Khaw Boon Wan
Singapore
“Motor vehicle dealerships and showrooms have been closed since the start of the circuit breaker. As COE bidding is done mostly by the motor vehicle dealers on behalf of prospective owners, the Land Transport Authority (LTA) suspended COE bidding for the months of April and May.”
“Though stressed by the financial pain, they press on with the immediate priority of fighting the virus and supporting essential services. Post-pandemic, we will see how public transport evolves. Will demand for public transport services simply return to the pre-pandemic level?”
“Under our rail financing framework, the Government fully pays for the cost of building new rail lines. In other words, we do not recover the cost of building the Cross Island Line (CRL) from commuters through fares. The CRL project is being implemented and the final costs will depend on tender bids.”
“There are around 5,000 private bus operators with a combined fleet of 13,500 private buses. As we do not track the number of private bus trips and passengers, we do not have data on their carbon emissions.”
“There are nursing rooms at 50% of our bus interchanges. We will provide nursing rooms at all new bus interchanges and integrated transport hubs. For the MRT network, we will provide nursing rooms at all new interchange stations. We will also explore providing such facilities when MRT stations undergo upgrading.”
“Over the last three years, Singapore carriers have reported a total of 20 incidents of food allergies on board their flights. None required the use of epinephrine or emergency flight diversions.”
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“Madam, may I seek your consent to move that progress be reported now and leave be asked to sit again on Monday, 7th March 2011?”
“But I took comfort that when I last looked at cancer patients – because cancer is more predictable, in the sense that we know there is a prognosis, and if the patient is at an advanced stage, the doctor cannot be precise about how many weeks or months but, at least, if it is end stage, they can plan for their end of life – the majority are able to die at home supported by us, whether it is HNF, hospice movement, home care or whatever. And we will see many more such cases, going forward.”
“Madam, Mr Low is correct that home care and home hospice are important. Those are all part and parcel of long-term care. We use the term "long-term care" because it is easy to use, easy to say and we define it loosely. I use it to mean any healthcare outside the hospitals. So it includes a wide range – community hospital, nursing home, hospices, home healthcare – and, increasingly, home care will be a significant segment of that. We must develop and expand all those. I see this whole journey as trying to improve quantity, that means scale it up; quality, that means, for example, the nursing home's rehabilitative activities must be able to be scaled up, ie, upskilled, and also have diversity. Because, in terms of different kinds of services, the needs may vary, different families have different needs and different patients may have different needs. So all those efforts will be what we are embarking upon over the next few years. We definitely would have *Cols. 3837-3838. to pump in more money and resources into all these. But back to the Member's point about home hospice and home care, the VWO home hospices are all funded by the Ministry of Health. While they raise donations and get supported by the public, they also receive subventions from the Ministry of Health. But as we scale up, of course, more subventions will have to flow down by the sheer increase in clientele and services that they are providing.”
“He says, "you have to re-brand it – stop calling it a nursing home." For this new generation of nursing homes that I hope to create, he said, we should call it "convalescent homes". A patient goes there for convalescence with a view of going home. In fact, the Chinese translation of nursing home is quite a good one, liao yang yuan (疗养院) (nursing home), and that is different from lao ren yuan (老人院 ) (old folks' home). (In Mandarin): [For vernacular speech, please refer to Appendix A*.] When you go to an old folks' home, you go there because you have no home and no children who look after you. So it becomes a home for old folks. Whereas the nursing home is like a hospital, except that there are no specialist doctors because they are not necessary.”
“Madam, since it is rather late in the day, let me continue in English. In layman's terms, the simplest is to look at the length of stay. I look at nursing homes as a facility, not unlike a hospital. When a patient goes to a hospital, he expects to get well and then he goes home. Likewise, if a person goes to a nursing home, because he has some disability, he hopes to improve so that he can also go home. But because rehabilitation takes a longer time, it may take several weeks or, often, several months. Whereas an old folks' home is one where somebody may not be severely disabled, but because he has no home to go back to – he has been forsaken, and therefore he is in a sheltered home. That is an old folks' home. Unfortunately, over the years, our nursing homes are behaving almost like old folks' home, because the patients go there and hardly come out, except when they die. So I am putting this challenge to the nursing homes – let us improve on our ability to rehabilitate the patients. If a patient goes in and, say, he is unable to do three activities of daily living (ADL), we hope, after a while, we can reduce it to two activities, and then reduce it to one, and then the patient can go home. That, I think, is success. In some countries, they have been able to do it. But to do that, we need many more physiotherapists, occupational therapists, rehabilitation specialists, etc. We need money which we will inject. Again, coming back to the $1 billion Community Trust Fund, that is what I want to tap on, to work together so that we can upgrade the nursing homes. But because of this historical baggage of nursing homes, which are almost like sheltered old folks' homes, Senior Minister Goh has a suggestion for me.”
“So, if we look at public hospital inpatient care, the Government subsidy is much more than half. I do not know – maybe 70%, or 80%. Then half of the remainder is 3Ms – Medisave, MediShield and insurance. And the rest is employers and out-of-pocket. When I gave that figure and I dived deeper into the breakdown, it gave me a lot of comfort. I think with many years of careful planning in our 3Ms healthcare financing sector, we have got a system which is not bad. Let us do not do silly things to destroy it.”
“45 pm What is the contribution for the 3Ms? I cannot recall the answer in 2000 that Ms Sylvia Lim mentioned. But the recent reply I gave about the 3Ms was because I wanted to give a meaningful answer. National health spending is a big basket of things. It perhaps includes buying and selling of herbs like ginseng, or cordyceps. All these, we all know, are personal expenditures. Over-the-counter drugs, like supplements, aesthetic treatments, and they too are in the national health spending. Whereas 3Ms is very specific, largely for inpatient care in public hospitals. In fact, it is also for private hospitals, because we also open it to private hospitals, largely for inpatient care. In recent years, we have opened it up to some outpatient care, but it remains small. Therefore, I have said that if we want to look at contribution, then we should compare apple with apple, ie, we should look at 3Ms spending versus total spending on inpatient care. Then it is a more meaningful figure. Whereas if we look at 3Ms spending versus total health spending, which includes aesthetic medicine, etc, and worse in the case of Singapore, because we have a significant medical tourism sector, even foreigners' spending also comes into our national health spending. So what meaning does it give? If I give her a figure, what does that mean to her? That is why I compute it to say, 3Ms versus inpatient care which includes public and private hospitals. And I thought the figure says a lot about our funding system in Singapore. If she reads the answer carefully, half of inpatient care was borne by Government. This is not just inpatient care in public hospitals but also inpatient care in private hospitals, which includes foreigners' spending, and so on. Despite all those things, it is half.”
