John Chen Seow Phun
Singapore
“Sir, Singapore has signed FTAs with a number of countries, including the developed nations, such as the US and Japan. These FTAs give us better access to these developed markets compared to other countries for goods that need the rules of origin.”
“Sir, I thank the Minister for asking the HDB to relook at the case I brought up, but I hope that he would not rule out providing the same loan amount to the family. I understand the need for credit assessment policy, and so on. But I think the policy should not be applied blindly.”
“It can also be stipulated that the grants can only be used to pay part of their mortgage loan monthly. I think this will go a long way in helping these families pay for their flats. I hope the Minister can look into this and see whether these families can be given such help.”
“My point is that the Minister should reconsider this case and exercise flexibility, so that the family will be helped. Otherwise, if the family was asked to sell their flat, it could be negative equity and the problem would come back to HDB. And HDB would be owed money and I do not think that is good for HDB as well.”
“We need to come up with a regular mechanism where older and lower income workers can benefit without the pitfalls of a crutch mentality. I think, in this regard, the Government has not spent enough time or thought to look into what other mechanisms that we can have.”
“On the other hand, at best, we get one Singapore pavilion with a dozen or so companies, and that is about it. If we are really serious with our globalisation effort, our Government agencies must put in more resources to encourage more companies to participate in such events.”
The complete record
Every one of 741 lines we hold for John Chen Seow Phun, in date order, each linked to its source. Free to read, in full, without an account. Page 11 of 15.
“Sir, I have to speak on this because I believe it is of public interest. The phase-out date for CFCs is now on 1st January 1996. This means that within two years, there will be no new supply of CFC-based coolant which is used in the air-conditioning system of our existing cars. The implication of this is that when the air-conditioning system of a car leaks, the owner will have a problem refilling the coolant. As the supply of the coolant dwindles, suppliers may demand high prices for the coolant. May I ask the Minister whether his Ministry is doing anything to prepare our motorists for the impending problem that they will be facing?”
“Sir, I beg to move, That the sum to be allocated for Head M of the Main Estimates be reduced by $10 in respect of Code MF 1500. Sir, oil tankers are known to cause sea pollution by desludging and dumping their sludge at the sea. This, however, can be prevented if every country has a set of procedures to control tanker cleaning and disposal of sludge and slop. The recent press report in Malaysia on the detention of the oil tanker "Arabian Sea Monrovia" seems to indicate that Singapore is without a sludge disposal facility. I would like to ask the Minister whether this is true for if it is true, then how are we to control tanker cleaning activities within Singapore waters. Sir, can I go on to the next cut.”
“Sir, the ownership of HDB shops is, I believe, 99 years and the ownership of JTC premises is 30 years. So I would like to urge the Minister to consider extending the ownership of hawker stalls to 30 years, without increasing the price. On that note, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“When we were passing the law on CWO (Corrective Work Order) in September 1992, the then Minister for the Environment made it clear that CWO is only meant for those recalcitrant and serious offenders. Since its implementation, we have seen a noticeable shift in how it is being enforced. Places where CWO is executed have changed from public beaches to housing estates. The types of littering offences for which CWO is applied have changed from bulky items to just a piece of paper. I am not saying that these changes are wrong. But many people are concerned that CWO may be applied indiscriminately. Enforcement action is usually left to the discretion of the environment officer. I have come across a case where there is clearly no intention of littering when an object is left behind but the officer simply would not reason and went ahead to book the person. So will we come to a stage where CWO will be applied on people who accidentally drop a small paper tab from their parking coupon? Where is the limit? Could the Minister please explain?”
“Sir, a Green Labelling Scheme was launched in 1992 to promote green consumerism. The response of consumers to the green products sold under this scheme would be a good gauge of not only how successful the scheme is, but also the level of environmental awareness among Singaporeans. May I have a progress report on green labelling from the Minister? Sir, may I carry on with the other amendment?”
“Sir, I beg to move, That the sum to be allocated for Head M of the Main Estimates be reduced by $10 in respect of Code MC 1500. Sir, the Ministry has indicated its intention to privatise hawker stalls but has not announced the details of the scheme. The greatest concern that most people have really is whether privatisation of hawker stalls will lead to an increase of hawker food prices. This is a legitimate concern because almost every family patronises hawker stalls. The hawkers themselves are also worried whether they can afford the selling price. I would therefore like to know from the Minister whether they have finalised the sale scheme. Is he able to indicate what kind of prices and discounts stallholders can expect and the ownership period? My concern is that if the selling price, translated into monthly rent, is much higher than the current rental the stallholder is paying, there will be pressure on the stallholder to increase his food prices. Could the Minister tell us his view on this? I would also like to suggest that once privatised existing restrictions on stallholders should be removed. They should be allowed to re-sell their stalls in the open market or sublet them. Restriction on range of food or produce sold should also be lifted.”
“Sir, I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.”
“One company told me that it had recently bid for an Indonesian project and was told that it would be given the contract because its price was the lowest. But it was told later that the contract would be given to a Swedish company because the Swedish government was financing the project through a loan scheme designed to help their companies to venture overseas. Sir, I noted that the Singapore Government has recently taken a one-third stake in a $1.2 billion investment fund called the AIG Asian Infrastructure Fund. I wonder whether the Ministry can play a catalytic role in getting such funds to take a closer look at environmental projects. The local environmental companies need project financing the most as they venture overseas. I would appreciate the Minister's response to my queries.”
