewing this process and, if necessary, we will amend the Workmen's Compensation Act to make the process more efficient, without compromising fairness to all parties concerned. EMPLOYMENT OF FOREIGN WORKERS (Publication of statistics) 11. Prof. Ivan Png Paak Liang asked the Minister for Manpower if his Ministry will publish statistics on the employment of foreign workers by industry sector, occupation, and employment status (employment pass/work permit), for the benefit of our citizens planning job moves and for the benefit of researchers.”
“Sir, could the Senior Parliamentary Secretary give an explanation to the House as to why there is a big difference in terms of the time taken to settle a case between a local worker and a foreign worker, ie, five months and 13 months respectively?”
“Sir, I would like to thank the Minister for his explanation and I was not making a general statement. I was asking whether a strategy is in place on the part of the Ministry. Specifically, I would like to ask: if a complaint is received from an older person that he is being discriminated against, despite having all the required attributes, what specific action can the Ministry take in order to assist him?”
“Does the Ministry have any strategy against employers who continue to discriminate against older people, despite the fact that they have the skills and experience and they are prepared to accept lower wages?”
“Sir, there are students who dropped out of school, either because they do not wish to go back to school or they are not readmitted, but yet, they may not have the essential qualifications to go into ITE or other such programmes. Are there any other programmes available presently to hold such students in the event? I think it is essential that we ensure they have some basic skills, whether it is skills for employment, lifeskills or whatever. Is there a bridging programme or other programmes for them?”
“Sir, I appreciate the explanation and assurance given by the Minister. But I think we will be even more assured if the Minister could give further assurance because we do see different standards in different schools. Some schools are more receptive to giving students, who have dropped out, a second chance, whilst other schools are not so receptive. So, if the Minister has a policy to assist parents, and particularly students who want to be given a second chance, I think that will be good. So I hope that assurance can be given, Sir.”
“Sir, I would like to ask the Minister how many applications has the Ministry received from students, or their parents, who have dropped out and want to go back to school, and what is the success rate of such applications. Secondly, how long does a school take to respond to a parent's or a student's request to go back to school? Because I have a case where I had to write two letters before I got a response from the school, and after one and a half months of taking up the matter, I have yet to receive a confirmation whether or not the student will be accepted back into school.”
“Sir, with regard to the $16.5 million, the Senior Minister of State's explanation was that details will be worked out according to the needs of the Indonesian government. With regard to the $75 million raised from Singaporeans, will the Government also provide some guidance or supervision in terms of how these funds will be channelled into reconstruction aid in specific projects in Indonesia?”
“If prevention is the key pillar, as it should be, it is an important aspect under Government's plans to control healthcare costs, then I think it is important that adequate resources are allocated to preventive efforts. In conclusion, Sir, although people worry a great deal about expenditure on healthcare, expenditure on healthcare actually forms only a small part of total household expenditure. In fact, MOH data also show that people are seldom hospitalised and only a small number will incur big hospital bills for serious illnesses. They comprise about 5% to 10% of the hospital bills. On average, only 10 in 100 people will be hospitalised in any given year. But although these are the facts, to a person who is ill or when a family member is affected, healthcare cost is a real and major worry. We are therefore moving in the right direction in focusing efforts to contain healthcare costs and in ensuring that healthcare remains affordable to Singaporeans.”
“My concern is that the message that the hospital may get is that they can now recruit more and more foreign talents and there may be less focus on our efforts to try and create opportunities through job redesign. And I am afraid this is the message which was also reinforced by the Ministry of Manpower's decision to make work passes much more flexible. Sir, I think it is also important in the healthcare sector to focus on providing better career opportunities and prospects for the paramedicals. A recent newspaper report has shown that there are shortages in various fields of paramedicals, such as podiatrists, speech therapists and those providing palliative care, for instance. And I also heard complaints from some of those who have left the service about salary and lack of career prospects as some issues that drove them out of the sector. In order to achieve medical excellence, this is one area, I think, that MOH has to focus on. Finally, Sir, let me touch on MOH's efforts to respond to infectious diseases. I note that plans are being formulated to respond to the outbreak of infectious diseases. To do this, I think it is important to allocate sufficient resources. Presently, there are only 11 practising infectious disease specialists who tackle everything from dengue, cholera to AIDS, SARS and bird flu and obviously doctors feel that this is not enough. They have called for an urgent need for more money, research and expertise to build up defences against the threats not just from AIDS but also other infectious diseases that are becoming much more rampant worldwide.”
