Howe Yoon Chong
Singapore
“Accidents, unfortunate as they are, can never be completely eliminated, but the accident rate will be kept to the minimum. INQUIRY INTO DEATH OF PTE V. RAJENDRAN 8. Mr J.B.”
“I am not as sanguine as my friend, the Member for Delta, who said that if you encourage them to do breakdancing, they will break their necks; so you will have no old people and there will be no old people problem. No.”
“That is the reason why there is a sense of immediacy when we suggested that it should be implemented with effect from the 1st of July, although we have not even set down the framework for the Coordinating Department. There is also the statement that it is a breach of faith to defer the CPF withdrawal age.”
“They cannot even help themselves! You may want to pray for him! Let me now come to the Member for Kebun Baru who has moved an amendment. He, I presume, wrote his speech even before he heard me speak.”
“The Member for Moulmein was most vehement when he said, "You talk so much of it. How is it that when civil servants retire (he was referring to teachers, I presume) only a few selected are allowed to be re-employed and even these few, though they have the same qualifications, are re-employed at different rates?" Do I repeat you right?”
“The problem that he does not understand is that while we give dignity to our citizens, he wants our citizens to be cringing and crawling, begging for State doles and stipends and for politicians to dish out various things so that they can go round and say, "i now dish you this. I now dish you that." We do not want that.”
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“Sir, I am indeed grateful to the Member for Thomson for explaining once again the importance of kidney transplant. It is not for want of our trying but so far even though the National Kidney Foundation has met with some degree of success in getting a few thousand people willing to donate their kidneys, that is not the answer to our problem because some of these people who are willing to sign the donation cards cannot be expected to give their kidneys until they die and it is of no help for us to wait until they die to get the kidneys. What we want is a change of attitude of the members of the public, particularly those people who are the relatives, the loved ones of people who have died or people who have met with serious accidents and have suffered brain death, to agree without any qualms to allow the kidneys to be harvested for transplantation. There is no shortage of skills or, no difficulty in matching the kidneys because we have got all the information easily available for us to match it. Therefore, at the risk of repeating some of what the Member for Thomson has said, I would like to seek the indulgence of this House to give a few more facts. There are between 150 and 200 patients with chronic kidney failure each year. Treatment is either through dialysis or kidney transplant. Dialysis prolongs life in terminal renal cases but renal transplant provides the apparent cure. Government has over the years expanded the haemodialysis programme and made efforts to increase the number of kidney transplants. However, it is handicapped by the high cost of haemodialysis and the increasing demand for such treatment and the slow response to appeals for kidney donations. The Government maintains at the moment three dialysis centres.”
“Under this Act, the Minister for Health may make regulations to control establishments which use appliances and equipment for the treatment of any disease or condition affecting the human body. This legislation has, however, not been brought into force for the very reason that, so far, there have been only a few isolated cases of abuse which could be dealt with under other legislation. Presently action against infringements is being taken under the Medicines Act and the Poisons Act. Any member of the public who is aggrieved by the beauty parlours that the Member for Buona Vista has mentioned and is being exploited by unscrupulous frauds is advised to seek the assistance of CASE or to take appropriate legal action to seek redress. My Ministry constantly monitors the number of cases of injury due to the use of electrical or electronic equipment and appliances, when such cases come for attention at one or other of our clinics, be it the skin, eye, plastic surgery or other specialist units in our hospitals. For the present I can assure the Member that there have been very few such cases of injury arising from beauty parlour treatments, but should, as the Member for Buona Vista feels, there be an increasing number of such cases seeking treatment from injuries resulting from visits to beauty parlours which use such equipment and novel methods of rejuvenation or beautification which are fantastic or fraudulent, serious consideration will be given to framing the regulation and to bring into force the Private Hospitals and Medical Clinics Act to stop such activities.”
“Sir, the Member for Buona Vista is rightly concerned in what he says, that there is a trend among beauty parlours to use equipment or novel methods of treatment which may pose hazards to those undergoing such treatment. My Ministry must also be concerned if this practice should become rampant or an increasing number of such cases is being discovered. My Ministry, however, at the moment is mainly concerned with medical and health treatment. Beauty treatment and its encroachment into medical and health treatment or under the guise of pseudo or fringe medical treatment is a rather gray area. There will always be in our society the wily who will make fraudulent and fantastic claims to prey on the gullible. This is in the nature of a society. It is therefore appropriate that Government should be on the watchout. But is it appropriate that the Government should constantly enact new legislation just to protect those who because of their weakness succumb to such fraudulent and fantastic claims? Or should the Government legislate to protect every citizen from his or her own weaknesses or to prevent people from doing foolish things? Sir, I would say that to do so will result in a vast array of oppression, resentment, interference with personal freedom and a whole lot of others. What is worse, the problem of enforcement becomes serious because with each new legislation invariably there will be a need for more and more bureaucracy to police and enforce the various prohibitions under that legislation. Can we afford to divert our already tight manpower resources to such unproductive work to protect a few gullible citizens? The Member for Buona Vista may be aware that we already have in July 1980 passed the Private Hospitals and Medical Clinics Act.”
“Sir, I will keep on repeating to him that my stand has got nothing to do with my job. There are two persons - one is a Minister and one is a person. For as long as I am here, I am speaking as the Minister. Wait till I get to the other side, I will speak as a person.”
“Sir, the feelings of the Minister may be very important, but in a case like this, it is irrelevant.”
“Sir, this is again what I have been trying to say. The Minister for Health is given the responsibility of that portfolio and he has been instructed to bring that legislation through this House and he has to do it. Whether or not he has got his own feelings, I do not know. But that is of no consequence because he is assigned that responsibility. The collective decision is, "You are a member of the Government. That is within your portfolio, you carry it out." I hope that is clear.”