“The resulting benefits are: compliance with regulations, conservation of resources and energy, minimisation of wastes and a better public image. The Ministry has taken the approach of persuasion rather than legislation in environmental auditing. I agree with this approach. However, the rapid development in this area in the developed countries has resulted in increasing demand for the formation of and adherence to industrial standards. The International Organisation for Standardisation (ISO) has formulated the ISO TC 207, Technical Committee on Environmental Management. Soon, internationally agreed standards may come about for environmental auditing, in the same way that such standards have come about for quality management. We must be prepared for this. Is the Ministry, therefore, working out some guides, perhaps in conjunction with SISIR, for our industry to follow? Sir, let me turn to the last point which is on environmental technology. Countries in the Asia Pacific region are undergoing rapid economic development. There are tremendous needs for projects to safeguard their environment. This is partly because of international pressure and partly because of increased environmental awareness. Whatever it is, there are tremendous business opportunities for environmental companies. Singapore is well poised to take advantage of such opportunities because of our experience in environmental protection. I have come to know of many such opportunities in Malaysia, Indonesia, China and Vietnam. Many Singapore environmental companies told me that such ventures are profitable, but they face the one most important problem of funds.”
“Sir, I now come to a few specific points on the recommendations of the action programmes. On waste minimisation, I noted that the Ministry aims to reduce domestic and trade waste from a current per capita rate of 1.1 kg per day to 0.9 kg per day by the year 2000. For industrial waste, recycling targets for the year 2000 have been set at 40% of wood and timber waste, 60% of paper and cardboard waste, 50% of plastic waste and 20% of construction and demolition debris. All these are ambitious targets. On domestic waste, I asked last year whether the Ministry was considering introducing measures such as tying refuse removal fees to the amount of refuse discarded to discourage waste generation. The then Minister answered that he was considering two alternatives of a volume-based fee: the pre-paid bag system and the variable bin system for landed properties. May I ask the Minister what his Ministry's decision is? Are we going ahead with a volume-based fee? And, if not, what other measures does he have in mind to ensure that we meet the target of 0.9 kg per capita per day? On recycling of industrial wastes, the recommendations in the action programme are only confined to such words as "encourage" and "promote". I know that the recycling industry cannot be forced to grow because economic considerations are important. But much remains to be done for the Ministry to come up with actual ways and means and incentives to influence the growth of the industry. Otherwise, the targets that we set would not be achievable. Does the Minister agree with me? Sir, environmental audits are increasingly being adopted by companies in the developed countries. They enable management to evaluate and improve the environmental performance of their organisation.”
“Sir, I beg to move, That the total sum to be allocated for Head M of the Main Estimates be reduced by $100. Sir, the action programmes of the Singapore Green Plan were finalised in October last year. They cover six areas which are important to our continuing socio-economic development in an increasingly environmentally conscious world. The six areas are: environmental education, environmental technology, resource conservation, clean technologies, nature conservation and environmental noise. These programmes reflect the progress we have made as a nation over the last 30 years. Our environmental concern in the early years was mainly pollution control and we have concentrated in building the regulations and the basic infrastructure for such environmental needs. Today, our environmental agenda ranges from concern for the problems of excessive wastes generated by an increasingly affluent population to how we can contribute as a member nation to global environmental issues. Sir, I am glad to see that clear steps and bold targets have been set forth in the action programmes. I must commend the Ministry for their vision and effort in preparing us for the year 2000 and beyond. What we need to do now is to turn these programmes into reality. This is by no means easy. The programmes are multi-dimensional. Their implementation requires the concerted effort of various Government Ministries, corporate bodies and Singaporeans at large. Could the Minister tell us what mechanism he has set in place to oversee, direct and coordinate such efforts? Such ambitious programmes also require, needless to say, adequate funding. I am therefore interested to know how much the Ministry is expected to spend to carry out the entire programme.”
“The irony is that even when companies have recognised the union's representation of executives, the Industrial Arbitration Court cannot certify a collective agreement which covers both categories of workers, because of section 16(3). Should we therefore review the law and remove the restriction? Second, under section 25, pioneer status companies covered under the Economic Expansion Incentives (Relief from Income Tax) Act and other companies covered under section 25(2) are prohibited from granting terms and conditions of service which are more favourable than those stipulated under Part IV of the Employment Act, such as annual leave, sick leave, etc. In view of Singapore's rapid economic growth and tight labour market, companies that do not provide good benefits cannot attract staff. Hence, many had asked for exemption from this provision. But the irony of this provision is that the minimum terms and conditions of service provided in the Employment Act became the maximum that are allowed under this provision of the Industrial Relations Act. This does not provide the flexibility that we are looking for in today's context. Again, this provision was introduced in 1968 and we need to review whether it has become irrelevant. Sir, there are other Acts which may also need to be refined. May I know whether the Minister intends to do so?”
“Sir, the Ministry has formed a Tripartite Committee to review the Employment Act. In doing so, it has recognised that some provisions in our labour legislation enacted and amended some time ago have become irrelevant and do not meet the needs of our fast changing economy and our prevailing social conditions. While a tripartite review of the Employment Act is under way, and I hope the Minister will later give this House a progress report on that, the Ministry has not indicated whether other labour legislation will be reviewed. 5.45 pm Sir, our economy and society have become more and more complex and sophisticated day by day. Our approach to labour legislation should be to provide more flexibility in order to meet these complexities. In addition to the Employment Act, I believe there are provisions in other Acts which need to be reviewed. Mr Othman has mentioned the Factories Act. Let me cite two provisions in the Industrial Relations Act. First, section 16(3) of the Industrial Relations Act provides that when the majority of a union's membership comprises rank and file members, then the union cannot represent those in managerial or executive positions. To address the problems of bogus titles, the Ministry has provided a set of guidelines to help weed out those who are genuinely not executives and hence should be allowed to be represented by the rank and file union. The guidelines, however, do not change the legal position under section 16(3). Executives still cannot be represented by rank and file unions even in cases where there is no discipline and control problem and no conflict of interest. This law hampers the union's organising efforts and deprives it of a potential source of leadership.”
“It is an uphill task because it requires people to understand and accept the new system. It is therefore very important for us to receive support from employers, unions and, not least, Government. Government can support MHS by allowing members of MHS to draw on Medisave to pay for the premiums. This will also be a strong signal from the Government that it is willing to give MHS a try. May I ask the Minister whether MHS will have his support.”