“He was very concerned about means testing. According to him, he had advised both his parents to sell their 3-room flat and live with him so that he could take care of them. But he is now concerned that, as a result of this move, he would have to incur higher medical fees for his parents if means testing were to come into effect. I think these are real concerns of middle income Singaporeans. People do not deliberately choose to fall sick and stay in a hospital. In my view, the purpose of means testing should be to determine the appropriate subsidies provided to families from low income as well as middle income groups so that long-term care would be affordable to them. Since long-term care implies a long-term financial commitment for the family members, some middle income families would also be financially strained if there is no Government assistance. I would therefore like to ask the Ministry of Health whether it can consider providing subsidies on a sliding scale to low income and middle income families commensurate with their income, instead of just cutting off at a certain income level for all Singaporeans. Sir, let me come to the need to develop a patient-centric healthcare system. I support the Ministry of Health's initiative to develop healthcare manpower and increase the supply and quality of medical and paramedical talent from local and foreign sources. However, the healthcare sector, Sir, is one sector where we are focusing efforts on job redesign. Therefore, I hope that where there are jobs that Singaporeans can do in the healthcare sector, the two hospital clusters will work closely with the unions and WDA to help Singaporeans get into these jobs.”
“Now, Sir, let me touch on portable medical benefits. For many years now, we have been discussing about the portable medical benefits scheme or the PMBS. The rationale of the PMBS is to put in place a system where a person can take care of his medical needs not only when he is employed but throughout his lifetime, that is, when he is in between jobs, when he is retrenched and after he retires. The system should be seamless and not financially burdensome to employers and workers. For the PMBS to work, it is important that there is a comprehensive basic medical insurance scheme that is put in place and which has wide coverage. Hence, the PMBS scheme is closely linked to the MediShield review. I would now like to ask whether the Ministry of Health can update this House on the progress that has been made to the PMBS. When will it be implemented? Is it possible for the employer providing benefit to act as a rider over the MediShield, for instance? For example, if under the revised MediShield, all employees are covered under the basic scheme, the benefit which employers provide could be used to pay for the deductibles. Alternatively, if the employer pays an additional amount into the Medisave, the employee can use this extra Medisave saving to pay for his share of the hospital bills, ie, the co-payment amount. Let me now come to means testing, Sir, the Ministry intends to implement means testing for hospitals. The principle is sound as the subsidy dollars should be targeted for those in greatest need. However, means testing is not easy to implement, and there are administrative and social costs which may far outweigh whatever savings that will be derived from introducing it. The other day I met a resident who is staying in a condominium in my area.”
“MOH's recent move to change the basis for giving grants to hospitals from the current system of piece rate reimbursement to one of block grants will, to some extent, help to cut costs for Singaporeans who are hospitalised, as there is less incentive for hospitals to keep them too long in the hospitals or order treatments that are not really necessary. But this block grant method of subsidising hospitals is a double-edged sword. While the concern of the old piece rate reimbursement system is that hospitals chase volume and over treat patients in order to get more grants from the Government, the concern with the block grants is that hospitals may now under treat patients instead, or push such patients to the polyclinics when they really need hospital care as their grant is fixed, regardless of how many patients they admit. This is a particular concern for Singaporeans who can only afford the subsidised wards as the longer they stay in the hospital, the more it will cost the hospital, and this will eat into their grant, which is fixed. Although the Ministry has assured us that an auditing system will be put in place, it is important that this system is patient-friendly. It is no use having an audit system if patients are not aware of it or do not find it user-friendly or accessible or they may not even know that it existed at all. Currently, it is unclear after the block grant system is implemented this year, how those who are unhappy can complain if they feel that they are not properly treated. Can the Ministry provide details of this audit system? How will the Ministry educate the public on this, because this forms part of the eco-system in helping people to both have quality healthcare as well as ensure that it is affordable.”