“Sir, I would like to repeat again, whatever my own personal feelings are, they do not count in this case because in the system of government that we have adopted, it is collective responsibility. Once a decision has been taken by the Government, I, having been given the portfolio of the Ministry of Health, have to carry it out. Therefore, I am the wrong person to appeal to and if it is in that respect I have become a modern Pontius Pilate, let it be so. The other point which the hon. Member for Whampoa did not take note of what I said earlier was that his is only one opinion. There may be other people who may not agree. I respect his opinion, as I said last year. But I do appeal to him that he has also to consider other people's opinion. We are in a very polyglot society and therefore the other suggestion that I have made is that he can bring enough public opinion to bear on the fact that this law is now unnecessary and the time may have come for this law to be changed. That is for him to do, not for me, as the Minister, to go against the collective decision of the Government. I hope that is clear now.”
“But I do doubt whether his comparison of the number of live births in 1960 as 61,000 as against today's 40,000-odd plus 19,000 being the same is valid or whether these two figures are comparable. Because in 1960, we did not have the same number of females of child-bearing age as we have now. I hope he accepts that. This is a problem that has been repeatedly, and as he says persistently, brought up year after year. I can only say that it is something that he must appeal to a higher authority. One is to the mentality of the people who come for this kind of abortions. The other one is probably to appeal to those who do not think seriously of setting up a family not to get involved in this. But the Ministry of Health has to provide the service for those cases where there have been accidents or health hazards and we have so provided. It may or may not be of any meaning to him in that the three questions that he asked are matters that the Ministry of Health cannot answer because, of the three, two are conjectures. How many of the babies that were not delivered would make it to the university? How many of them would be gifted? I have not the means to answer him. We only provide the service and for as long as the law requires the Ministry of Health to provide that service, we provide it. His recourse may be in one way or other to get enough public pressure or public opinion to try and get the law changed. I, as the Minister carry out what is already approved by this House. I render the service to the best possible way that the Ministry of Health can do.”
“Mr Deputy Speaker, Sir, I think I must respect the convictions of the Member for Whampoa for his persistence in bringing this up as if the problem of abortion is something that is the total responsibility of the Ministry of Health. I would like to remind him that it is not. It is the responsibility of the whole Government of Singapore of which he is a part. If the Ministry of Health is assigned the responsibility of looking after family planning, we try as far as possible to do a good job of it. I said it last year and, just as he is persistent in bringing this question up, I am also persistent in giving him the same reply, that his is one point of view and that he must respect other people's point of view as well. If he says and he has so dramatically appealed to the people that this is wrong, then it is not the dispensation of the Ministry of Health to change it. It is the dispensation of this Parliament to change the law. We are just one of the agents implementing the wishes of the Government. I also want to repeat again what I said last year that the Ministry of Health through the Singapore Family Planning Board, provides the service. If we did not provide the service, the people seeking this service would be forced to go underground or forced to have to pay very high charges for it. At the Family Planning Board, we do advise - and this is the part that he may or may not want to believe - those coming for abortion are advised to consider very carefully, they should think it over and not just rush into it. But if it is the wish of the person to want the abortion, and if we do not give it, we will not be discharging our responsibility. I know that the figures that he quoted are valid.”
“But should it come about that in spite of public demand for LDM the doctors in the private sector still will not adopt this practice on their own, then my Ministry will have no option but to bring in new regulations and effect enforcement. ASSISTANCE TO RESETTLERS IN HOUSING BOARD ESTATES 4. Dr Tan Cheng Bock asked the Minister for National Development whether his Ministry will consider setting up a special unit to assist those affected by resettlement to adjust to their new life-style in Housing and Development Board estates and to help those who have lost their only means of livelihood, e.g. farmers, to find new jobs.”
“I must thank the Member for Ayer Rajah for his concern over this matter. Legislation already exists to empower my Ministry to make regulations to impose requirements for the labelling of dispensed medicines (LDM). There have been comments, however, that this Government exercises too much unnecessary control and the Ministry of Health felt that perhaps administrative guidance and public insistence can have the same effect as legislation. To take the lead, the Ministry of Health implemented labelling of dispensed medicines in its pharmacies and clinics in 1979. This has benefited both the doctors and patients. In April 1980, the Ministry publicised the labelling of medicines in the hope that the private sector would follow suit. Both the Singapore Medical Association and the Pharmaceutical Society of Singapore supported the move and urged their members to adopt the practice. In reality, probably only a small number of private doctors are practising it, otherwise the Member for Ayer Rajah would not have suggested that we consider legislation for LDM. He has expressed his concern before that, in spite of Government encouragement, very few private doctors have adopted LDM. All are agreed that there are undoubtedly merits in LDM both to the doctor and his patients. My Ministry believes that sooner or later all doctors in the private sector will voluntarily adopt LDM without the need to enforce Government regulations. My Ministry will share its experience with private medical clinics and pharmacies which are interested in labelling their medicines.”
“Class 'C' patients who are supplied with food by the hospitals are charged a daily meal fee of $5. Patients, other than those ordered by the doctor to be on special diets, can have food brought from their homes. Where no food is supplied, there will not be any charge. The option will be on an "all or none" basis. Patients on special diets will be charged the normal fee. Those who are specifically not provided with any food at all for medical reasons and those in Intensive Care Units will not be levied the fee for the number of days when no food is supplied. PURCHASE OF E-2C PLANES 3. Mr J.B. Jeyaretnam asked the Minister of Defence and Second Minister for Health (a) whether the purchase of the four E-2C planes from the United States of America has now been finalised; (b) does he now have the precise financial cost to Singapore in the purchase of these planes; (c) is Singapore now committed to purchasing these planes; and (d) when will they be delivered.”
“In the process the wards at each level must be closed down before work could begin. Inevitably these repairs caused much inconvenience to both the patients and the hospital staff. To minimise such inconvenience the hospital diverted as many patients as vacancies could permit in the 0 & G units in Toa Payoh Hospital and Alexandra Hospital. The PWD has also been asked to urge the contractors to expedite their work. But in the interim the disruption and inconvenience to patients and hospital staff alike must be borne with equanimity and tolerance. HDB APARTMENT BLOCKS (Additional R.F. amplifiers and antennae for Channel 12) 9. Mr Eric Cheong Yuen Chee asked the Minister for National Development (a) whether he will request the Housing and Development Board to consider installing additional R.F. amplifiers and antennae in all existing HDB apartment blocks having common antenna systems to cater for the Singapore Broadcasting Corporation's new Channel 12 which is due to operate in February 1984; and (b) whether this facility will be incorporated in the common antenna systems in all HDB apartment blocks that are now under construction.”