“To address this concern, MHS will allow members to stay in the plan by paying the premiums on their own after they retire from work. This, we believe, will be a very attractive feature for workers. Sir, those who are sceptical of MHS have two main reservations. First, they feel that MHS works well in the US because health care expenditure there is so high that it becomes worthwhile for MHS to operate. They feel that MHS may not be necessary here because of our low health care expenditure and the competitive environment at the primary care level. They fear that whatever MHS saves, it may have to give back to the administrative costs it incurs. Second, they feel that under MHS, quality of care may suffer if doctors are too cost conscious. I understand those concerns. But my answer to the first reservation is that health care costs are rising and MHS can help to slow down the pace. We have to start early and we will see more and more benefits as we go along. Besides, if we look at our present health care expenditure pattern, on the average and on an annualised basis, a person incurs about two to three times as much on outpatient expenses compared to his hospital expenses. I believe, therefore, there is room for improvement even at the outpatient level. On the concern about quality, I believe most doctors will not be found wanting in delivering to patients whatever care necessary. MHS will cause them to be conscious about delivering the most appropriate level of care at the least costs. Notwithstanding this, MHS will monitor the utilisation of medical care and treatment outcomes to provide quality assurance. Sir, NTUC is trying to provide through MHS another approach within our national health care delivery system to help curb rising health care costs.”
“The results of all these are that wastages in terms of over-treatment and unnecessary visits to doctors can and do occur. However, if doctors are given a reasonable budget on a capitation basis to look after a group of patients under him, ie, they manage the patients within an agreed budget and therefore take certain financial risks upon themselves, they are likely to be cost conscious and minimise wastage. At the same time, if we can make a patient choose one doctor and always go to him under normal circumstances, then we can also promote the family doctor concept and thus provide better care more efficiently. Sir, the MHS plan which NTUC is working on is based on the principles I have just described. For a premium, depending on age, MHS will provide a comprehensive range of health care, from primary to specialist and hospital care. Physicians providing primary care will be paid on a capitation basis. They will also be given financial incentives to serve as "gatekeepers" under a referral system to keep out unnecessary specialist and hospital treatments. To encourage personal responsibility in line with the White Paper on Affordable Health Care, MHS members will be required to make a co-payment for outpatient care. There will also be a small co-insurance for hospital care which can be met by Medisave or even MediShield. To help members meet the co-payment for outpatient care, each member will be given an annual credit which can be used for their co-payment. This is also to encourage members to stay healthy so that they can keep the balance if the credit is not used up. At present, workers are worried that once they retire and no longer enjoy their employer medical benefits, they will be left without medical coverage, especially if they have an existing illness.”
“Government, employers and workers are all concerned about rising health care costs. Government believes that health care is a case of market failure. That is why the White Paper on Affordable Health Care has proposed measures to control both the supply and demand of health care services. On the supply side, Government will control the supply of doctors, regulate key areas of pricing and operations of subvented hospitals, and control charges on private sector Medisave patients. On the demand side, Government has taken the lead to emphasize personal responsibility by way of co-payment among the civil servants to moderate demand. It has also capped the tax deductibility of medical expenses by companies, and will be regulating medical insurance. 3.00 pm Long before the White Paper was published, the NTUC was already studying how the labour movement can provide workers with a comprehensive health care scheme and, at the same time, minimise increases in health care costs. We found the Managed Healthcare System (MHS), originated in the United States, attractive, and have modified the system to suit our needs. Many US health maintenance organisations have adopted the MHS. They have been able to reduce substantially the health care expenditure of their members. Sir, under the present system in Singapore, doctors are paid a fee for their service. The patient, if he is employed, usually claims his expenses from his employer. Alternatively, doctors bill employers directly. Under these circumstances, doctors need not be cost conscious and they have no incentive to provide the most cost effective care. Patients, on the other hand, can and do, for various reasons, doctor-hop. Sometimes, they go direct to the specialist which may not be necessary.”
“Sir, I am not concerned for the younger workers because I believe that they would be able to meet the Minimum Sum scheme in time to come. But my concern is for the older workers and the whole objective of the CPF Minimum Sum scheme is to ensure that they have enough money for their old age. So we must do whatever we can to help this group of people. I would like to ask the Minister two questions: Firstly, for those who are prepared to contribute in cash to their parents' Minimum Sum, will they enjoy tax deduction? And if no, why not? Because that is a very good way of encouraging people to contribute to their parents' old age. The second point is - I have mentioned this in the Budget debate on the CPF Minimum Sum Top-up Scheme provided by the Government - I believe that it should not be across-the-board. It should be given to those who do not have enough savings, and we must work out a set of criteria to make sure that a certain principle is upheld, for instance, if you work, we give you more. The principle is similar to the SOTUS scheme. I would like the Minister's response to this.”
“He gets his new salary. Cdre Teo Chee Hean: That is correct. He gets the new salary. But only for the pre-existing illnesses will he have his medical benefits restored as before.”
“Sir, may I seek a clarification from the Minister of State? He mentioned that for civil servants with pre-existing illnesses who are not insurable, Government will restore their original medical benefits. Does he mean that if a civil servant chooses option B, the CCS scheme, and goes on the new salary, he will also at the same time enjoy the old medical benefits?”
“Mr Speaker, Sir, we had a mini debate earlier on foreign workers' levy, but there is one very important point which was not touched on, ie, if we allow companies to have access to cheap labour, then there will be no incentive for companies to upgrade the skills of the workers to go for higher value-added activities. And at the end ---”
“Mr Speaker, Sir, they have not answered my question. With regard to Mr Low Thia Khiang's remark, I would like to ask him this: If the Government does not impose the foreign workers' levy, to whose pocket will this money go? Would it not go back to the pocket of the employers? How can this benefit the foreign workers? If it is in the form of the foreign workers' levy, then the Government collects the money, and Singaporeans will benefit from it. This is a very important point. Mr Low Thia Khiang( In Mandarin): Mr Speaker, Sir, I do not deny the possibility of the money going back to the employers. But, if you are talking about exploitation, then from the workers' point of view, it is indeed an exploitation, because the money is taken away by the Government. Otherwise the employers can pay the workers more. Mr Choo Wee Khiang rose ---”
“At the moment, we have a Special Account in our CPF and we can use this Special Account to form part of the cash requirement in the Minimum Sum Scheme. But we should not force people to cough up cash to top up to the amount that we think is necessary because, if we do so, there will be people who will find it difficult to meet the requirement. With these remarks, I support the motion.”