“First, on the question of transparency, I have no issue with greater transparency. My colleagues know me well that in the Ministry of Health, I have a statement, which is "there is no secret in the Ministry of Health". There are only two secrets in the Ministry of Health. One is personnel records of staff; two is patients' records. That is privacy. Everything else is to be open because health policies ought to be argued on logic. If I formulate a particular policy, those are the assumptions and reasons. If you have a better way of doing it, I would like to know too so that we can change the policy. I now hear Ms Sylvia Lim talking about possible benefits of making this list public. I really have no problem. If need be, we just put it on the website, except that it will be a long string of chemicals. My initial reaction was what value does it give, other than satisfying some curiosities. But if it is so important, for me, putting up the list is not an issue at all. What we do not want is intense lobbying by pharmaceutical companies for self-interest and they have subject me to lobbying very often. Every time a top CEO comes to see me, we usually do not talk about other things. He would say, "Please put my new drug onto your list." This is self-serving, not so much to improve the health of the people in a way which is sustainable and affordable, because some of these are very expensive drugs, when cheaper options are available. One of the reasons why we spend 4% and America 18% is this – we use lower cost alternatives, because they are equally effective. Why should we over-spend and spend additional money? But we will take a look and see if it is really so important to many people to put this list on the website. I personally have no problem at all. 6.”
“The answer is "yes", and I agree with Mdm Halimah. That is one of the motivation behind this $1 billion Community Trust Fund. The objective is really to upgrade long-term care. We are happy with current level of long-term care as provided by the VWOs all these years. I think we are grateful to them for delivering this level of service, but what we are hoping in the next decade is to raise it to a much higher level of capabilities, especially in rehabilitation. They would need money, they would need skills, they would need training and they would need resources. That is what this $1 billion injection of fund is meant to achieve, and we would do it in a way without displacing the VWOs. As I said just now, if we come in a big way, and then get them out of business, push them out and become a public service, I think we would be poorer for it. The ideal situation is how we can combine funding both from the Government as well as from society, but, more importantly, professional skills of the Ministry of Health with the community VWOs' passion and compassion. If we can combine the two and fuse it well, I think we will get a world-class long-term care. This, I am optimistic and I am confident. We cannot achieve it in one year. I think we probably need a decade to achieve this transformation. But if we do it well, in five years we should be able to see significant difference.”
“Therefore, the more we are able to get them socially engaged, that is most crucial. That is why Minister Lim Boon Heng's Committee is so busy, working with all Members on the Wellness Programme in the community. Let us support him and his Committee – get our residents out of their apartments. But for some who have difficulty because they are not able to move about, this Fund of $10 million will come in handy. The approach we are taking is not a macro bureaucratic way, whereby the Ministry of Health is the one who invites applications and then assess them. That is a wrong way of doing it. But we will give money to the local VWOs. Our job is to sniff around and see which are the good VWOs doing good work on the ground, helping these residents to move around, and then we will support them with the money. It is not restricted to just devices. That is why I talked about services. It could be a transport service, if necessary, to bring the seniors to a day rehabilitation centre, which we know is a major gap on the ground currently. We will work through the VWOs. If we should set up a technology centre of a higher caliber research type, then $10 million is not enough. But we will have facilities where we help senior citizens who have stroke or whatever to shop around for devices that will help them move around. We do have those centres. We set it up in Khoo Teck Puat Hospital and, I think, in due course, there will be similar facilities in some HDB towns. As for the completion date, I mentioned 2020 to be safe, but I will work very hard to try to bring it forward, if we can. 6.30 pm”
“Madam, the size of the Sengkang General Hospital is one of the subjects that we are studying now. It is part of the planning. But Members can assume that it will be similar to Khoo Teck Puat Hospital. It should have a capacity of 500-600 beds. It depends on the catchment population size. That is some of the data that we are looking at. But it will definitely be a full-fledged general hospital, meaning that it covers all the major disciplines. The idea of a regional general hospital concept is that in each region of sufficient population, the general hospitals plus its partners – community hospital, nursing home and so on – should be able to look after maybe 85% to 90% of the healthcare needs of the region. It is only the occasional patient with cancer or severe transplant requirements, who need to go to SGH or NUH. In this way, it brings convenience for the people but, of course, it does not mean that if you are a resident in Sengkang, you must go to Sengkang General Hospital. You are free to choose to go to Changi General Hospital or Khoo Teck Puat Hospital. That contestability must always be there, and that will bring about better service level. On the Seniors Mobility Fund: the key word is "mobility". We are quite prepared to define it widely and loosely. Anything that will help the seniors move around. We look at it from the outcome point of view. Right now, you are stuck and you need a wheelchair or you need a walking frame so that you can move around, and move out of your apartment. I think talking to our patients, one clear conclusion is always this for the elderly. The moment they lock themselves up in an apartment, almost certainly their health condition just goes downhill. It does not get better.”
“They do facilitate the Diploma graduates from continuing on to get a foreign degree. That approach will continue. Ms Ellen Lee noted the setting up of TCM clinics in many hospitals and asked if we should allow them to be set up in polyclinics. There are more than 1,000 TCM clinics in Singapore, mostly in HDB towns. I believe access to TCM clinics is not a major issue. Wellness-centric community health model Assoc. Prof. Fatimah Lateef: Madam, the incidence of lifestyle diseases continues to increase. Singaporeans must take ownership of their health. We need to do more to facilitate this, encourage more proactive health promotion and people coming forward for voluntary screening. Our infrastructure too has to support this. These are some of the ways and essential ingredients I would like to mention. First, a more proactive health promotion programme that increases awareness of health risk associated with certain personal behaviours. Two, patient-centric health management goals. Three, encouragement to have a single provider relationship where they can receive on-going education, primary care and advice on specialty care. Four, continued surveillance of health indicator factors. The most important step in all these is actually strengthening our primary care set-up with more seamless community care centres, integration across GPs and also family practitioners as well as polyclinics and more ambulatory care set- up in the community in the various areas. Can I know MOH's plan pertaining to this? Rising obesity in Singapore”
“Whether this will change in the future will depend on how TCM intends to reform its practice and approach. In fact, it is also not obvious if TCM needs to or even if it wishes to, can reform and emulate the western medicine approach. China, for many years, has tried to integrate TCM and western medicine and has not found it easy. One professor in Nanjing TCM University, when I visited them, told me they tried and the result was liang bai ju shang (两败俱伤), that means both sides suffered when they tried to integrate east and west. Zuo bu lai ( 做不来), that is, they cannot do it. If you look at the outcome, there are many times more western-trained doctors in China than TCM-trained physicians. Meanwhile, we will continue to raise their level of professional standards within the traditional TCM framework. TCM practitioners wishing to upgrade themselves with a degree have several options. The two local TCM colleges have partnered PRC TCM universities. Their Diploma graduates can go on to acquire a recognised PRC degree. The NTU also runs a double degree programme in Biomedical Science and Chinese Medicine course. I heard Mr Chan Soo Sen's comments just now. He might be mistaken. It is not as if the Diploma graduates of the local TCM school cannot continue to train and get a China university TCM. They can. It is no different than say a nurse in Nanyang Polytechnic and with a twinning degree programme that we are now trying to set up through MOE, will finally get a degree from, say, the University of Manchester, or whatever. Likewise, it is the same thing here. What MOE does is to regulate which institution in Singapore can issue a Singapore Degree but for Diploma, that is a different story.”