“Consultation Rooms of the Specialist Clinics There are 14 consultation rooms in KKH. In April this year the Honourable Member for Telok Blangah brought to my Ministry's attention the poor conditions in two of the consultation rooms (Rooms No. 57 and 58). These two airconditioned rooms on Level 1 of Block I are used by the University O & G Department. Condensation and fungus growth on the ceilings of these rooms were caused by the sterilizers of the Labour Ward which were located immediately above these rooms in Level 2. PWD attempted to solve the problem by applying anti-fungus paint on the ceilings. But the problem recurs and presently repainting is done every other month. As a long term solution, the University O & G Department will create more consultation rooms for its staff. These will be ready soon and the staff presently occupying Rooms 57 and 58 will move to enable these 2 rooms to be renovated by PWD contractors who will instal suspended false ceilings and provide new furniture which will improve the conditions in these consultation rooms. Renovation of Hospital Wards There are 3 ward blocks in KKH. Block 11 has 4 levels and houses 272 beds. Many of the pillars in Levels 1, 2 and 3 in Block 11 show signs of cracking. Early this year PWD engineers ascertained that some 52 pillars in all were defective. Though they did not pose structural risks or danger to patients and staff, nevertheless PWD decided that these defective pillars should be reinforced and strengthened with concrete. In the process the utility services had first to be diverted and then put back again. Remedial works began in August and the contractors were given 15 months to complete the whole job. They have however to do their work level by level starting from the lowest.”
“Upgrading of hospital services and facilities. Wherever feasible continuous efforts are being made by my Ministry to improve the physical environment of all government hospitals and to upgrade their services and facilities. The Kandang Kerbau Hospital (KKH) is no exception. There are however many physical constraints to the extent these improvements can be successful given the existing conditions in the old buildings. Short of demolishing and rebuilding the whole hospital, we cannot expect to upgrade KKH to a standard of accommodation equivalent for instance to the new Singapore General Hospital (SGH). We may therefore have to live with what by modern yardsticks are considered out-of-date and inconvenient services and facilities. During the last 4 years, we spent a total of $1.1 million improving the facilities in KKH, particularly in the following areas:- (a) conversion of 4 open Class C wards into Class 62 wards which offer better privacy to the patients. This is in line with patients' rising expectations for better ward accommodation and privacy; (b) extending patients' waiting areas in the specialist outpatient clinics to accommodate larger numbers of patients; (c) upgrading the kitchen; (d) providing aluminium sun screens for the ward blocks. Next year, the hospital plans to improve the following facilities:- (a) rebuilding the Boiler House and replacing the old oil-fired boilers with more efficient gas-fired boilers; (b) upgrading the consultation rooms of the specialists' clinics; (c) renovation to the nurseries for premature babies to relieve the present congestion. There are also plans to convert 2 more Class C wards into Class A and B2 wards to meet increasing demand for better ward accommodation.”
“Jayakumar); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. CONSTRUCTION INDUSTRY DEVELOPMENT BOARD BILL "to establish the Construction Industry Development Board, to provide for its functions and for matters connected therewith", presented by the Minister for National Development (Mr Teh Cheang Wan); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. STATUTORY BOARDS (TAXABLE SERVICES) (AMENDMENT) BILL "to amend the Statutory Boards (Taxable Services) Act (Chapter 149 of the Revised Edition)", recommendation of President signified; presented by the Minister for Finance and Minister for Trade and Industry (Dr Tony Tan Keng Yam); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. POST OFFICE SAVINGS BANK OF SINGAPORE (AMENDMENT) BILL "to amend the Post Office Savings Bank of Singapore Act, 1971 (No. 13 of 1971)", presented by Dr Tony Tan Keng Yam; read the First time; to be read a Second time on the next available sitting of Parliament and to be printed. FACTORIES (AMENDMENT) BILL "to amend the Factories Act, 1973 (No. 6 of 1973)", presented by Prof. S. Jayakumar; read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. WATER POLLUTION CONTROL AND DRAINAGE (AMENDMENT) BILL Order for Second Reading read. 4.08 pm”
“Mr Deputy Speaker, Sir, I would like to say that, apart from the last question asking for details which are not yet available, the other three questions can be answered; except, of course, the part about the tax revenues that are paid into the consolidated fund. That is not within my purview. With the increase in fees, instead of collecting a revenue of $91 million from the patients, the estimated collection will be $97 million when we upgrade certain wards, and $106 million when we impose the new charges. Therefore, it is slightly more than the 14.7%. We intend first to cost every item - bed space charge, meal charge, prescription charge, nursing attention charge, X-ray, laboratory, various other costs and then itemize them and charge the A-class to expect at least recovery of costs. So the A-class will reflect the actual cost. For the B1 we will charge 75% of the cost. For the B2 we will charge 25% of the cost. For the C we will charge 15% of the cost. But, in addition, as I say, the B2 and the C-class patients will have the cut-off so that it will not give the charges an extra burdensome character. As to what percentage of total revenue these various tests will constitute, I cannot give him the answer. I probably will want to work it out before giving it to him later. 4.03 pm BILLS INTRODUCED BANKING (AMENDMENT) BILL "to amend the Banking Act (Chapter 182 of the Revised Edition)", presented by the First Deputy Prime Minister and Minister of Education (Dr Goh Keng Swee); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. COMPANIES (AMENDMENT) BILL "to amend the Companies Act (Chapter 185 of the Revised Edition)", presented by the Ag Minister for Labour (Prof. S.”