“Many elderly Singaporeans do not have their own Medisave savings or have insufficient amounts to provide for their old-age medical needs. A 1998 National Survey of Senior Citizens found that more than half of those aged 55 years and above depend on their children's Medisave to pay for their hospital bills. Only about 30% of the men have their own Medisave to finance their own healthcare. The situation is worse for women as only 7% depend on their Medisave. This being the case, any increase in MediShield premiums and deductibles will have an impact on the elderly and the low income families. Workers depend on their Medisave to pay for not only their own MediSheild premiums but also that of their family's as well and also to pay the co-payment amounts not covered by MediShield. I would therefore like to urge the Government to take into consideration the needs of the low income and the elderly when raising the deductibles and premiums, and ensure that they continue to be able to afford basic healthcare services. The Government should also consider helping the low income and the elderly pay for the increased premiums through topping up of their Medisave or other means. Sir, let me now touch on medical inflation. Even if our healthcare financing mechanism is strengthened with the review of the MediShield scheme, if healthcare costs are not contained, it will be difficult to ensure that healthcare cost remains affordable. I therefore agree that the various measures that are put in place, such as making hospitals publish their fees, would help Singaporeans in making informed choices and go for cheaper hospitals and treatments.”
“If people want more than the basic, then they could be allowed to purchase an additional tier or riders. Secondly, for the principle of risk pooling to really work, the revamped MediShield should preferably be made compulsory, so that there is basic protection for all Singaporeans. Under a voluntary scheme, some may opt out not because they do not need the coverage but because they may be unaware of the long-term consequences of their action in the event that they have to incur high medical costs in the future. We should ensure that our workers do not opt out of MediShield even if their employers provide adequate medical benefits. The Ministry of Health could also consider conducting a one-time exercise to enable those that have opted out of MediShield previously to rejoin the scheme. A major concern is that a significant number of Singaporeans are still not covered by MediShield or any of the Medisave approved medical insurance scheme. This would cause problems when they grow old and have inadequate savings to take care of their medical needs. Thirdly, Sir, the current level of payment for big bills today, at 30%, is grossly inadequate. MOH had said that it intends to increase this coverage to 60%. This is a good move. MOH should also review both the annual and lifetime claimable limits as well as the adequacy of limiting coverage to only 80 years, as people are living longer. Fourthly, there is a concern over the increase in premiums and deductibles. MOH has suggested increasing the premiums by a maximum of $10. With an average MediShield balance of about $11,500, most Singaporeans may be able to afford this increase. However, the low income and the elderly may face difficulties.”
“Most feel confident that so long as they are working, their healthcare costs will be covered but are concerned about big medical bills for their dependants, and also how to pay for their medical bills after they retire. These concerns are not far off the mark. Medical costs in Singapore have been rising. From 1990 to 2004, medical costs have gone up by 4% a year, compared to the overall CPI of 1.6%. There are, of course, many reasons for this. An ageing population and the more prevalent use of medical technologies have contributed to the rapid increase in costs but these are not the only reasons. I believe that more can be done to make healthcare affordable to Singaporeans, including the costs of medicine as not all medicines prescribed by hospitals are subsidised. I am therefore glad to note that the Ministry of Health will be focusing on keeping healthcare affordable and in controlling healthcare costs. Singaporeans' twin concerns are with the cost and quality of healthcare. They are concerned over how to pay for their medical bills. At the same time, they worry whether they are receiving good treatment when they fall sick. Sir, let me now come to the MediShield review. The feedback that I have received from many Singaporeans is that this review is timely and necessary. In NTUC, we have formed a study team to study this issue. Let me just state briefly what we hope this review would achieve. Firstly, the principle of risk pooling through insurance is a sound one. The revamped MediShield should provide a minimum coverage that is adequate and affordable for everyone. In this way, all Singaporeans would be covered by a basic level of healthcare when they are hospitalised.”