“I think that is a possible niche role for us in TCM. Likewise, some of our western-trained doctors are very interested in TCM and I know they have started doing joint studies and clinical trials with TCM physicians. I know of a small group in SGH which has been doing similar studies for several months now, looking at diabetes because the Chinese have their own way of treating diabetes too. Of course, there are western ways of treating diabetes. We want to see, through such joint efforts, if TCM improves the effectiveness or outcomes. If we can subject those TCM practices to scientific scrutiny and then publish them in western medical journals, that would be of benefit to the world. Perhaps, this could be another niche area for Singapore. Over the next few years, I certainly hope the TCM leadership can think through these questions, and there could be other possibilities to help us determine the way going forward. If the TCM legislation needs to be amended to facilitate the next stage of TCM development, I would be happy to do so. But we must acknowledge the vast difference between TCM and western medicine, both in philosophy and in approach. They are two different things, almost like two different religions. The different regulatory regimes reflect these differences. The global healthcare system is based on western medicine. TCM is considered as a complementary medicine, regulated to different benchmarks. A TCM physician is not regulated to the same extent as a western-trained doctor. A Chinese herb is not regulated to the same degree as a western drug. That is the reason why Medisave does not cover TCM and that is also the reason why many employers do not accept medical certificates (MCs) issued by TCM physicians.”
“They pumped in money so that the course is heavily subsidised and parents will find the fees affordable. 5.45 pm Ms Ellen Lee and Mr Chan Soo Sen spoke on TCM. As pointed out by Mr Chan, we have now 10 years of TCM regulation and we have made some progress in raising the standard of practice and training. Of course, there is scope to do much more. To me, the key question is this. Going forward, do we simply just copy what China is doing and then adapt it here? Or do we try to forge a niche role for ourselves in Singapore, given our different history and greater exposure to western medicine? I believe either approaches are sensible. The second approach is, of course, much more challenging but it also opens up new opportunities. Let me give some illustrations. For example, for western drugs, it is standard practice to report adverse events. Some patients may take the drugs and had some problems, and adverse events have to be reported to the Health Sciences Authority (HSA) routinely so that we collect those information, get them analysed and we can give proper advisory to the consuming public. But this is not done for Chinese herbs. Likewise, there could be adverse events as a result of taking Chinese herbs and western drugs. Are there adverse events as a result of the interaction between the two? If so, I think somebody, somewhere, need to know. There are really no such good resource centres, not even in China. I have been discussing with HSA because of their expertise in western drugs and I have also discussed with the leadership of TCM recently. Can we not do something like this? We can develop a resource centre. It will not only be good for Singapore but it may become a very good resource centre for the region, or even for China.”
“There is a wide spectrum of mental illness, not everyone and it is only a small number who may cause danger to themselves or to others, and those patients are all in IMH. Those that we released back to the community, they have stabilised. The key is we support them and, from the doctors' side, make sure that they take their medications. Mr Laurence Wee and Mr Chiam See Tong spoke up about a different subject of helping the parents of children with special needs. Children with development difficulties are prone to displaying difficult behaviour; aggression, disobedience or even engaging in dangerous activities, and it is a major, major source of stress for the parents and can even impact their mental health. All these can take a toll on family relationships and, often, parents are just at a loss of what to do. KKH and NUH have been conducting Parents' Forums for a long time for such parents. More recently, we have a new initiative which we are very proud of – KKH is partnering an Australian Parenting Research Centre to launch a training programme to equip parents to understand their child's difficult behaviour and develop their own ways to manage them effectively and prevent the further development of behavioural concerns. This is a parenting support course, delivered through a network of qualified facilitators. The original programme in the state of Victoria, Australia, has been around for several years and has been very successful. We are bringing to Singapore, adapting it to local conditions. We hope we can achieve the same results as it did in Victoria. Here again, money was not an issue. We get the support of Temasek Care which is a foundation of Temasek Holdings.”
“Mdm Cynthia Phua talked about the hotline in IMH currently serving essentially their discharged patients. The intent, certainly, is for such a national helpline to look after all patients, not necessary just ex-IMH patients. Third, we will help our patients pick up skills needed to return to the workforce so that they can achieve independence in the community. This is key. To avoid relapse, the better we are able to get them properly reintegrated back, the best chances of recovery for those patients. But to do so, I need the support of many more enlightened employers to provide job opportunities for these ex-patients. The Institute of Mental Health (IMH) has a "Job Club" which helps to support patients' reintegration to the workforce. Since its launch in 2009 – so that is less than two years – more than 550 patients have been successfully placed within the Job Club scheme. We certainly need more employers to come forward to help us. For us, we will continue to provide the service providers with adequate funding. Recently, the Tote Board Community Healthcare Fund has pumped in an additional $15 million for us to push this programme. It is a very important boost to our efforts and I will always try my best to seek more funds to support this cause. My sense is this: that actually money is not the real bottleneck, but enlightened people, whether it is employers or family members or neighbours who are prepared to keep their minds open and to accept that this somebody – fellow Singaporeans, fellow human beings – let us give them a hand. If IMH decided that they can be returned to the community, it is safe.”
“By that I mean we have tried it out in small areas of Singapore and now, in the final stage, we want to bring it up nationwide. But the initial results are promising, improving quality of life for the patients and their families and, importantly, reduce their re-admissions to hospitals – usually IMH. We are scaling up the programmes nationwide. We certainly need to involve the community much more intimately. First, we are building up a community network to support the patients through neighbourhood social services, general practitioners (GPs), polyclinics and other care centres. Today, we have a GP Partnership network where stable patients are put on a shared-care programme with GP partners managing and providing follow-up in the community. This way, patients do not have to go back to IMH and it is also much more convenient for them. There are nearly 50 GPs and more than 600 patients on the programme. We are also putting multi-disciplinary mental health intervention teams in the community. They will support the GPs to manage simpler cases as well as provide basic psychotherapy, counselling or case management. This is an area where we will always be short of physiatrists and the more we can train up and make use of allied health professionals to support the doctors the better it will be. Second, we are strengthening the capabilities amongst the community organisations and social service providers to better manage the patients in the community. Training is being rolled out to equip staff with the right skill sets. So far, we have trained over 2,000 grassroots leaders and frontline staff in eldercare agencies. We have also put in place community support mechanisms such as helplines to link up patients with the appropriate services or resources they need.”
“Madam, we launched the National Mental Health Blueprint in 2007. The Minister for Finance gave us very strong support, with $178 million invested so far. The key thrust is to strengthen and develop mental health services in the community. The two key words are: de-institutionalisation and de-stigmatisation. We are half way through the implementation, but some impact is already being felt on the ground. Recently, I met a group of psychiatrists. I asked them point blank how do they compare, how do they rate the current state of mental health as compared with, say, five years ago. They told me that the progress was significant as a result of the Blueprint but they added that we still have much to do. The situation, as described by Ms Ellen Lee and the others, confirms the psychiatrists' assessment that the cup is half-full. We will press on to top up the cup. Mdm Cynthia Phua, Ms Ellen Lee, Mr Sin Boon Ann asked for more help, more services, more support for this programme and for the patients, and I agree with them. We will do more, we are doing more, a lot more will continue to happen over the next few years. The key is we need to detect patients early so that there is timely intervention. But to do so, we need to reduce the stigma surrounding mental illness so that the patients can be confident to come forward to be treated and, after receiving treatment, to integrate back into the community. Under the Blueprint, we have set up a series of multi-disciplinary community mental health teams to bring about early detection and to initiate treatment. They are organised under four different programmes, separately targeting children, youths, adults and the elderly. Each programme caters to a specific age group. The programmes are at different stages of implementation.”