“But I can assure him that even after all the reclassification, there will be 50% C wards. As regards the means test, we are not very sure whether we want to introduce it at all. It depends on how this present increase works out and whether or not many people who claim that they want to go to C, although we know that they come in big cars, still insist on C. But with this rationalization of rates, there may not be the kind of people who want to go to C. My feeling is that they want to go to C now because the present rate structure is totally inequitable. I go to A. I want to save face. I pay $4,900. If I go to C, I pay only $248. The rate structure is totally skewed, lopsided. So we are not very sure when or even if we want to introduce the means test.”
“Mr Deputy Speaker, Sir, as regards the increase in fees, I am well aware that there will probably be people who feel that they are being charged too much. But, as I tried to explain, if you want the services to improve, it is unavoidable that these fees will have to increase. As regards the question why we are so keen to implement it even before the Medisave comes into force, I have indicated that we will try to make regular but gradual increases. Since the last one was 1st January, 1983, it is a good date to have it on 1st January, 1984. The difference is three months. In my Statement, I have also referred to the assurance that I gave that medical services will be provided to people even though they cannot pay, Those who are poor can ask for write-off of their medical charges and we have done this regularly. I think the Member for Whampoa has experience in writing to my Ministry and some of the appeals that he made on behalf of the patients have been very sympathetically considered. We are not the monsters that you imagine us to be. In any case, every appeal for help goes directly to the medical social worker stationed in the hospital. And -I am quite sure the medical social worker has been trained to be sympathetic to the poor. So that assurance having been given, we will probably meet with some people who claim that there will be difficulty. But I think that these problems can be ironed out. As regards the question, what is the reclassification of wards from C to B to A, our decisions are more dictated by the demand. And paradoxically, there is more demand for A and B1 wards than for C wards. At the moment, 70% of our hospital wards are C and we find that we cannot satisfy some of the B1 wards and better B2 wards. So there will be gradual reclassification.”
“The figure is in the region of $15-$16 million which does not contribute to make-up the increase between $340 million and $390 million. I hope he is satisfied.”
“Mr Deputy Speaker, Sir, as far as I know there are only two questions. One is whether I am aware that the current fee of $10 is made up of $6 for this, $2.50 for that and $1.50 for the other. That might have been in the colonial times. But now, ever since 1st January, 1983, the $10 was just an all-inclusive charge for Class C. And I have explained just now in my Statement that this is unsatisfactory because in order to control costs we have to itemize and cost every item so that we can decide what to charge. Otherwise there will be no financial control of the subsidies. He also asks whether or not I am aware that this is 180% of the present charge. I am more than aware of this. But, as I explained to him the last time, his reference to percentages i& totally irrelevant. If I were charging 50 cents before and I now raise it to $1.50, 1 will be increasing it by 200%, making it 300%. It is irrelevant. If last year I did not charge anything, and this year I increase it to 1 cent, I will be charging one billion per cent or maybe more. So all these are irrelevancies. Then he brings up the question of taxes for motorcars. I have nothing to do with those things. So I cannot answer him, Then he asks what is the increase in fees. I have given you the figures. This year the cost to the Government or the Ministry of Health is $340 million. Next year it will be $390 million. And I am quite sure that the year after, it will be more. So every year it will be more, We are saying that since these are the people receiving the treatment and the services, they should bear part of the cost. He asked one relevant question. What will be the amount of increase in revenue that will arise from these increases in charges for hospitals and clinics?”
“Treatment of the mentally and chronically sick will continue to be heavily subsidized by Government. They will pay the nominal daily fee of $2 and $5 respectively now levied on Class C mentally and chronically sick patients. Mr Deputy Speaker, Sir, these increases that I have outlined are minimal in order to ensure that the subsidies that are paid out for hospital and health care will not be increased beyond the policy guidelines that are laid down by the Government. Regular revisions in fees will be unavoidable if we are to improve the services provided by our hospitals and clinics in the light of rapidly changing and improving scientific and medical discoveries and in view of continuing increases in recurrent expenditures. My Ministry, as I have said earlier, will take special steps to ensure that these increases will be gradual and will bear in mind the Singaporeans' capacity to pay for health care.”
“Patients who require follow-up attention at the outpatient dispensaries (OPDs) for minor procedures, dressings, or injections without the need to see the doctor in attendance, currently pay the full attendance fee of $4. This OPD fee will now be raised from 1st January, 1984, to $5. But where patients are not attended to by the doctor and only receive minor procedures, dressings, and injections from the nurse in attendance, the fee is reduced to half, i.e. $2.50 per attendance. Patients who attend the hospital specialist outpatient clinics (SOCs) will be advised to obtain their dressings or injections at the outpatient dispensaries nearest their homes. This will save them considerable time, money, and travel expenses. If, however, they choose to return to the specialist outpatient clinics in the hospitals for dressings and injections, they will have to pay the full specialist outpatient clinic attendance fee of $10 (or $12 at the Singapore General Hospital). The intention of the Ministry of Health is to reduce the congestion and long queues at the specialist outpatient clinics and to make better use of the outpatient dispensaries nearer the patients' homes where the running costs are lower. Senior citizens aged 65 and above and children under 18 years of age who are not employed, as well as students in schools and junior colleges, will continue to enjoy a 50% concession in respect of outpatient dispensary fees. They will also enjoy similar concessions for dental treatment. No change in A & E and SOC fees, and charges for the mentally and chronically sick In spite of increasing running costs, the current Accidents and Emergency Units. Specialist Outpatient Clinics and other prescription fees at these clinics have not been increased.”