“The Government moved swiftly and decisively by mobilising resources and galvanising support for our neighbours who had suffered great losses in lives and property. This strong leadership is then duplicated all the way down in the way the various organisations, businesses, and ordinary Singaporeans rallied to the call and mobilised support in any way that they can. We certainly do not need another tsunami to show the importance of good leadership. But for our programmes to succeed, we do need good leadership at all levels. We have a good Government and a strong people, and we are therefore well poised to meet the new challenges ahead. Certainly, Sir, a working poor in Singapore stands a better chance than a working poor in many other countries. This is because we are conscious of the issue and are taking measures to help them, such as job redesign where low-paying jobs can be upgraded and pay better salaries. On this note, Sir, let me now touch on the issue of healthcare costs. The President correctly stressed that affordable healthcare is a major concern of Singaporeans. Let me illustrate this point. The other day I took a taxi and was chatting with the taxi driver. I asked him how things were with him, and he responded quite positively but added a caveat. He said that he was okay, so long as he was healthy. He said that if ever he fell very sick and was unable to work, then the best thing would be for him to die quickly as he felt that the healthcare cost would be a burden to him and his family. He is not the only one who is concerned. The feedback I get from many workers is the same.”
“Mr Speaker, Sir, in his speech, the President had touched on many aspects of great relevance to Singapore's future and the well-being of Singaporeans. A key point that the President had touched on was the importance of good governance at all levels, to implement policies and programmes to benefit the people. In the words of the President, "through the hard work of Singaporeans, the application of sound Government policies, and the dedication of capable leaders at all levels, Singapore has enjoyed four decades of stability and progress". Sir, I cannot agree with him more. We can have the best systems, infrastructures and resources but without good, capable leaders that have the trust and confidence of the people, we will not be able to have sustained growth and prosperity. Let me cite something that a friend had quoted to me from the Complete Analects of Confucius. One of the favourite disciples of Confucius had once asked him about the way to govern a country. And Confucius said: "To govern well, one must have sufficient food, an adequate army and the people's trust in the government." The disciple then asked him: "If one was forced to forgo one of the three, which should one forgo?" Confucius said: "Get rid of the army." The disciple continued to ask: "Out of the remaining two, if one were to forgo one, which should it be?" Confucius said: "Forgo food first. Although without food, humans will die, yet death has been a fact of life since the beginning of time. But if one were to lose people's trust, one would have lost the basis of any government." We have seen examples of such a strong leadership. The recent tsunami crisis was one such example.”
“Sir, I would like to ask the Minister whether he thinks it is necessary to have a committee or agency that is cross-cutting, ie, cuts across all the Ministries, because issues pertaining to the family cut across all Ministries. If we talk about juvenile delinquency, it is the Ministry of Law. If we talk about ageing, that comes under the Ministry of Health. If one wants to talk about work-family balance, that comes under the Ministry of Manpower. So, is there a need for such a coordinating agency or committee to deal with cost-cutting issues pertaining to the family?”
“Sir, I have three supplementary questions. My first question to the Senior Minister of State is: what is his evaluation of his public education campaigns? How effective are they, in particular, in terms of targetting the sex tourists, either those from Singapore or those who transit through Singapore, who go to places primarily for such activities? Can the messages be more focused and targetted in order to help prevent communication of such diseases? My second question is that the Minister has mentioned earlier about targetting campaigns at the workplace. There is a guideline on handling HIV cases at the workplace. Will the Ministry be able to provide a lot more support, in terms of promoting that guideline? This is the joint tripartite guidelines actually. My third question is: are there sufficient resources allocated to the prevention of communicable diseases, such as HIV? Are enough resources allocated, including the recruitment of specialists, to deal with such diseases?”
“So I do hope that in its review process, the Ministry will take into consideration this point as well and will continue to expand on efforts to promote multi-culturalism, both in and outside the school. It may sound odd, Sir, but I must tell you that from Primary 3 to Secondary 4, I was taught the Malay Language by a Singaporean Chinese teacher. That was also something uniquely Singaporean then. On this note, Sir, I support the motion.”
“Will it also consider allowing students who are taking non-Tamil Indian languages as their mother tongue to use their marks for the purpose of applying for scholarships and other awards? And for the teachers, when their promotions are being considered. Currently, non-Tamil Indian languages are treated differently from the Tamil Language and they should be reviewed. In conclusion, Sir, I would like to stress that MOE's efforts to promote greater use of the Chinese Language among the young must be balanced against continued efforts to develop initiatives on multi-culturalism. In today's turbulent world where ethnic and religious strife can be found in almost every part of the world, we have been able to maintain a great deal of sanity and rationality in our inter-ethnic relations. This is not a coincidence, but has been a subject of special nurturing by increasing the common space and developing a common understanding over sometimes very sensitive issues of race and religion. All our races have been able to co-exist in peace because we share the same common values and goals. We need to continue to expand this common space. For the students who are doing the Chinese Bicultural Studies Programme, the aim is to help them develop, and I quote from the Report, an "intuitive understanding of history, culture and contemporary developments in China". If these students have a very strong understanding of China but know little about the other races and their cultures and traditions, then the opportunity to develop common grounds will be very much reduced, and this will have repercussions on us. I want to stress, Sir, that my comments would equally apply to Malay and Tamil students who undergo the Bicultural Studies Programme, if this programme is indeed extended to them as well.”