“And this should have covered practically all the major chronic diseases; (v) We will expand the Primary Care Partnership Scheme (PCPS) that Mr Low mentioned just now, to cover all the 10 major chronic diseases. This will, as he put it, make it convenient for the elderly to receive subsidised care from the many participating GPs in their neighbourhood; and (vi) We will also extend PCPS to cover two specialist dental procedures – root canal treatment and crowning. Before I conclude, let me briefly address some specific comments made by Members. Ms Ellen Lee asked whether we could run polyclinics 24 hours. I am not keen. The reason is there are only so few polyclinics but there are thousands of GPs outside. I think we should try to leverage on the network of the GPs through PCPS. I think that is a much more cost-effective solution. Dr Lam and Assoc. Prof. Straughan suggested that we incentivise healthy behaviour, like health screening, giving credit for citizens who participate in health screening. We do subsidise such screening for the seniors. But I am not persuaded that we need to bribe them to do what is good for them. Dr Lam had a question on utilisation of Medisave overseas. So far, only 58, less than 60, have withdrawn about $125,000 from their Medisave for the treatment in Malaysia. What is the benefit of the scheme when I introduced it? It is to widen choices, and I still believe in it. It widens choices but the low utilisation re-affirms the confidence that Singaporeans have in Singapore healthcare. And I think we should be proud of that.”
“I see them sweating away like farmers. And when I spoke to them, they said, wo men zuo de hen kai xin (我们做得很开心) or we are so happy doing it. Why? Because they know that the harvests go to benefit the patients in the wards. We will continue to encourage and support such community spirit. Finally, our commitment to continue ensuring that healthcare remains affordable for all Singaporeans is firm. Our 3Ms framework – Medisave, MediShield and Medifund – is time-tested. It is an important supplement to the Government subsidy framework which is the main financier of inpatient care. This year's Budget will put nearly $7 billion into healthcare – $4 billion in MOH budget and $3 billion in the various top-ups to help Singaporeans pay their medical bills. This has enabled us to help more needy Singaporeans and we will also continue to enhance our 3Ms. In the new financial year: (i) We will increase Medifund budget allocation to $85 million, from $80 million to help more subsidised patients; (ii) We will double the Medication Assistance Fund (MAF) to $20 million, to help needy patients pay for expensive drugs. MAF will be extended to cover six more drugs – I cannot even pronounce their names – they are drugs to treat heart diseases, breast cancer and non-Hodgkin's lymphoma; (iii) We will double the subsidy cap for surgical implants to $1,000. I remember Mdm Halimah made this request last month. This will now cover up to 90% of all implants used in our public hospitals; (iv) We will expand Medisave to cover outpatient treatment for two more diseases – dementia and bi-polar disorder - in addition to eight existing chronic diseases, making it a total of 10.”
“Tan Sri Khoo was an eminent philanthropist of this century and deserved the recognition when we named the new hospital at Yishun after him. There are other eminent philanthropists. I am happy to inform this House that the family of the late Mr Ng Teng Fong has decided to donate $125 million towards the new hospital in Jurong. That is a big boost to our efforts to provide high quality healthcare for Singaporeans living in the west. And in recognition of the significant donation, we will name it Ng Teng Fong Hospital. Both are Government hospitals fully funded by the Government. But the private donations provide additional assistance to needy patients, besides funding other worthy services. In similar spirit, through the $1 billion Community Silver Trust, we hope to inspire successful Singaporeans to come forward to co-develop our long-term care sector. This sector has always been served by the VWOs with passion and compassion. But for the next stage of development, we need to inject more funds, more skills, more resources, more diversity to help raise capabilities and make them world-class. By matching donations, we preserve the legacy of the long-term care sector being driven largely by VWOs and the community. I think it will be wrong if we move in in a big way and displace the VWOs. By matching public donations, we hope to attract larger donations into this relatively less glamorous sector. Community support does not merely come in the form of financial donations. Many Singaporeans have been volunteering their services in the hospitals. For example, a team of volunteers has been nursing the roof-top garden at Khoo Teck Puat Hospital, contributing their labour and expertise every day. I go there quite often, different time of the day, sometimes at noon.”
“Our society is built on meritocracy and equal opportunities for all. But some will do much better than others. The more successful, in turn, help the less fortunate. That is how philanthropy underpins social bonding and unites people as one. Hence, the Chinese saying "滴水之恩，当涌泉相报" (di shui zhi en, dang yong quan xiang bao), to exhort people to pay it forward in society when able to do so. Our migrant forefathers walked such talk. For example, in healthcare, the late Mr Tan Tock Seng and Mr Lee Kong Chian left behind their philanthropist legacies in the Tan Tock Seng Hospital and the Lee Kong Chian Medical School. They were the eminent philanthropists of the last century. In the US, Bill Gates and Warren Buffet are spearheading a modern version of philanthropy by pledging at least half of their fortune to charity. At least 40 billionaires have joined their cause. Their efforts are softening the "winners take all" capitalist model. The American system has always had philanthropists who supported their top universities and their top hospitals. What is different this time is that they are parting with their fortune while they are still alive. As Mr Michael Bloomberg, one of the 40 billionaires, put it, I quote: "You don't have to wait to die to give it away. It never made a lot of sense to me why you'd want to change the world for the better and not be around to see it." Several years ago, the family of the late Tan Sri Khoo Teck Puat indicated that they would like to donate to the healthcare sector. I suggested that they consider supporting the new hospital which we were then building in Yishun. They readily responded with a generous donation of $125 million.”
“We have increased the budget for the Health Promotion Board to $120 million. They will find creative ways to promote the healthy lifestyle message and to involve the community extensively. Taking Senior Minister Goh’s advice, we will shift the National Healthy Lifestyle Campaign from being top-down to a more ground-up initiative. Soon we will be coming to the MPs to seek your support and active involvement to help us achieve this breakthrough. A healthy lifestyle includes a habit to go for regular health checks. Last month, the Academy of Medicine published very useful guidelines on what to screen. My Ministry has accepted the guidelines in full. It will help Singaporeans, in consultation with their General Practitioners (GPs) to choose the appropriate health screening tests that they should undergo given their age and individual risk profile. 5.00 pm Among the guidelines, there are two relatively costly items: colonoscopy and mammogram. I agree with Dr Lam that we should make these tests affordable through Medisave. Dr Lily Neo and Mdm Halimah made a similar call for mammograms before. I agree with them. We will extend Medisave, within withdrawal limits, to cover mammograms for breast cancer screening in women aged 50 and above, and colonoscopies for colorectal cancer screening for persons aged 50 and above. We will get this implemented as soon as we can make the necessary changes to the computer programmes. Sixth, we will strongly involve the community on healthcare issues. There are several aspects to it. Keeping Singaporeans healthy requires the community to collectively keep the environment clean. Peer support helps to sustain a healthy lifestyle among all Singaporeans. Fighting viruses requires a united community response.”