“The Child Psychiatric Clinic and the School Health Services as well as the general psychiatric outpatient clinics will also have medical social workers to assist patients with their emotional, social, and financial problems. Accouchement fees Accouchement fees have been raised to reflect increased costs. To discourage large families, there will be an increase of $50 for the third order birth and $100 for the fourth and subsequent birth for all classes of patients. Item 8 on page 3 (Cols. 299 - 300) of the Schedule sets out the various charges in respect of accouchement fees. Reduction of fees In respect of certain laboratory tests and investigations where automation and electronic technology have replaced laborious manual work and thus drastically reducing costs and saving time, the benefits achieved will be passed on to the patients. In this respect, many of the laboratory and investigation test fees have been reclassified and lowered. There has also been a rationalization of these investigative and laboratory test charges into eight groups with a range from $5 to $40. Concessions Mr Deputy Speaker, Sir, my Ministry is conscious that some categories of patients will require more assistance. Radiotherapy patients, for instance, will need treatment daily. Such patients will with effect from 1st January, 1984, no longer be required to pay the attendance fee of $12 at each radiotherapy session. This fee will only be paid when they attend the designated specialist outpatient clinic for review by a doctor periodically. My Ministry estimates that this concession will result in a reduction of revenue of $1 million a year, but as a consequence many patients will be able to save between $240 and $480 in attendance fees depending on the length of treatment.”
“303 - 304) As regards surgical fees and medical treatment charges, Class B2 and Class C patients will pay up to a maximum of $200 and $120 respectively for an operation; and $40 and $25 respectively for all the necessary tests and investigations per admission regardless of the complexity of the operation or the number of X-rays, laboratory procedures, investigations and tests that were carried out. In the Singapore General Hospital, Class B2 and Class C patients undergoing surgery will pay up to a maximum of $215 and $129 respectively due to higher operating theatre and equipment costs. Perhaps a simple illustration will bring out the extent of subsidy to Class B2 and Class C patients. A Class A patient staying for six days in hospital to undergo surgery of a serious nature will be charged in excess of $2,200 in a hospital. For the same kind of surgery and treatment a Class C patient need only pay $248. The treatment and operation are exactly similar, so too is the length of stay in hospital. In the same way, while a Class A patient will be charged $4,300 (or $4,900 at SGH) in surgical operation fees alone for a major operation; but for a similar major operation a Class B2 patient need only pay the maximum surgical fee of $200 (or $215 in the SGH) while a Class C patient pays $120 (or $129 in the SGH). Assistance for the poor Mr Deputy Speaker, Sir, I wish to emphasize that no Singaporean will be deprived of medical treatment merely on the ground of financial hardship. The genuinely poor can continue to apply for remission of medical fees and for welfare assistance. A medical social work service is available in all our hospitals.”
“Class Bl patients will not enjoy this privilege, but they will pay at the reduced rate of 75% of Class A charges. Thus Class B2 and Class C patients should not be put to excessive difficulty in meeting the revised hospital charges. Fees payable by Class B2 and Class C patients It is necessary that I elaborate on the increased hospital charges that affect Class B2 and Class C patients. For a long time now these patients have paid a minimum all-inclusive fee per day in our hospitals. But with effect from 1st January, 1984, this will change. A separate daily meal fee of $5, as I have said, will be levied in addition to the present daily ward fee of $20 for Class B2 in hospitals other than the Singapore General Hospital, (where the daily ward fee is $30). Class C patients will pay a daily meal fee of $5 in addition to the daily ward fee of $10. In respect of professional treatment, prescriptions, X-rays, laboratory tests and other investigations, Class B2 and Class C patients will pay 25% and 15% respectively of Class A rates. To lighten the burden of Class B2 and Class C patients, they will pay only up to a fixed maximum on a per admission or per specialist outpatient attendance basis as specified in Appendix I (Cols. 303 - 304) to the Schedule circulated to Members. This maximum ceiling will apply to the groups of services and investigations, tests, irrespective of the number done per admission or specialist outpatient attendance. Appendix I - MAXIMUM FEES PAYABLE BY CLASS B2 AND C PATIENTS PER ADMISSION OR SPECIALIST OUTPATIENT ATTENDANCE (Cols.”
“The principle is that while Government can continue to subsidize heavy health care services, the Ministry of Health should not be burdened with the job of subsidizing the provision of meals in the hospitals. Class A and Bl patients will pay a separate daily meal fee of $15, while Class B2 and C patients will pay a daily meal fee of $5. This daily meal fee, however, will not be levied on patients in intensive care units, neither will it be levied on the chronic and mentally ill patients. Same services for all Classes Apart from the separate daily meal fee, logically for all classes of patients only one scale of fees should be levied in respect of professional services, investigations, surgical operations, and treatment. But this will clearly cause much hardship to people, many of whom may not be able to afford the full Class A medical treatment and surgical operation fees in the public hospitals. Present Government policy is to ensure that the hospital fees for Class A should reflect actual recurrent costs. This means that our hospitals can recover run- ning costs but will not be able to recover capital and equipment costs even from the Class A patients. In respect of Classes Bl, B2 and C patients, they will be subsidized up to 25%, 75%, and 85% respectively of Class A rates for the various treatment, surgical operation, X-rays, laboratory, and investigative services. Further, it is likely that even after such heavy subsidies some hardship can still be caused to a small number of patients. Because of this, for the next few years at least, my Ministry will fix maximum levels of charges for Class B2 and Class C patients, beyond which levels the charges will be borne by the Government.”
“295 - 304) Reason for fee increase For this reason and taking into account the increasing recurrent expenditures on medical and health services, which expenditures are likely to exceed $340 million for the current financial year and estimated to increase to $390 million for the next financial year 1984, it is necessary for regular upward revisions to be made to the fees and charges for services provided by our hospitals, outpatient clinics, and dental clinics. For this revision minimal increases will be made in respect of fees charged at the outpatient and dental clinics. These slight increases are set out in items 9 and 10 on pages 3 and 4 of the Schedule that has been circulated to Members. Itemized charges for hospital services There will also be readjustments of fees and charges for the various services pro- vided by our hospitals. I must emphasize that in the Government hospitals, with the exception of the daily meals that are different, all the medical services, investigations, X-rays, laboratory tests, surgical operations, and treatment are the same for all classes of patients. Currently Class A and Class B1 patients are charged fees in respect of professional treatment and prescriptions, X-rays, laboratory, and other investigative tests and services. Class B2 and Class C patients have hitherto been paying only an all-inclusive daily ward fee which covers all these services. This implies that the daily ward fee includes the cost of meals and all the other services whether supplied or not. For proper accounting purposes, each item of service rendered should be costed and charged. With effect from 1st January, 1984, a separate daily meal fee will be charged.”