“If he does not get a COE, of course, in the last resort, he will downgrade to a lower category. When that happens, the people who are bidding in the slower category will lose out. In the end, you will find that you have a situation where the COE prices could become unmanageable and those who intend to renew their COEs after 10 years would find it too expensive to do so. By spreading these taxes across-the-board on a number of measures, it is obvious that the situation is more manageable. I am just giving examples to show that Singaporeans must also take note of their biases and that they should try to find out more for themselves the reasons why a particular policy is implemented. I believe that cohesion is the key for us to continue to have intense competition and progress economically. But unless and until all three parties - the Government, the employers and the people of Singapore - realise their roles and understand that they should not always insist on their views, we will not be able to continue with our objective of generating wealth through competition in a sustained manner. On the subject of the Minimum Sum Scheme, I support the scheme because I can see the problem coming. There are many people who now retire without enough cash and it is very difficult for them to sell away their house. Even if they do so, I have seen many cases where their cash quickly disappears because of demands from family members, relatives, friends and so on. We need to have the Minimum Sum Scheme in place and we also need to ensure that there is enough cash when the people retire so that they could continue to enjoy a decent living. But we need to be careful on how we implement the scheme.”
“The Government should come out with the improved MediShield as quickly as possible and as simple as possible, and explain what a patient can expect from his bill with the intended lowering of deductibles and limits. Sir, for employers, I believe that they must also do likewise. There should always be consultations and discussions before any policy of the company is implemented because workers do not usually see it from the management's point of view. As for the people, they need to be more objective in their criticism of Government policies. I have held discussions with many of my friends, many of whom are professionals and highly intellectual people, but I can observe that they do not see things as widely as they should. They look at it usually from a narrow angle and sometimes their views are coloured by their own personal interests. Take the case of COEs (Certificates of Entitlement), for instance. Today, many still argue that since we have COEs, we can take away all the other taxes in the form of ARF, road tax, and so on. They think that because we have COEs to control the number of vehicles, it alone should therefore work. But they fail to understand that if you do that, then all the savings that you can have from other taxes like ARF will be transferred to the prices of COEs. In the end, who is going to suffer? The people who buy smaller cars are going to suffer. Why? Because at the moment the ARF works against those who buy huge cars. When a person does not have to pay his ARF any more, and assuming he is buying a big car, the amount that he saves would naturally be transferred to his bidding in order to ensure that he gets a COE. But there is no guarantee that he will get a COE.”
“The Government has done well to provide equal opportunities for every citizen to learn, to compete and to succeed in life, and a safety net to those who need it. It has also started an asset enhancement programme for Singaporeans. However, the Government could do more to strengthen its bond with the people. This can be done through paying more attention to the feelings of Singaporeans when implementing policies. While it is true that Government has always considered a wide range of reasons before deciding on a policy, it must remember that the ordinary citizen does not have the same perspective and he usually looks at it narrowly from his point of view. There must therefore be proper explanations, consultations and discussions to see whether any genuine problems, however small, can be resolved. A case in point is the recent changes in medical benefits and salary revisions for public sector employees. Up to today, there are still some unresolved issues. For example, if we accept that those who opt for the Co-payment on Ward Charges Scheme should forgo their salary revision this round, why should they be denied future revisions? There is also the unresolved issue of whether there should be a minimum increase of salary in dollar terms. How can the offer be attractive to some officers if it works out to be just $20-$30 a month? Under the Comprehensive Co-payment Scheme, while it is true that MediShield can help look after the co-payment when one incurs a substantial hospital bill, very few people understand fully how it works. Some workers have enquired at the CPF, but their apprehensions have not been removed because of the complexity of the scheme involving limits to daily charges and operation charges, etc.”
“Mr Speaker, Sir, one major factor for Singapore's success is our ability to learn from the experience and expertise of other nations. We formulated our policies by combining the good points that we have learned and avoiding the pitfalls that we have seen. Today, we have evolved a uniquely Singaporean system which others are now learning from us, because of our success. Our system is one which emphasises competition based on market principles to maximise results but maintains a strong sense of cohesion and fairness. This balance between competition and cohesion is the basis for a dynamic, just and progressive society. It underpins the principles, policies and methods in all our Government functions, be it education, health care, workers' welfare, housing or transportation. It seems to me that this is perhaps the only model that will prevent wealthy nations from declining which we have seen it happened too often in history. So if Singaporeans want to have more of the good things in life, they will have to compete to get them. This is the only way. But as competition becomes more intense, and as differences of achievements become more stark, greater efforts will be needed to maintain cohesion. The cohesion which we have developed among our people over the last 30 years has also enabled us to compete better against other nations. In our country, the Government works with the people. In our companies, the management works with the unions and the workers, and among the people, different races work in harmony. All these may not be true in other countries. So we need to maintain this advantage. The question is: how? Maintaining cohesion requires the effort of everyone -the Government, the employers, and the people.”