“They are the unsung heroes and heroines, making huge personal sacrifices, whether out of love, filial piety or simply plain human decency. My Ministry will do all we can to support them with skills training, counselling, psychological support, and sometimes just a shoulder to cry on. Dr Lam asked about caregiver allowance. Obviously, this goes beyond my Ministry’s purview. Minister Lim Boon Heng has addressed this point a few days ago. Let me give you my personal take on this issue. I believe paying caregivers to provide care-giving is an insult. It cheapens the sacrifice that they are making. If you believe in this cause, the whole society ought to be supportive. We have our fair share of and we have met some of these dedicated caregivers. When we see them and to help them, me and my grassroots leaders, we simply take money out of our own pockets, or to periodically top up the Welfare Fund. Or, it may be within our clan, our own extended family. In my own extended family, I have a handful of those very dedicated caregivers who sacrificed their lives, sometimes staying single in order to look after somebody that they love. Chinese New Year, we distribute ang pows, I give extra big ang pows for those people. Not to say, "this is your allowance or your bonus", but to say, "thank you for being a kind person and sorry that I cannot be with you shoulder to shoulder to help look after this relative". I think that is how we should address this whole issue of supporting caregivers as a society. Fifth, we will step up efforts to help Singaporeans stay healthy. As stressed by Dr Lam, this is ultimately the most basic strategy: Singaporeans must take ownership of their own health, and embrace a healthy lifestyle.”
“The desired outcome is to enable the elderly achieve independence so that they can move around with greater ease to perform necessary tasks like getting to their day rehabilitation exercises or simply just going downstairs to the void deck or to the coffee shop. Transforming our long-term care includes transforming our nursing homes. One significant step is our Nursing Home Development Programme to build new nursing homes in HDB towns. I have discussed this before, including on how to raise their rehabilitative capabilities to help their patients get well and go home. In other words, as Mr Ang Mong Seng put it, to regain their ability in a nursing home and not an old folks’ home. I will, in due course, try to explain in Mandarin the difference between the two. Such improved outcomes also require us to transform our home healthcare sector. Ms Ellen Lee, Dr Lam and several MPs stressed this point. This means putting in place supportive structures and services in the community. We are ramping up the Home Nursing Foundation (HNF). They now have nurses in TTSH to connect up with patients about to be discharged to ensure a smooth handover for patients who are likely to require home healthcare. Once the patient is home, HNF coordinates with other providers to meet the patient’s care needs in the community. There are now over 300 patients under their care. We will expand this programme to the other regions so that more Singaporeans can benefit from home care. But it is not just HNF, we will similarly support other VWOs like Touch Community Services and other providers such as NTUC ElderCare to expand home care. For home and community care to work, I agree with Members on the central role of the caregivers.”
“Khoo Teck Puat Hospital (KTPH) works with St Joseph’s Home on tele-consultation, so that the nursing home can consult the Khoo Teck Puat Hospital's geriatrician, over the Internet, before they call the ambulance. Not all admissions are necessary and timely advice from the hospital geriatrician is often what is needed. Patients, doctors, nursing homes and hospitals’ A&Es save time as a result. Everyone benefits. For our healthy elderly who are living at home, we want to help them stay active within the community. Some eventually may suffer from age-related functional decline. In particular, mobility can become a problem. It raises the risk of falls and the need for greater caregiver support. A simple mobility device like a walking frame or a wheelchair can make a difference. But VWOs have told us that some of their clients cannot afford such devices. They cannot pay, so they make do with umbrellas. But umbrellas are lousy substitutes, so they still fall. The VWOs raise funds to help them pay for those walking frames and wheelchairs. What they can do is limited by how much they can collect from public donations. That is why we are setting up the Senior’s Mobility Fund and we will put in $10 million for a start. The objective is to help the VWOs reach out to more such low-income elderly and provide them with basic mobility devices. There will, of course, be some means-testing, needs-assessment and some co-payment. All these will be done by the VWOs. This way, we allow greater flexibility and responsiveness in adapting the scheme to local needs. For example, there may also be cases where some sort of transport assistance to help seniors go for their regular rehabilitation exercises may be greatly beneficial.”
“Their services include helping the patients to arrange relevant community services for the patient and their caregivers. They have already touched the lives of over 10,000 patients. "Hassle-free", "integrated care", "clinical pathways" are abstract technical terms. But when translated into actual actions on the ground, they make a world of difference for the patients and their families. Just ask Mdm Samsiah Saifi. Her husband suffered a stroke, became paralysed and bedridden. Overnight, she became both sole breadwinner and sole caregiver. She was at her wits' end. Her ACTION care coordinator from NUH slowly coached her on the appropriate homecare services that her husband will need and followed up by visiting her husband to check on his condition and medication. Mdm Saifi has her handphone number to consult round the clock. This has given her confidence and peace of mind. AIC has brought cheer back to her life and that of her family. With AIC, there are now many such success stories. We are scaling up AIC operations nationwide to benefit even more patients. One primary objective is to help Singaporeans avoid unnecessary hospitalisation. For example, old folks falling resulting in emergency hospital admission are common stories. You avoid falls, you avoid hospitalisation. Tan Tock Seng Hospital (TTSH) works closely with the elderly in the community to assess or measure what is your risk of falling and then pick up the high-risk group, coach them to help them improve their balance because it is a skill that can be coached. As a result, admissions to hospitals by this group of elderly come down. Every day, some seniors in some nursing homes will develop some complications. Without resident geriatricians, the only recourse is to call for an ambulance to send them to A&E.”
“The objective is to help them manage the disease well, so that they can have a good quality of life. Transforming long-term care is our top priority in the next decade. We will sharpen our focus on geriatric care. We will equip all our doctors, nurses and allied health professionals with knowledge of geriatric medicine as a core competency. Of course, the healthcare professionals must also acquire the soft skills to understand the needs and concerns of the elderly patients in order to deliver better care, as Mr Ang Mong Seng pointed out just now. We have begun preparations to set up a Geriatric Education and Research Institute this year to develop, coordinate and implement various initiatives to strengthen geriatric education and research. We will develop integrated care pathways starting with five groups of patients with hip fractures, stroke, heart failure, COPD and diabetes. By standardising critical elements of care and defined clinical indicators, these integrated care pathways will enable patients to transit smoothly from one healthcare provider to another across the care continuum. This is what I meant by a "hassle-free healthcare system". This is also the sort of preferred outcome that Mdm Halimah spoke about just now. Truly integrated care. Our AIC – the Agency for Integrated Care is just one year old, but it is already making impact in the long-term care sector. They are doing what Dr Lam described as supportive services to facilitate care in the community. To give an example, AIC stations teams of what we call Aged Care TransitION (ACTION) care coordinators in hospitals to help patients with complex needs transit smoothly from the hospital back into their homes and communities.”