“Mr Deputy Speaker, Sir, permit me to make what must be deemed a rather unpopular statement regarding the increase of hospital, outpatient, and dental fees and the rationalization of the way some of these fees are charged. For as long as my Ministry of Health is required to provide up-to-date and progressively better medical and health services to keep pace not only with the rapidly advancing medical science and technology but also to satisfy increasingly sophisticated public demands, and for as long as there is inflation causing escalation in wages and running costs of hospitals and clinics, I am afraid regular revisions of hospital, outpatient, and dental charges will be necessary. I have circulated to Members of the House a Schedule (Cols. 295 - 304) setting out the main changes in hospital, outpatient and dental fees that will be implemented with effect from 1st January, 1984. When my Ministry announced the last revision of fees which took effect on 1st January, 1983, it stated that fees should keep pace with improved services and rising running costs, as otherwise there could not be any improvement in our health care services. Fee increases, however, would be gradual and would take into account Singaporeans' capacity to pay for health care. Schedule - REVISION OF HOSPITAL, OUTPATIENT AND DENTAL CHARGES, MAXIMUM FEES PAYABLE BY CLASS B2 AND C PATIENTS PER ADMISSION OR SPECIALIST OUTPATIENT ATTENDANCE (Cols.”
“This Unit is partly financed by donations. When completed next month (Sept 83), it will have 10 SDDU stations with space for expansion to 20 stations later on. There are also plans to expand the SDDU in AH to 20 stations in the near future. (4) Treatment of chronic renal failure is a difficult area in medicine. It is a long lasting ailment, complicated by the fact that treatment is expensive while possible cure depends on the availability of donated kidneys. The Government is doing as much as possible within its limited resources for the unfortunate victims. However, members of the community and philanthropic foundations can play their part. The urgent need is for available kidneys for transplantation, failing which for more funds to meet the high establishment and operating costs of dialysis stations. (5) It must be recognised that haemodialysis is no substitute for kidney transplant to achieve a better prospect for cure. A successful kidney transplantation will not only ensure a better lease of life to the recipient but will also create a vacancy for those anxiously waiting their turn for dialysis. Therefore the public can help positively by supporting kidney donations. Similarly, voluntary and community organisations can supplement the efforts of Government by providing funds and facilities for haemodialysis. VACANT HOUSING AND DEVELOPMENT BOARD RENTAL FLATS 6. Mr J.B. Jeyaretnam asked the Minister for National Development if he will furnish a statement of the numbers of rental flats that were vacant as at 1st June,1983 in the various housing estates where the Housing and Development Board has flats for rent and the number of months the flats have remained vacant.”
“There are 2 Government centres for renal dialysis treatment, one at Singapore General Hospital (SGH) and the other at Alexandra Hospital (AH). In SGH, dialysis is done by a team of trained nurses. In AH, dialysis is carried out by the patients who are assisted by their relatives under the supervision of a trained nurse. The centre in AH is known as a Self-Dependency Dialysis Unit (SDDU). The SGH dialysis centre has 10 stations plus 4 training stations for SDDU, while the AH SDDU centre has 11 stations. The total number of patients presently undergoing dialysis treatment at the 2 Government centres is 89, 45 at SGH and 44 at AH. (2) Every year, there are well over 100 new cases referred to the Department of Renal Medicine with end stage renal disease who require dialysis. Data over the last 7 years are shown below:- 1976 - 180 patients 1977 - 142 patients 1978 - 107 patients 1979 - 122 patients 1980 - 107 patients 1981 - 150 patients 1982 - 165 patients On a national basis, the actual number of new cases is higher as some patients are treated by the private sector. At any one time, there are about 20 patients on the waiting list for dialysis treatment at Government centres. The Ministry does not have record of those treated or on the waiting list for dialysis treatment by private doctors. (3) The estimated capital cost is about $500,000 for converting and renovating an existing building into a dialysis unit. The estimated recurrent cost is about $392,200 per 10-station SDDU per year for 40 patients, or over $9,800 per patient per year. Of the total recurrent cost of $392,200, approximately 90% or $352,000 are for expendables (dialysers, blood lines, chemicals). The Ministry is developing a second SDDU in Tan Tock Seng Hospital (TTSH) at a cost of $559,100.”
“Mr Rohan bin Kamis asked the Minister for National Development if he will elaborate on the administration of the Housing and Development Board/Urban Redevelopment Authority coupon parking scheme, in particular, the safeguards to ensure that the motoring public is not unduly penalised by any administrative error.”
“Mr Speaker, Sir, there is a pharmacy in each of the nine Government hospitals. Three other smaller hospitals which do not have a pharmacy of their own obtain their drugs from the pharmacy at a nearby hospital or at an outpatient clinic. Each pharmacy is staffed with one or more qualified Pharmacists, depending on the size of the hospital. They are assisted by trained Dispensing Assistants. Two of the nine pharmacies operate beyond normal office hours. One in the Singapore General Hospital which works from 7 am to 7 pm daily. After 7 pm, a skeleton staff from the pharmacy is stationed at the Accident & Emergency (A&E) Department where pre-packed medicine is issued. The other pharmacy with extended hours is at Toa Payoh Hospital which is open daily from 8 am to 6 pm. There are no immediate plans to expand night pharmacies. Present practice is to stock all the A&E Departments with commonly prescribed pre-packed medications for use when the pharmacies are closed. At the Singapore General Hospital A&E Department, any emergency case requiring a drug outside the pre-packed range will have to be supplied by the main pharmacy. In the other hospitals, A&E cases requiring certain drugs urgently outside office hours will obtain such supplies from the wards. All acute hospitals stock sufficient supplies of medicines in the wards and Intensive Care Units for emergency purposes. There is a pharmacist on call all the time. The pharmacist oncall can still be summoned if necessary. One pharmacist is on-call every night. These arrangements have served the needs of the hospitals adequately. There is therefore no necessity for the Ministry to expand night pharmacies at the A&E Departments. COUPON PARKING SCHEME (Administration) 12.”