“Sir, the Deputy Prime Minister has mentioned that additional salary adjustment to offset the impact of the revised medical benefits package averages 0.5% for Division I and II officers and 1% for Division III and Division IV officers and DREs. He further said that the offset is sufficient as the higher co-payments will amount to only an extra 0.2% of Division I and II salaries and 0.5% of Division III, Division IV and DRE salaries. For those who do not fall sick, the offset is an additional income. But no one will know when he or she will fall sick and they therefore need to have the assurance that they can cope with the co-payment when they do. This is where insurance comes in. For hospitalisation, it is true that with Medisave and MediShield, there should be no problem for them to cope. But public sector employees are also concerned with whether they can cope with outpatient payments. This is especially so for those low income workers who may not have the cash to pay for certain outpatient treatments. There is therefore a need to look into providing insurance or health care plans for outpatient care for civil servants. Government should therefore look into providing the civil servant with an alternative of getting outpatient care. One suggestion is for Government to pay, say, 1% of the salary into his Medisave in lieu of benefits in kind for outpatient care and allow him to purchase an approved health care plan encompassing both outpatient and hospitalisation benefits. The Managed Healthcare System (MHS) plan which NTUC is working on hopes to provide civil servants the cover that they need for both outpatient treatment and hospitalisation. I hope the Minister will look into my suggestion. Sir, I support the salary revision.”
“If we are promoting ourselves as a medical hub, more pressure will be here, and how does that impact on us. The pressure of charges from there actually goes up. The nursing staff and the administrative staff in the private sector hospitals like to treat the foreign nationals because they also tip them very well, they pay very well, and they are less fussy than Singaporeans. I was told of this when I visited them. There is no fuss in getting through the CPF and Medisave approval and things like that. The other matter is the medicine fee versus the non-medicine charges. We were told at one feedback session that the medicines that the Government has in the hospitals, they actually charge something like five to seven times their cost. We do not know whether there should be a cap in the way medicine is priced. Even for a simple non-medicine thing like cotton wool and the gauze, they are charged at very high prices and different clinics and hospitals charge them differently.”
“It is our hope that the views described would contribute towards the successful implementation." So this suggests to me that they have not been consulted. Very quickly, they came out with the fear about the capping of the CPF and whether that will affect their income. They also go on to say, if I can quote the editorial: `One is likely to blame the doctor when health care costs go up. Besides the doctor's fees and the service fees described above, there are also administrative costs and it is important that these two are kept down. Doctors are at the mercy of free market forces too, the cost of premises and staff salaries ...' So what they are trying to say here is, do not just blame the poor doctors. But they are those who buy a lot of bungalows! The health care cost components are the doctor's fees, drugs, laboratory tests, hospital charges, operating theatre charges, and so on and so forth. Actually, the doctors also have the incentive to be doctors in that you are capping the number of doctors. As Assoc. Prof. Low has questioned earlier, is that capping itself sound in the long term? We seem to have missed out on the pressure from the fact that we are promoting ourselves as the medical hub. No mention is made in the White Paper about the impact of the foreign nationals seeking treatment in Singapore. The ratio is 1:650. But those who come here for medical treatment are the people who are coming here to exert the pressure. Very often, we know that specialists do charge the foreign nationals higher charges than Singaporeans. I was told of this, but I do not know how far it is true. How much of the incomes of these specialists and the hospitals actually come from foreign nationals? I think that part is not reflected in the White Paper.”
“So if the employers' group is also paying in that region, probably we could have, instead of percentages, a fixed quantum, to be fair to the lower income earners. It does not mean that the higher income earners will fall sick more often and need more medical attention. Many Singaporeans are actually worried about the affordability of the future. That is why, on and off, when we talk about the cost of living, the retirees are a group that we single out. Very soon, many of us Singaporeans will be on the retiring bench. So one way to actually allay this fear is to have a special retirement account. On good years the Finance Minister has been very generous in giving a 5% or 10% tax rebate. Probably, in future, instead of giving tax rebates, where they actually net off the cash, we could start a Retirement Account where the 5% or 10% tax rebate could go into that account. Over the years, they could accumulate a huge sum and they know that when they retire there is a sum for them to draw on for their old age. The health care cost component is something that we should look at. In the White Paper, we seem to have left out the doctors' participation. It is as if they do not matter. From what I read of the Singapore Medical Association's latest November Report, they were invited on Wednesday, 3rd November, to a feedback session to give their comments. They came out with a quick comment. They said that it was too short a time for them to study the White Paper. So it suggests to me that the different medical bodies have not been consulted. The report says that "the medical profession supports the general principle enunciated in the White Paper towards providing affordable health care for our people.”
“And if they do not claim it, we can waive or pay for their MediShield premium because they are not consuming the State's expenditure on health care. What about allowing discounted entries into sports facilities? Could it be that our sports facilities are charging exorbitantly that very few can actually have regular exercises? Even credit card companies give discounts for those who spend using their cards. What about lucky draws? We have a lot of condominiums to go by for lucky draws if they do not consume medical services. We have got to think of ways of getting people to maximise the incentives, and getting people to be concerned and actually put it on themselves. After a while it becomes natural that they will stay fit and healthy. The idea of MediShield II is good. The unions are worried that employers would just pass the buck to the workers but I think the union leaders are responsible. So are the employers' group. Under such a tight labour situation, they cannot just get away. But as the two Ministers have spoken, at the end of the day, whatever the company pays for, it is part of the wage package. That is clear. But the 2% cap on salaries is not fair to the lower income earners. I think the executive workers are drawing a higher salary and topping up 2% on their salary is not fair. I am happy the Minister for Finance has said that for the civil service they are capping the 1% up to $7,000 of salary. But a fairer thing would be a quantum for the two groups: an executive group and a non-executive group. Probably even the age group has got to be taken into consideration. The civil service is talking about a cap of $350.”