“They are also multi-disciplinary, no longer just doctors, nurses and patients, but with advanced practice nurses, clinical pharmacists, podiatrists and clinical psychologists providing consultations, side by side with family physicians. Patients with chronic diseases are given clinic appointments for their regular follow-ups. It is no longer just simply walk-in. This has cut down their waiting time for those with appointments. In other words, our polyclinics are no longer like in the past and that is why I have arranged some MPs to visit them so that they do not live with the image of the polyclinics of the past. 4.45 pm One patient emailed me last month, pleasantly surprised by the transformation. I quote him: "I visited the Marine Parade Polyclinic. The service was fast, friendly and efficient. The time from registration to payment was less than half an hour, a far cry from the days when a visit to the polyclinic was a two-hour affair". I know that waiting remains a problem in polyclinics for walk-in patients without any appointments. But for those with appointments, waiting is now manageable. We will continue to upgrade the other polyclinics. Over the next five years, Ang Mo Kio, Bedok, Geylang, Tampines and Yishun Polyclinics will benefit from this polyclinic redevelopment programme. This will cost us $50 million. For the rapidly expanding population in Punggol, we are also planning a new polyclinic in that town. This will help relieve Sengkang Polyclinic. Fourth, we will transform long-term care like community care hospitals, nursing homes, day rehabilitation and home health care, which many MPs spoke about. Done well, this will particularly benefit the elderly with chronic diseases.”
“My vision is to get our morbidity indicators to match the top tier of OECD countries in the key disease areas which matter to us, like heart disease, diabetes, mental disorders and cancer. We are currently about average, among the OECD countries. Let us move up to a higher tier. This means knowing how to better treat these common diseases, whether in terms of prevention, early detection, treatment, rehabilitation or continuing care. For example, Assoc. Prof. Straughan mentioned just now our mammogram screening rate. We are below OECD average and we have to make progress there. This will require us to raise the capabilities and outcomes of our national specialist centres to match the best elsewhere. Where appropriate, we will invest in building new capability peaks in areas such as organ transplant, geriatrics and rehabilitation. Third, we have been redeveloping our polyclinics to meet the challenges of an ageing population. Over the past five years, we have upgraded eight polyclinics, including Woodlands, Bukit Batok, Pasir Ris and Hougang Polyclinics. As Assoc. Prof. Fatimah Lateef put it, strengthening primary care is important. Several MPs toured the upgraded Pasir Ris Polyclinic recently. The upgraded polyclinics are now paperless, fully computerised. They are film-less with tele-radiology services. X-rays are being read in India by US Board-certified radiologists and returned within half an hour. They are scriptless, that is no more paper prescription, with e-prescription (electronic prescription) capability. They are also piloting tele-ophthalmology to cut down unnecessary referrals to the hospital ophthalmologist. The use of technology – a point that Mdm Cynthia Phua mentioned just now – all those are happening in our upgraded polyclinics.”
“First, we will realise our vision of a general hospital in every region. In the north, KTPH has added 550 beds to our bed capacity. In the west, the Jurong General Hospital (JGH) is on track to open in 2014 with 700 beds. Dr Lam will be pleased to know that a new general hospital will come up in his constituency to serve the residents living in the north-east. The new Sengkang General Hospital will be located next to the Cheng Lim LRT Station. It will also be within walking distance to the Sengkang MRT Station which is in Mr Charles Chong’s constituency. It will open by 2020. Given a lead time of six or seven years to design and build, it is not too soon nor too late to start planning. I have asked the SingHealth Cluster to assemble a young outstanding team to take charge of this project. I will challenge them to build a hospital, even better than KTPH and JGH, measured from the patients’ point of view. All the three general hospitals will have community hospitals adjoining them, and this will significantly expand our community hospital capacity. These are multi-billion-dollar investments but they are worthy investments. Together with TTSH serving the central region and CGH serving the east, they will realise our vision of bringing healthcare close to the residents living in each region of Singapore. Good healthcare will be within 30 minutes of every patient. Second, we have achieved very good mortality indicators, including life expectancy, child mortality and other disease-specific death rates. We will now measure how specific diseases impact the overall well-being of Singaporeans. To do so, we will track morbidity indicators and strive for further improvement.”
“Singaporeans are living longer and, with it, there will be greater demand for healthcare services. They also want to age in place, at home and in the community, except for the occasional emergencies to the acute hospitals. Much of the healthcare services for the elderly can be competently delivered in the community, away from costly hospitals. That is why Budget 2011 places so much emphasis on long-term care. Even as we improve our hospitals, we will do even more to transform our long-term care sector and many MPs spoke about this. We have already started this journey and we are on track. The new Khoo Teck Puat Hospital (KTPH) illustrates how we are making progress. Most MPs have visited it. You have seen how we have raised services, especially for patients in Class B2 and Class C, to a higher level, delivering a "hassle-free" hospital experience. You have also heard how KTPH is reaching out to the community outside of the hospital and supporting them to look after the discharged patients. In other words, all the hospitals’ CEOs know that their responsibility now extends beyond the hospital walls. It is not just within the hospital walls. And this transformation is not just in KTPH. There is also a quiet revolution in Changi General Hospital (CGH), Tan Tock Seng Hospital (TTSH), National University Hospital and polyclinics. We have made progress in mental health, chronic disease management, integrated care between hospitals and the community. But the work is not finished yet. I still have a substantive agenda of things to accomplish. If we stay the course, over the next five to 10 years, we can further transform our healthcare, to be among the best in the world. Let me sketch out our plan in seven areas.”
“In my Ministry, we have crafted a phrase "with peace of mind" into our vision to help Singaporeans "live well, live long and with peace of mind". We meant this seriously. I took this mission diligently. My personal mission in life is to help serve the young and the old so that they have peace of mind. In Chinese we call it "老者安之，少者怀之". This came from Confucius. That was his personal mission in life when asked by one of his students. We cannot eliminate death and suffering. But we can avoid inflicting unnecessary pain and suffering to the natural process of dying by being wise in our healthcare policies and in how we structure our healthcare system. In her book, Susan Jacoby also wrote about an American woman who, just a month before her 100th birthday, underwent surgery to install a special defibrillator and pacemaker in her failing heart. When it happened, it was front page news on New York Times. That is a great achievement in medical science. The surgery postponed her death and extended her life for a while. But it was a life full of suffering, requiring the full-time services of a home healthcare aide, paid for by taxpayers and being confined to a wheelchair with both failing vision and failing hearing. This may be an extreme example, but in the US healthcare system, such cases of aggressive medical intervention during one’s last few months or weeks are not uncommon. We have a good and relatively inexpensive healthcare system because we have sensible and wise doctors. We must not port in mindlessly foreign practices based on fallacies and unrealistic expectations. That will only bring misery to the patients and their families at great cost to society.”