“Mr Speaker, Sir, the appreciation would be that we hope he will keep good health. Therefore, giving him any indication that can lead to self-pity is not appreciation. PHARMACIES IN GOVERNMENT HOSPITALS 11. Encik Mansor Haji Sukaimi asked the Minister for Health (a) how many pharmacies are operating in the government hospitals; (b) whether they are adequately staffed with qualified personnel; (c) how many of these pharmacies are operating outside office hours; and (d) whether there are plans to expand these night pharmacies, particularly those in the Accident and Emergency units, in the interest of the public.”
“It was not a medical team. The team that helped us in the design of the hospital was a British architectural team by the name of Llewellyn Davis. They helped in the design of the General Hospital. There was such a team but there was no report. You engage an architect, the architect does not give you a report. He talks about the British and Mrs Thatcher. I think it will be invidious for me to say anything bad about a friendly government. So I would rather not say it. As to the real reason for the British not wanting to do away with the welfare services programme, even though their think tank has advised that it be done with, it is a political decision. It may be a decision like what our Member for Anson is always doing, to catch votes, "since the general election is on the way, you do not throw away votes." I think he can understand that. Question on the amendment put, and negatived.”
“Sir, I will answer that, and more. I still owe him an answer as to whether or not there was a British team to help in the building of a hospital. That was not what he asked for. He asked whether there was a British team to review our medical service. There was none. If he had said, did we or did we not engage a consultant to help on the design of the hospital -”
“Eventually when we work harder, we get more income; we will pay for more and more. But you do not want that. You want to catch votes by saying, "Take it from all those who have and give it to the poor." Singapore will be forever poor if you preach that. Yours is a message of despair. You do not understand it because you are like Rip van Winkle. Having learned something in the late '40s or the early '5Os in London about social welfare and the welfare state, you come back with that idea and, having got elected after seven attempts, you say, "Now I will apply it.", without knowing that 40 years have passed and all the people who have practised it are now on the road to perdition. And you want Singapore to follow that road. You must have your head examined by my doctors.”
“Pompous, since the 1950s, whatever word he may have used. But I have not been abusive towards him. I have just been educating him. But, of course, having been a teacher, I know that some people can be educated, others cannot. He may not have caught the point which I made in reply to the Member for Rochore that for those who are really poor and cannot pay, the Government picks up the tabs. But that will be after we have been able to establish that there is nobody to pay for him. He says that we are undercharging the A Class. I do not know what he means by undercharging the A Class when we tell him: (a) that the C Class ward is being subsidized to the tune of 90% for the same services, except that the bed is different; (b) that the B2 Class wards are being subsidized up to 80%; (c) but in the case of the Bl Class and the A Class wards, we recover the full amount, and (d) that in the case of the A Class, we recover the full amount of the running cost plus a little bit that contributes to our capital and development costs. He wants us to raise it. We will have to raise it for all, together, because these services are being used by our people. The A Class patient is still our citizen. The Bl Class patient is still our citizen. The B2 Class patient is still our citizen. The C Class patient is still our citizen. We treat all of them as citizens. But you want to level everybody to the C Class so that they will all be poor, so that they will support you. That is an action of total despair. You are preaching what is called, the message of despair. What the PAP has been preaching is the message of hope. You are all poor. We are all poor. Let us put our efforts together, work hard. We will only pay for what we can afford.”
“There is no need for me to do that. I do not want to. He refers to me as having known me to be a bombastic fellow since the 1950s. Some hon. Members: Pompous.”
“Sir, I have for the last year or more restrained myself and bottled myself from being personal. But I see that the Member for Anson wants to be personal. He says -”
“Increase it? Mr Jeyaretnam: Oh yes, I say increase it for these private patients. Why charge them $100 for a one-bed room in the Government hospitals when they have to pay $180 at Mount Elizabeth and, I think $150 at Mount Alvernia Hospital, and $180 at the Thomson Medical Centre. I stand corrected on this. But that is what I think the figures are. By all means, increase it for these people, and I am sure they will still go to the Government hospitals. But why do you put the burden on the less well-to-do people, people that the Member for Rochore spoke about, people who are earning only $500 a month and have to give up 25% of that - not yet, but nearly that - now by way of CPF so that they take home less than $400. Why increase the burden on them? That is what I would like to know, instead of mouthing just abuse and saying, "You will not get anything free." There are some things that must be provided free in society, to those people who cannot afford to pay. It is no good coming with your high-sounding talk about "nothing is for free". Any government which is conscious of its responsibilities, of its obligations to the less well-to-do people in its midst will realize that it is the duty of the rest of the society to care for these people and to pay for them. It is as simple as that. The Acting Minister for Social Affairs (Dr Ahmad Mattar): Sir, public assistance recipients do get free hospitalization.”
“Again, you read your newspaper wrong, as usual. He was talking about our specialist doctors going out to practise to claim that they were as good as the best. Therefore, they charged more. His other illustration was that some of our specialists "are charging more and higher fees than Mayo clinic." I think Mayo clinic was mentioned. That is true. It is like a state player demanding a certain fee, but our estate player is demanding more. I think that kind of language he will understand. We have a long way to go. There is no doubt about it. Then he says that the fee for A & E is now $12. Because it is $12, it is too much. The A & E fee is $10. But because the facilities in the General Hospital are much more modern and much more elaborate, in order to distinguish it from the ordinary hospital, we have raised the fee by $2. It is now $12. We agree with him - that is the only point we agree with him - that health care is a very important thing and we will provide the best health care possible, but not for free. You have to pay for it.”
“That is to make the point. He is worried about our turning this place into a centre for medical excellence. He read about my Permanent Secretary saying that we have a long way to go. Yes, we have a long way to go. We have a very long way to go to be anywhere near a centre of medical excellence that is known worldwide.”