“Because the very purpose is to ensure that we have a health care system that is: (a) sound, (b) equitable, (c) fair, (d) sustainable, and (e) not detrimental to the country. The Government cannot promote an irresponsible free spending system that will bankrupt the country. Minister Dhanabalan had yesterday explained that all subsidies are ultimately paid for by the people. If we run into debt, then we are talking about following the western world that actually makes the future generations pay for what they consume today. I think that is not allowed and, in fact, it should be the duty of the Government to keep away from such pitfalls. The fact is that users of health care must pay. I fully agree that we owe it to ourselves individually to keep fit and healthy. But from the report we are just talking about 14% of Singaporeans who are actually actively exercising. So the Government intends to give the individual maximum incentives to stay healthy, save on its medical expenses and avoid unnecessary consumption, resulting in huge wastage. On the question of incentives, probably we could venture a little further. As we all agree, prevention is better than cure. A fit and healthy individual actually benefits the company and the country as well as himself. Therefore, we should introduce even more incentives. On the part of the State, what about following the National Service reservists' fitness scheme where we could give them some incentives, maybe a personal allowance of $1,000 per annum, based on a certificate of fitness, and not entitlement, if they keep fit? What about rewarding those who do not consume the State's health care expenditure? It is like the insurance no-claim bonus.”
“If we allow Medisave to pay for the private medical insurance, we will encourage people to participate in private medical insurance schemes. I do not think this is a good move. If there is any good reason for having a specific medical insurance, it should be run by a non-profit making enterprise, every citizen should participate in this scheme and with some form of co-payment like MediShield. In this way, the insured will use his own resources to pay for part of his medical expenses to avoid excessive and unnecessary medical consumption. With more people participating, it will be more cost effective and the premiums could be reduced. The White Paper also mentions about the implementation of MediShield II. However, the White Paper does not give details on the implementation of this scheme, except stating that the insured patients be allowed to use this to pay for A class ward expenses. This will certainly lead to the consumption of more medical services. People would then choose to stay in the A class ward because of this scheme, otherwise, he would just stay in a B1 class ward. This will run counter to the principle of the White Paper. Sir, apart from the comments I have made above, I would like to support this motion. Mr Chia Shi Teck (Nominated Member): May I first refer to Mr Low Thia Khiang's point that the Government is duty-bound to provide for the medical needs of the people. I think those of us who have read the White Paper can clearly see that that is precisely what the Government is trying to do. The Government spells out a health care philosophy based on the five fundamental objectives. If the Opposition Member has read them, he should say whether those objectives are fundamentally wrong or whether he has better ideas than those fundamental objectives.”
“I do not think it is a good move to increase the contribution rate to Medisave, because the direct result will be that there will be big sums of money in the people's Medisave accounts. It cannot be used for other purposes except to purchase medical services. People would then tend to use this money for their medical expenses, excessively and wastefully. I feel that there should be other ways in place of the proposed increase in the contribution rate towards Medisave, such as allowing the account holders to transfer a limited sum of money from their Ordinary Account to Medisave account to pay for their medical expenses. This will give them flexibility to make use of thei6r Ordinary Account for medical expenses or to use it on buying property and investment. In this way, it could heop in avoiding the rising health care cost. Thirdly, private medical insurance. I feel that this scheme, if not handled properly will lead to wastage in medical expenses. If we do not restrain the use of private medical insurance, we will fall into a trap similar to that of the US medical insurance. Fortunately, these private medical insurance schemes are not quite popular in Singapore. The White Paper mentions that we can use Medisave to pay for private medical insurance. I do not think it is a good move because this will encourage more people to buy medical insurance. The White Paper also mentions the fact that the medical insurance companies have been spending 22% of their budget on administration. If, including the profit of the insurance company less than 70% of the premium will be used on medical expenses. The medical insurance scheme, directly leads to the increase in health care cost.”
“However, the recommendations in the White Paper seem to be in conflict with the general principle. We should study them more carefully. First, doctor to population ratio. The White Paper mentioned that the present ratio is one doctor to 800 people and by the year 2000, the ratio will be increased to one doctor to 650 people. The number of specialists will be 40% of the number of doctors. This doctor-to-people ratio and the ratio of specialists to general practitioners are quite similar to those in the UK. We know that the UK government has met with immense difficulties in their health care system. So this makes me wonder whether the ratio that we propose is advisable. Is it higher than that in the UK? Is the rate correct? If you take into account the density of population in UK, we will find that our doctor-to-population ratio is much higher than in the UK. I think we should re-consider it. Following the principle outlined in the White Paper which mentioned that the medical demand is supply initiated, the over-supply of medical services, including doctors, the health care cost is bound to go up. Secondly, Medisave. The White Paper recommends that we should increase the Medisave contribution rate in order to make up for the increase in health care cost. Eventually, it will be increased to 10% of the salary. Although Medisave is a good scheme, we should understand that Medisave is also a contributing factor towards rising health care cost. We observe that more than half of the newborn babies in Singapore are delivered in private hospitals and that 17% of patients who live in A class wards are earning salaries of less than $1,000 per month. Why is this so? I feel that this is because of the generous use of Medisave fund.”
“NTUC hopes to discuss with the Ministry of Health the details of the scheme so as to obtain their support to treat MHS as an approved health care plan to draw on Medisave. Sir, I support the motion. Assoc. Prof. Low Seow Chay (Chua Chu Kang)( In Mandarin): Mr Speaker, Sir, the White Paper on health care is a result of realising the immense difficulties faced by the advanced countries in the West, in their health care problems. This White Paper provides a health care programme which will not burden our State and our people. I fully support the philosophy of the White Paper that the State should provide health care to every one, including the poor and destitute who cannot afford to pay for their health care expenses. A lot of space has been spent on explaining how to curb rising medical cost due to uncontrolled medical cost and consumption. I agree with the two approaches mentioned in the White Paper. Firstly, avoiding the stimulation on excessive medical consumption due to health care over supply of services. Secondly, we should curb those unnecessary medical demand due to over-subsidy and free medical care. There are many reasons for the long-term increase in health care cost. Many MPs have already spoken on this. But I feel there are two major reasons. Firstly, the general rise in costs and, secondly, the increased consumption of health care. The former is an economic issue which is directly linked to the rise in prices in the market place, and it is not easy to curb or to overcome it. But the latter, I think if we can curb the excessive use of our health care services, we will be able to moderate the rate of increase in health care cost. If we can curb or put a restraint on those unnecessary consumption of health care service, I think we will achieve our purpose.”