“Will I develop dementia and lose my mind? At every Chinese New Year, I wish my residents "健康长寿" or good health and longevity. They said "yes" to the first part, good health. But on longevity, many said: "not too long please" and I know what they mean. We all strive for a long, meaningful life, but the two words "long" and "meaningful" have to come together in order to make a happy person. A long life of pain and suffering is a miserable life. I am reading Susan Jacoby’s latest book “Never Say Die”. This is my bedside reading at the moment. She was most critical of the American approach to end-of-life care. In it, she related her last conversation with her grandmother in a nursing home when she was nearly 100 years old. This was what she recalled: "A small boy tossed a beach ball in our direction. Gran tried to rise from her chair and throw the ball back but she was too frail to stand without help. Collapsing backward, she said in a soft voice devoid of either self-pity or anger, 'the worst thing about having lived too long is you know you are of absolutely no use to anyone.' It was agonising for me to hear my grandmother said this, because she defined herself by her usefulness." I often visit nursing homes with my grassroots leaders. Some patients welcome our visit as it breaks their daily routine and we do bring cheer to them. But many with severe dementia live in their own lost world, oblivious to what is going on around them. Many others are clearly suffering. Often, I just looked at my grassroots leaders and by our body language, without a word being spoken, we say to one another: "Let’s hope we do not end our life this way." I would silently offer a prayer for the patients.”
“While most people are honest, some patients and some providers do abuse the system at the expense of the vast majority of honest people. More healthcare does not always deliver better health. Beyond some point, there are limits to medical science. Many healthcare problems are self-inflicted. Dr Lam gave the example of the patient with Chronic Obstructive Pulmonary Disease (COPD). No medicine, for example, can help a patient with COPD unless he or she stops smoking. Incentives can work in healthcare but poorly-designed though well-intentioned health policies can end up distorting behaviour. Lastly, and most importantly, we are all mortals and eventually we all have to die. Many other healthcare systems choose to ignore these hard truths and are, for instance, based on wishful thinking that people can live forever, that more treatment is better, and there is a cure for every disease, "a pill for every ill". For the terminally ill, they will strive to prolong life at all costs, never mind the quality of life nor the futility of such efforts. The US spent 18% of its GDP on healthcare and they know that much of that is unnecessary. My recent heart bypass has sharpened my sense of my own mortality. I have regained my fitness level. In fact, today is exactly 10 months after my bypass and I have become even more diligent in my regular exercises. Before coming here, I did four and a half kilometres on the treadmill. But I know the score of having to live with heart disease. I am 59 and I do my best to keep my body in good condition, live a full life, and hope to grow old with dignity. But I am under no delusion and I know that someday I, too, will leave. The question is how? Like others, I have my share of worries. Will I suffer a stroke that condemns me to severe disability?”
“Madam, last month, I tossed vegetarian lo-hei with Prof. William Haseltine. He is an outstanding academic, inventor and entrepreneur, a very rare talent. At Harvard University, he became a founding father in an evolving branch of research which sequenced DNA, and then used the human genome to identify and treat diseases. He holds many patents and founded several bio-tech companies. His current interest is to seek out healthcare innovations and apply them globally to bring about cheaper and better health. I first met him last year at an NUS Healthcare Forum. He was intrigued by our healthcare system, delivering first world standards at only 4% of our GDP. Many OECD countries spend more than 10%. He was in town to find out more with the intention of writing about it. Prof. Haseltine's assessment corroborates with several commentaries about Singapore's healthcare system that appeared during Obama's health reform debates. For example, a Wall Street Journal article in November 2009 described Singapore as having "world-class quality care at world competitive prices". The article added that "Singapore's example might have something to teach them about the kind of reform Americans really need." The Austrian Health Minister was also in town last month. After spending some time at the Khoo Teck Puat Hospital (KTPH), he remarked to me that many of the policies that he was planning to introduce in Austria were routinely done here. I took that as a compliment from a well-informed peer. We do not claim our system to be perfect. But we achieve a better outcome for our people because we have more readily acknowledged the hard truths of healthcare and forged our system based on such insights. What are the hard truths? 4.30 pm There is no free healthcare; someone has to pay the bill.”
“There is a wide range of cancer drugs and my Ministry subsidises 55 of them. The list is reviewed regularly and the most recent additions include Paclitaxel (for breast and ovarian cancer) and Oxaliplatin (for colorectal cancer). In addition, we subsidise 17 drugs which are used for supportive or palliative cancer therapy. For the treatment of osteoporosis, we subsidise the two key drugs: Alendronic acid and Risedronic acid. We also subsidise Calcium and Vitamin D used in the supportive therapy for osteoporotic patients. RE-OFFENDING, RECIDIVISM STATISTICS 3. Ms Sylvia Lim asked the Minister for Home Affairs for the period of 2003 to 2005, what is the rate of re-offending within five years of release for (i) persons released from prisons in those years; (ii) persons who had completed reformative training in those years; and (iii) persons who were released in those years from institutions that are gazetted under the Children and Young Persons Act for juvenile offenders.”
“Ms Sylvia Lim asked the Minister for Health what drugs are included in the Standard Drug List to treat (i) cancer and (ii) osteoporosis.”
“Total healthcare expenditure, or more commonly called national healthcare expenditure (NHE), comprises a basket of many different kinds of healthcare spending, ranging from inpatient care, outpatient care, long term care, medical products (eg, multivitamins, health supplements, contact lenses, Chinese herbs), other healthcare services (eg, dental treatment, tuina, acupuncture) to medical research, medical education, etc. As a national basket, it includes spending by citizens, foreigners and medical tourists. As 3Ms (Medisave, MediShield and Medifund) are intended primarily to help Singapore residents with their inpatient care (and to a lesser extent, some outpatient and long term care), looking at the proportion of NHE financed by 3Ms would not be meaningful. Instead, it is more meaningful to measure the contribution of 3Ms to the relevant component of NHE, like inpatient care. Of the total inpatient care spending by Singapore residents in both public and private hospitals, 3Ms financed 23% (2009 data). The rest of the inpatient spending was borne by Government (51%), employers and patients (27%). The proportions will not stay static, as they will alter with demographic changes, patients' choices of ward classes, extent of insurance coverage, etc. My Ministry has no projection on how the proportions will change. But we will always ensure that good healthcare remains affordable for all Singaporeans. We do this through regular revisions to Medisave withdrawal limits, MediShield payouts and Medifund allocations, as well as substantial top-ups to Medisave and Medifund when the economy does well and the Budget is strong. STANDARD DRUG LIST (Drugs for treatment of cancer and osteoporosis) 2.”
“INTERIM RENTAL HOUSING (Transition to long-term housing) The following Question stood in the name of Dr Ahmad Mohd Magad – 3. To ask the Minister for National Development since the introduction of the Interim Rental Housing (IRH) scheme in 2009 (a) what is the average duration that a family remains under the IRH; (b) what efforts are being made to help these families transit from interim housing arrangements; and (c) how many families have been successfully moved into more sustainable living arrangements.”