“Malay Language teachers have raised concerns about the opportunities for them to upgrade their skills and improve their career prospects. There have been improvements. But more can be done to help them upgrade their knowledge and skills and therefore be more effective Malay Language teachers. Sir, the Review Committee has proposed the introduction of the Bicultural Studies Programme to promote a deeper understanding of the Chinese culture and language among Chinese students. I would like to know if the same type of programme will be extended to the Malay and Tamil students as there is a need in the two communities as well for a core group of people who are well versed and understand deeply our language and culture. So I hope that the Minister would also address this point. Let me now raise two points with regard to teaching of the Tamil Language mother tongue. Some Tamil parents have expressed concern that if the number of Tamil students continues to decline, the Ministry of Education will stop conducting Tamil Language classes at certain schools. In line with our efforts, Sir, to promote greater mother tongue proficiency across all the language streams, I would like to ask the Ministry of Education to give an assurance that schools will continue to conduct Tamil Language classes even if the number of Tamil pupils declines. Secondly, Sir, I would like to ask what the Ministry intends to do for non-Tamil Indian languages. I note that my parliamentary colleague, Mr Inderjit Singh is not here, so I thought it opportune that I should raise it on his behalf as well. Will the Ministry be conducting the same review as it is doing for the Tamil Language?”
“If we accept that books and other reading materials are important in helping to transmit values and culture, then we should be concerned that our children may be picking up a lot of the values and culture that are alien and foreign to us. In my view, the Ministry of Education should explore ways of encouraging and incentivising the publication of more good quality reading materials in Malay, such as books, magazines, periodicals and even comics that are interesting but, at the same time, will capture the shared experiences of Singaporeans and the Malay community here. A lot of the materials in Malay that are available here are quite unreadable, not just from the language point of view but also in terms of the contents and the messages that are being transmitted. In order to cultivate a greater interest in our mother tongue languages, whether Malay, Chinese or Tamil, it is not sufficient to merely look at the school system. We should study the entire eco-system to see how we can create an environment that will make it easier for people to use our mother tongues. Sir, the Chinese Language Review Committee touched on several key areas in its work. This includes a review of the methodology and the curriculum as well as the training of teachers. I will not repeat those points except to say that the same areas and for the same reasons mentioned in the Report, those should be the focus of review for the Malay Language. The young today live in a multi-media world and traditional methods will no longer appeal to them. Methodology needs to change through the use of IT or other forms of teaching methods which are lively, interesting and challenging.”
“Mr Speaker, Sir, there are a few areas which I think the Ministry should look into when reviewing the teaching of Malay Language in our schools. In my view, there should be a greater focus on improving the oral communication skills among Malay students. There is a concern that our students lack strong oral communication skills and this is obvious when you listen to even bright students from the JCs, polytechnics or universities. Although Malay students continue to do well in the examinations, there is a lack of interest in using the Malay Language outside school. This inability to communicate well orally is particularly obvious when conversations require the articulation of more complex ideas and thought processes. So the challenge for us is how to make the Malay Language more alive and interesting, particularly to the young, so that they will use it not only in schools but also in their normal everyday life. Sir, we also need to promote greater interest in the reading of Malay reading materials. I agree that this arises partly because of a lack of interest in the language, but I believe that it is also a chicken and egg problem. There is a dearth of good Malay reading materials, both in the bookshops and in our libraries. Even Malay assessment books are hard to get, the nightmare of many children, but that is a fact. Our libraries do not stock up enough Malay books and the selection is limited. Those interested in buying Malay books often have to cross the Causeway and purchase them from bookshops there. As a result, young Malays today read more English books, magazines and periodicals.”