“There is therefore a need to increase the element of personal responsibility in this regard. Second, unions can consider co-payment if employers are prepared to extend medical benefits to dependants, just like the Government has done. Third, employers, with the support of unions, can convert their medical benefits to the Managed Healthcare System (MHS) which NTUC INCOME and NTUC Healthcare Cooperative will be offering next year. MHS is different from a normal medical insurance scheme. Physicians in the normal insurance scheme have no incentive to save on medical costs because they are paid on a fee-for-service basis. Under the MHS, which provides for primary, specialist and hospital care, physicians providing primary care will be paid on a capitation basis, ie, a fixed sum per member regardless of the actual utilisation of medical care. This will minimise over-treatment by the physicians, who will be given incentives to serve as "gatekeepers" to keep out unnecessary specialist and hospital treatments. At the same time, co-payments for consultation and cappings or deductibles for hospital care will be introduced to promote personal responsibility. A system of providing rebates to members who do not make excessive use of medical care will also be put in place. Monitoring the utilisation of medical care and the treatment outcomes will be done to ensure that members receive good quality care. Managed health care is not new in Singapore. Our system of polyclinics, secondary and tertiary public hospitals offer a form of managed health care. We should bring managed health care into the private sector and the NTUC MHS will be an attractive scheme to treat patients in the most cost effective way.”
“They are concerned about the co-payment they have to make for treatment charges and whether Government will give them enough compensation in terms of wages. This fear of uncertainty is particularly felt among the older employees. In fact, many of them hope that they can opt to stay in the existing scheme, ie, to continue to enjoy the treatment free of charge. And even if change is certain, they would want to know whether the Government would allow them to buy an insurance plan to cover their co-payment. In other words, because they are old and they know that they are prone to be hospitalised, they do not know whether they can afford the co-payment. So for the co-payment part, they would like to buy an insurance plan so that they are fully covered. I wish to seek the view of the Government on this matter. Sir, for the private sector, there are a number of possibilities for employer medical benefits to include an element of personal responsibility. First, it can be in the form of deductibles or co-insurance, although the latter will be more difficult to accept for older workers. Deductibles are likely to be acceptable because there is less uncertainty. Savings through the new introduction of deductibles can be passed back to the workers. Alternatively, employers can consider setting up reimbursement accounts that employees can use to satisfy deductibles and co-insurance or pay for uncovered health care services. According to our CA analysis, more and more companies are adopting medical insurance policies to cover workers' hospitalisation expenses. The percentage of companies with medical insurance policies is now 31% compared to 10% in 1989. These policies have no deductibles or co-insurance although there are caps on the entitlement.”
“On the personal responsibility aspect, it is generally true that when an employee has to pay part of the medical services at the point of consumption, it will give him the incentive to use medical services responsibly. The NTUC will encourage unions to consider incorporating this aspect of personal responsibility in their future CA negotiations. However, to enable unions to be receptive to such changes, we must address two legitimate concerns they have. The first is that such changes should not result in costs shifting from employers to workers. Workers should not become financially worse off for the same benefits they enjoy. Second, the effects on older workers have to be specially looked into as they are more likely to use medical services. The Government will be taking the lead as the largest employer. For new recruits, they will receive additional Medisave contributions over and above the statutory Medisave contributions. The Finance Minister has earlier briefed us on the new scheme but he has not touched on what the MediShield II Scheme will be like. Because for those who opt for the MSO Scheme, they will have to use their Medisave to purchase medical services. At the moment, they cannot use that to purchase an insurance scheme and we know that the existing MediShield Scheme is too conservative. So we look forward to the new scheme and we hope that the improved MediShield or MediShield II should provide sufficient hospital coverage for them and their dependants without depleting their Medisave. As choosing a level of medical services to suit one's needs is not a straightforward matter, the Government should provide consumer education to the new recruits. Existing Government employees are already paying 20% of their hospital ward charges.”
“On the supply side, I fully support the Government's proposal to regulate key areas of pricing and operations of subvented hospitals and control charges of private sector Medisave patients. This will help ensure that treatment is carried out only when there is medical necessity and with the most cost-effective means. On the demand side, workers have to accept two things. First, they must realise that asking from employers better and better medical benefits, CA after CA, is not necessarily good for them. Second, they must accept certain personal responsibility in the utilisation of medical benefits. During the public debate on escalating medical costs last year, some employers have expressed concern that unions have been pushing for better medical benefits in each CA negotiation. The NTUC has since advised unions that this may not be a wise thing to do. High medical costs will not only affect wages directly, it can erode the competitiveness of a company to the detriment of both the employer and the employees. To find out whether our unions have taken heed of this advice, I did a check on all the CAs that have been signed in 1993. There are 126 of them covering almost 19,000 bargainable workers. I discovered that only four unions covering 9% of the workers have asked for their class ward entitlement to be upgraded. Two of them upgraded their ward entitlement from C to B2 and the other two upgraded from B2 to B1. On the other hand, there are three unions covering 12% of the workers which have actually lowered their class ward entitlement from B1 to B2 or from B2 to C on an optional basis. Workers who opt for a lower class ward will be given an allowance. The above observation shows that our unions have, by and large, taken our advice.”
“Mr Speaker, Sir, the NTUC has set up a Committee on Health Care Policies to examine the implications of the White Paper, especially on medical benefits for workers. The Committee is examining how employer medical benefits can be restructured to ensure that workers continue to be provided with good health care, without leading to excessive costs. As Chairman of the Committee, I wish to share our preliminary findings and position. Workers currently enjoy both outpatient and hospitalisation benefits provided by employers. A recent analysis based on almost 1,000 collective agreements (CAs) in the unionised private sector reveals the following: For outpatient treatment, the majority of companies (about 99%) allow workers free medical treatment if prescribed by a company doctor, or company appointed doctor. Most companies do not allow workers to consult a private doctor unless there is an emergency. For hospitalisation benefits, while 20% of the CAs impose no limit to total hospitalisation charges, the remaining CAs exercise cost control through a cap on hospitalisation entitlement. Such caps come in the form of either a limit to the maximum number of days of ward stay, or a limit to the surgical or specialist fees incurred per year, or per disability, or a predetermined level of coverage under medical insurance schemes. The controls on medical benefits exercised by employers have, to a large extent, prevented abuses. What is lacking are incentives to the worker and his doctor to save on medical costs. When a third party, either the employer or the insurance company, is picking up the tab, it is natural that the patient (the demand side) and his doctors (the supply side) will be less cost conscious.”