“For those who have opted out, we leave it as it is because organ donation really ought to be purely voluntary. All over the world, the preferred approach is for an "opt in" scheme. But it is not effective to get the required numbers and that is why nations, like us, go for the "opt-out" scheme. For those who have expressed a decision to opt out, we respect their wishes. We do not make any effort to try to dissuade them or persuade them to re-opt back in. But the general public education on the value of organ donations and how it can save lives continues and that goes across to the whole population. As for the dozen or so live donor applications which were rejected, there were a number of reasons. These are decisions made by the Ethics Committee. The applicants have to satisfy the Ethics Committee that the donors are fully informed of what they are going into and there is no coercion of any kind. If the Committee is suspicious about the motive behind the applications, it will reject the applicants. So, I suppose, some of the reasons could be that. As for the NKF scheme, I would not describe it as achieving little. I thought they have achieved a lot for a very new scheme which has yet to reach one year. Having benefited almost a dozen lives – about one a month – I consider the outcome as quite successful. In reaching out to the possible applicants, a natural platform is there as these are patients who are undergoing dialysis. Hence, NKF has a way of reaching out to them and can explain to them that it would be better if they can get family members or whoever to come forward to donate. And where they may have been concerned about financial expenses, the NKF scheme comes in extremely handy.”
“To support needy Singaporean patients, the National Kidney Foundation has set up the Live Donor Support Fund. So far, it has received 11 applications and approved 10 of them. This is about one a month. The eleventh application is still under review.”
“The Human Organ Transplant Act (HOTA) was enacted in 1987. As at the end of last year, 52 hearts, 144 livers, 1,080 kidneys and 1,181 corneas from deceased donors have been successfully transplanted. Many lives have been saved by HOTA. All Members of this House can claim some credit for this outcome by supporting this Bill. The vast majority of Singaporeans support organ donation. Less than 3% of the potential HOTA population, or about 77,000 people, have opted out. As we do not ask objectors to indicate their religion, I do not know how many are Muslims. As for the question on applications by living donors for reimbursements of expenses, I do not have the data in the format as requested. But last year, there were 156 applications for living donor organ transplant. Of these, 142 were approved by the Transplant Ethics Committee (TEC). The majority of living donations are between family members and close relatives. In such cases, there is no reimbursement per se but the family will pool its resources to pay for all the medical expenses. For the others, most recipients would pay for their donors’ hospitalisation directly to the hospitals. The size of the medical bills would depend on the type of transplant, the class of ward and the extent of subsidy enjoyed by the patients. In addition to the direct payment for hospitalisation expenses, there would be regular follow-up expenses for the donors. These follow-ups usually cost about $100 to $300 per consultation. They would be picked up by the recipients in most cases. There were a few cases where the recipients had also reimbursed their donors for loss of income. The average quantum of such reimbursement ranged from $500 to $750.”
“Dr Muhammad Faishal Ibrahim asked the Minister for Transport (a) whether there has been a significant increase in the number of users of off-peak cars who have been caught without valid e-Day Licences during the restricted hours since its implementation on 23rd November 2009; and (b) whether LTA has taken adequate measures to inform owners of off-peak cars of the e-Day Licence system.”
“More than 13,900 people have signed the Advance Medical Directives (AMDs). Over the years, 31 people have registered their revocations with the AMD Registry. A person who has made an AMD may reconsider his decision and revoke his AMD. There may be situations where the revocation may need to be done quickly, eg, before an urgent operation. Hence, the process of revocation is relatively simpler than making an AMD. An AMD can be revoked at any time in the presence of at least one witness. The person can do so by filling in the standard form for revocation of an AMD. Alternatively, the person or his witness could write a letter to the Registrar of AMDs, stating the particulars of the person revoking the AMD and of the witness, and the time, date and place of revocation. If the person revoking the AMD is unable to write, the AMD can be revoked orally. Under the AMD Act, there is a duty under section 7(2) for the revocation to be registered, and there is also a duty under section 7(3) and (4) for anyone with knowledge of the revocation to report this fact to the Registrar of AMDs. The Act provides for additional checks before effecting an AMD. Under section 10(2) if the attending doctor has reasonable ground to believe that a revocation has been sent to the Registry or that the person has communicated to any medical practitioner his intention to revoke the directive, then the doctor will not proceed with the AMD. E-DAY LICENCE SYSTEM FOR OFF-PEAK CARS 8. Assoc. Prof.”
“As I have said, we review the Standard Drug List as well as the subsidy cap regularly. We will revise them when necessary but it has to be based on logic and evidence. Whether we would include more drugs into SDL: if there is justification for it, we will. We have been reviewing the SDL annually. In fact, we are right now in this exercise. The inputs from the doctors are rolling in and the committee will be meeting soon, and we will see. The special fund that the Member mentioned is the Medication Assistance Fund (MAF) which I introduced last year, precisely to help needy patients who are hit by very expensive but essential drugs which are not yet on the Standard Drug List, subject to means testing. Again, we are in the midst of reviewing the MAF and I may be able to do some adjustments soon. As for the payment of non-standard items which are ordered by the doctors and for which patients have difficulty in payment: remember our 3Ms. Subsidy is not the only pillar for ensuring affordability. There is also Medisave, MediShield and Medifund. And that is why, periodically, I adjust Medisave withdrawal limits and MediShield claim limits to assist patients with that kind of problem. If over and above that, there is a need for Medifund, we will always be sympathetic. GAZETTING THE ONLINE CITIZEN 9. Mr Viswa Sadasivan asked the Prime Minister (a) what are the principal considerations for the Government's decision to gazette The Online Citizen (TOC) as a political association; (b) what did the TOC do that differentiates it from other blogs that post political and social commentaries; and (c) what are the principal restrictions on the TOC as a political association in using its new media platforms in a general election.”
“Our Standard Drug List (SDL) was modelled after the World Health Organization's (WHO) Essential Drug List, with modifications to suit local disease profiles and practice. It consists of drugs assessed to be cost-effective and essential to the provision of medical care to all Singaporeans. The assessment is done objectively and professionally by the Drug Advisory Committee (DAC) which comprises a few senior doctors and chaired by the Director of Medical Services. The DAC, with inputs from other clinicians, reviews the SDL on a yearly basis to take into account changes in clinical practice and advances in medical science. It considers three main factors when determining whether a drug should enter into the SDL: (i) whether the drug is essential for the treatment of medical conditions that are important causes of morbidity and mortality in Singapore; (ii) whether the drug offers a major improvement in terms of efficacy and effectiveness, as compared to existing standard drugs; and (iii) whether there is sufficient evidence of long-term safety and cost-benefits of the drug. As for implants, we do not have an equivalent standard implant list. Instead, our general policy is to subsidise 50% of the cost of the implant prescribed by the doctor, subject to a cap of $500 per implant. The guideline to our doctors is to prescribe implants that are cost-effective. This is to save money for the subsidised patients. We review the subsidy cap regularly to ensure that implants remain affordable. Eighty per cent of implants used in the public hospitals cost below $1,000 each. This explains the current subsidy cap.”
“The short answer is "yes". Once the panel has completed its findings, we will certainly want to share them with other organisers as well as to make them public. DRUGS ON THE STANDARD LIST 8. Mdm Halimah Yacob asked the Minister for Health (a) what criteria are used to determine whether or not a drug is to be listed on the Standard List and how often is this list reviewed; and (b) whether the Ministry can consider higher subsidies for implants instead of the current fixed quantum for patients in the subsidised wards.”
“Sir, may I have your permission to take Question Nos. 6 and 7 together?”