“There is no report. What report? We do not know what report you are referring to. You heard. You dreamed. We are providing the best medical care that we can. Irrespective of A Class, B Class or C Class, the medical care is exactly the same. It is only when you go to a C class bed, that you are charged $7 a day. When you go to a B Class or A Class bed, you are charged very much more. If you go to a C Class bed, the total subsidy for your hospital bill is 90%. You go to a B2 Class, it is 80%; you go to Bl Class, there is no subsidy; you go to Al Class, you pay a little bit more than the running cost, so that we can recover some capital and development costs. It is as simple as that. From $7 to $10, by his very simple, superficial, facile argument, of course, it is a 43% increase. If it is $1, and we increase it to $2, it is 100% increase. If it is from zero, and we charge 50 cents, it is infinity increase. What stupidity! The $10 that he is now paying is for the bed plus the nursing service, the doctor service, the food - all for $10 a day. You [pointing at Mr Jeyaretnam] tell - me which lodging house can get you all those facilities for $10?”
“Mr Speaker, Sir, as usual, from the Member for Anson, we get a hotchpotch of vote-catching ideas; they all mean nothing. He hears that there is a British report. But what report it is, he does not know. "If it is a report, it must be tabled in the House."”
“Or purposely. I do not know whether it is possible or not possible, but not impossible. I have not accused the Member for Whampoa of being bigoted. I just said that it is his point of view and I respect his moral and religious principles. As to whether or not permissiveness will bring with it interference with the moral fabric of our society, who are we to say? We, as I said to him, cannot cushion ourselves from the development. It was not very long ago that boys do not see girls until after the wedding. Today we put boys and girls together in the same school. What are we to do? Turn the clock back and at the same time demand that we should have modern technology? It may be that our religious teachings, our moral education, our education system itself and even higher education, have not kept pace with the development of modern science and technology. I do not know. I have no answers. We know that we have passed the Abortion Act in this House and, as far as the Ministry of Health is concerned, we are trying within the confines of this Act to provide the service as conscientiously as possible on social and humanitarian grounds. We do not force anybody to go for abortion. It is a voluntary choice. That is the point I would like to make.”
“Sir, I do not argue with the Member for Whampoa whether he is right or wrong. This is something for higher authority. If you take his figures of 15,000-odd abortions per year, and you look at the 300 women who were advised to do menstrual regulation and the 1,000-plus women who were advised to go for abortion, the figures probably are the ones where there is genuine error on the part of the pregnant women who need the help. It is not because our Maternity and Child Health people have carelessly, using his words, "advised them to go for abortion."”
“He will want to practise his profession with great dignity and with great understanding of what medicine is all about. That is at the front line. We notice that many doctors do not have clinics that can provide more than the simple treatment of simple cases. When a case is a complicated one, it is not that the doctor cannot treat the complicated case but he simply has not got the facilities to treat it. So what he does now is to refer the patient to the hospital. For the good of the country this must change. The cost of a hospital bed is going up year by year. It started in the General Hospital in the mid-1970s, for instance, when a bed cost just under $150,000. Today when we are developing Kent Ridge, by the time Kent Ridge is completed, each hospital bed will cost nearer $350,000. If you have just an accident, it is not necessary that you must go to a hospital where a bed costs $350,000 or $400,000. A general practitioner can easily treat you, but you may need to be put in plaster and will require rest in a hospital and be attended to. That is the purpose of the community hospital. We ourselves have not yet fully crystallized this concept. We hope to be able to bring in a body of general practitioners who will give us their views on how a community hospital should best be operated. And I would welcome the Member for Ayer Rajah's contribution, if he so wishes to help us.”
“Under the National Health Plan, in addition to advising the members of the public to look after themselves, that to exercise prevention is better than cure, we have envisaged a multi-line of delivery of health services. At the front line is the general practitioner and the Government clinics. We hope that eventually people in Singapore will get into the habit of having family practitioners. The family doctor will not only know the ailments of the family but also have an understanding of their psychological and family background, so that if anything happens to any member of that family, this general practitioner, who is the family doctor, will be the first to give them counsel and advice. In that way we will not get into the situation today where a young man who is a swinger, having spent the night before at the disco, has a headache the next morning and, instead of going to a doctor who will probably advise him to take two Panadols costing ten cents, will insist on going for a head scan which will cost $500. He can afford it and he wants it, because he wants the best of everything for himself. This is unnecessary. If there is a family doctor, the family doctor will be able to counsel him. That is the first line of defence. We are hoping that the family doctor will spend more time with the family and understand the family better so that the delivery of the health service on the front line will be a health service of much higher quality than now. Today there is the arrangement that if you see a general practitioner and if your case is simple, you get treated with some pills. If your case is complicated, he refers you to a specialist or to the hospital. So his job is made very easy. I am quite sure a sincere and genuine doctor will not want that kind of a practice.”
“If we want to have access to the world of the West, we are not able to cushion ourselves, to isolate our young people, from the other influences. It may be necessary that we should do more education; we should pay more attention to teachings, to moral and religious teachings, it may be necessary that we train our parents to take on greater responsibility. But we cannot blame all this on the Abortion law. It is just like saying that road accidents are happening and, therefore, the motor car is the cause. Therefore let us ban motor cars. The motor car is only one of the contributory factors to the increase in the number of accidents. But we do have this advantage in that by bringing abortion to the open there are more lives that are being saved than if we were to make it difficult and they go underground and seek unqualified, unskilled advice or assistance and end up as corpses. So we do have a plus point in our Abortion law. I would plead with him. We have heard him many times. His arguments are cogent. But, as I say, it is his point of view. There are so many other points of view. The most important thing I would like to stress is that our Abortion law is to provide a service to people who voluntarily want to use it. There is no compulsion. There is no such thing as you must do it. It is the choice of the person. I do accept that it makes it easier, but to make it more difficult would be to chase it underground, with much more serious and deleterious results. I come to the Member for Ayer Rajah. He wants to know more about community hospitals. I am grateful to him for giving me this opportunity to talk about community hospitals.”