“The US has developed and refined an approach called the Diagnosis-Related-Group (DRG) to control medical costs. DRG is a classification system of illnesses based upon medical diagnosis, sex, age and procedures performed and stipulates the average cost of treatment. Although such a system is complicated, it is a good way to control charges. Sir, controlling charges for private hospitals is also necessary because their practices have a significant impact on the public sector. The public sector has had to raise the earnings of its medical staff to prevent them from leaving for the private sector. If we do not control private hospital charges, then a vicious cycle may happen resulting in the spiralling of earnings of doctors and charges in both private and public hospitals. One way is to cap what private hospitals can charge when treating Medisave patients. This will protect most Singaporeans as most will have Medisave accounts or use their Medisave for their immediate family members. It will ensure that their Medisave will not be depleted too quickly. Sir, many countries have found it necessary to control hospital charges. Some countries limit balanced billing, ie, charges that a doctor would bill patients on top of what certain approved insurance or medical schemes would pay him. In the United States, the government provides the elderly with a medical scheme called Medicare. The United States government also requires hospitals, when treating Medicare patients, to follow a certain schedule, the DRG schedule. Sir, I therefore would like to ask the Minister whether MOH has any intention to control charges for both subvented and private hospitals, and whether they would look into using DRGs.”
“Sir, the US experience has shown that the health care system is a case of market failure. Supply generates its own demand. The consumers, ie, the patients, are not in a position to decide what kind of treatment he needs, what kind of tests or drugs are required and how long he needs to stay in the hospital. So when you have more doctors, more hospital beds and more and newer medical equipment, the tendency is for supply to chase after demand and to provide more services than necessary. The US situation is also aggravated by the practice of unrestricted and open-ended medical insurance. It is further compounded by the fact that, to protect themselves from malpractice suits, tests and more tests are ordered to be potentially part of a legal "record" rather than of practical value. The lesson for us is clear. We must control medical manpower, the provision of medical facilities and health care financing. We must do it now before we get to the stage where the US is in. I therefore support the Government's plan to limit the overall number of doctors and specialists. But more needs to be done. Not only should the provision of medical facilities, ie, the number and classes of beds and the types of specialisation and medical equipment in restructured and Government hospitals be controlled and coordinated, what is even more important is the regulation of medical charges for both subvented and private hospitals. The logic is simple. Once we decide to control supply, we must also ensure that charges are reasonable. Controlling charges will also force the hospitals to be more efficient and make services more affordable. The concern for service quality can always be met by proper medical audit.”
“Sir, I thank the Minister for his answer and I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $248,428,600 for Head M ordered to stand part of the Main Estimates. The sum of $207,785,400 for Head M ordered to stand part of the Development Estimates. Head K -”
“Sir, I would like to testify to what the Minister had said about old cars using unleaded petrol. I own an old car and I was reluctant at first to switch until a friend of mine told me that many Americans in America use unleaded petrol for their 10 or 20-year old cars. I did a switch and found that it did not affect the performance of my car. Sir, the question I would like to ask the Minister is this. Does he have any idea how much it will cost the existing vehicle owner to modify his car to use the new coolants, the non-CFC based coolants?”
“Sir, at the fourth meeting of parties to the Montreal Protocol held in Copenhagen in November 1992, the phase-out schedules of CFCs and other ozone-depleting substances of the Montreal Protocol had been accelerated. Is Singapore complying with this accelerated phase-out schedule? I understand that the phasing out of ozone-depleting substances will not only affect our industries, but it will also affect the general public. Most of our air-conditioning systems for offices, homes and cars use coolants which are CFC-based. Their systems will probably have to be modified when such coolants become unavailable. Would the Minister tell us when will our offices, homes and cars be affected, whether there is a replacement for the coolants, and if not, what are the things people need to do to continue using their air-conditioning systems?”
“Sir, I beg to move, That the sum to be allocated for Head M of the Main Estimates be reduced by $10 in respect of Code MF 1500. Sir, the variety and volume of chemicals and chemical products handled in Singapore have been increasing rapidly due to the success of our industrialisation programme. While this contributes significantly to our economy, it will also pose a great challenge to both the industries and the Government to maintain a safe and healthy environment expected by the workers and the public. 1.00 pm The Government has so far been able to avoid major chemical disasters through stringent controls and legislation. However, some of the chemical plants have been in existence for some years now. Whether the original design for safety controls is adequate or is still within the safety standards after a number of years of wearing down is of great concern to the workers and the public. There is therefore a need for companies in the chemical industry to perform regular safety audits for their plants. May I ask the Minister whether such requirement is being worked out for these companies to follow so as to protect both our workers and the environment.”
“Sir, before I withdraw the amendment, I would like the Minister to consider carefully the implications of the two alternatives that he mentioned for the collection of refuse. First, by using a pre-paid bag, we may cut down the volume, but not necessarily the weight, which means that the waste generated can still be the same, but it is easier for collection. Secondly, the variable bin might encourage people to dump their rubbish into other people's bin. These are the implications that I hope the Minister will look into. Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, the Government launched a Green Labelling Scheme last year and a number of product categories were released to promote green consumerism. The success of this scheme will be judged not just by the initial number of companies applying to join the scheme, but also by the response of the consumers to the green products. Can the Minister tell us what is the progress made on Green Labelling, whether the green products have received good response from the consumers, and what else the Ministry would do to further promote green consumerism?”