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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“From FY 2007 to FY 2009, about $200 million was paid out from Medifund to help needy patients with their medical bills. A total of one million hospital bills were involved. The number of patients who benefitted from Medifund was less as many had incurred several hospital bills. For FY 2010, we have stepped up the level of assistance, and we expect to pay out $80 million from Medifund. Medifund ensures that all Singaporeans can afford basic healthcare services. All subsidised Singaporean patients are eligible for Medifund assistance. We have local Medifund Committees of public-spirited volunteers who assess and determine the assistance provided to each case based on merit. The beneficiaries will largely come from the lower-income households, below the 30th percentile of the population. But the Medifund Committees are prepared and have, indeed, helped many who are outside of this income group when they face exceptional circumstances. Medifund covers subsidised treatment in the public hospitals, community hospitals and nursing homes. Eighty-five percent of the assistance goes towards acute hospitalisation. FOUNDING FATHERS OF SINGAPORE 21. Mdm Ho Geok Choo asked the Acting Minister for Information, Communications and the Arts (a) what other measures are being taken to honour Singapore's founding fathers and leaders who are still with us; and (b) how can future generations of Singaporeans be reminded of their contributions and sacrifices. RAdm [NS] Lui Tuck Yew: In his National Day Rally speech, Prime Minister Lee said that it is important that the nation remembers the founding fathers properly.”
“Since its formation in July 2007, the Optometrists and Opticians Board has implemented the following key measures to raise the standard of primary eye care in Singapore: (i) It requires optometrists and opticians to be registered before they can practise. There are now 749 optometrists and 1,544 opticians on the register; (ii) It requires all fresh optometry and opticianry graduates to work under the supervision of an experienced practitioner for a period of one year for optometrists and two years for opticians. This will guide the new graduates in their practice and ensure that professional standards are met; (iii) It encourages all registered optometrists and opticians to participate in continuing professional education (CPE). CPE will be made mandatory for all registrants next year; and (iv) It has published the Code of Professional Conduct and the Professional Practice Guidelines for Optometrists and Opticians. These documents set the standards of optometry and opticianry practice for all the registered optometrists and opticians. So far, the Board has received two complaints from the public. One was dismissed while the other is currently being investigated. No disciplinary hearing has yet been conducted. EMERGENCY PLANS FOR FLOODS AND MAINTENANCE OF TREES IN SCHOOLS 3. Mdm Cynthia Phua asked the Minister for Education (a) whether schools have emergency plans to help students who are stranded by floods; and (b) how do schools check on old trees within their premises to ensure that they do not endanger the students and staff.”
“We have started the Agency for Integrated Care (AIC) to help facilitate this transformation. This is still work in progress. But, already, their Aged Care Transition (ACTION) Teams based in the restructured hospitals are doing good work, facilitating discharge planning and coordinating referrals to intermediate and long-term care services to smoothen patient transitions between institutions. We are expanding the AIC to coordinate and drive care integration efforts. We are transforming our acute hospitals into regional hospitals to bring together public, private and VWO providers across various healthcare settings and strengthen the linkages between them. They will need infrastructure support, including the upcoming National Electronic Health Records system. We do not underestimate the huge challenges in this transformation of our healthcare services. It is literally a revolution, but a quiet one, making progress day by day, clinic by clinic, hospital by hospital. But if we succeed, Singaporeans will be better able to live well, live long and with peace of mind. CONCESSIONARY FARE FOR SENIOR CITIZENS 42. Assoc. Prof. Fatimah Lateef asked the Minister for Transport whether in the central bus planning process, LTA will consider granting concessionary fare for senior citizens who start their journeys earlier than 9.00 am on weekdays. 43. Er Lee Bee Wah asked the Minister for Transport if he will consider (i) allowing senior citizens concession when they alight from buses or trains before 9.00 am; and (ii) giving further concession fares to working senior citizens who are earning reduced wages.”
“The Health Promotion Board has branded this as the national Integrated Screening Programme (ISP) to encourage all Singaporeans above 40 to be screened regularly for diabetes, high blood pressure, high blood cholesterol and obesity. Many general practitioners (GPs) have joined us in this effort. Our surveys showed that more than 70% of Singaporeans above age 40 had gone for a recent health screening for diabetes and high blood cholesterol. This is encouraging and we will continue to push it. Health screening is not a once-off event, but must be done regularly. ISP has now been extended to the workplaces, to the door step of employees working in small and medium-sized enterprises (SMEs). We are making screening accessible but we need Singaporeans to join in. Fifth, chronic disease has to be treated, either with medication and/or lifestyle change. This requires the patients to work closely with their GPs. Make sure you have a regular Family Physician who knows you well and whom you trust. Take his advice and comply with his prescription. Medisave can help pay part of the outpatient treatment and many patients have benefited from this programme. Finally, a senior patient will likely need to consult several healthcare professionals from the acute hospital, community hospital, home and day healthcare providers, GP clinics and, for some, the nursing homes. Services are fragmented with poor coordination. We are striving to transform the delivery model so that these diverse services can be better coordinated and integrated where possible. The strategic intent is to enable a frail elderly who tend to have multiple and more complex care needs, to receive care more seamlessly and in the appropriate settings.”
“I have shared the specific initiatives frequently and widely. I do not propose to repeat them comprehensively. Briefly they include six key elements. First, ensure that capacity and capabilities match rising demand. This includes building new general hospitals, community hospitals and nursing homes, training and recruiting healthcare professionals, including doctors, nurses and allied health professionals. Second, encourage Singaporeans to embrace a healthy lifestyle seriously. Make it a part of our life. It is not that difficult: do not smoke, do not over-eat, exercise regularly, socialise and make friends, avoid junk food. Third, build up the home and day healthcare sector. Seniors do not want to visit hospitals, if they can help it. The risk of a hospital-acquired infection is real. Most treatment is routine and can be done by properly trained doctors, nurses and therapists in the community setting. Among the various initiatives, we are helping to transform the Home Nursing Foundation to help push this effort. Fourth, many Singaporeans will have some sort of a chronic illness, like diabetes or a heart disease like me. Go for regular screening so that you are aware of your illness and work with your doctors to manage it before it becomes critical and irreversible. In my case, the heart screening literally saved my life and avoided a fatal heart attack. For many years, several MPs, including Dr Lily Neo and Mdm Halimah, have supported community health screening among our seniors. We have built on these bottom-up efforts and grown them into a national programme.”
“Singaporeans are indeed living better and longer. Among 193 countries with published life expectancy at birth, we are ranked number nine in the world, together with seven other countries. This is a commendable achievement. Correspondingly, our Disability-Adjusted Life Expectancy (DALE) has also improved. DALE is a population health indicator based on life expectancy, with an adjustment for years lived in poor health due to illness or injury. It has since been renamed HALE for Healthy Life Expectancy. HALE for Singaporeans at age 60 is now 17.0 years for men and 20.3 years for women. This suggests an expected loss in healthy years of 4.1 years for men and 4.6 years for women. This is better than the global figure of 4.3 years for men and 5.3 years for women. But we must continue to make improvements where we can. How are we preparing for the ageing of our population is a subject that occupies the mind of many Ministers. We take a whole-of-Government approach to this important subject. Minister Lim Boon Heng chairs a Committee on Ageing, of which I am a member. We meet regularly to discuss and brainstorm this subject. Our strategy and plans are regularly shared with the public and are often discussed in this House. In the areas under my purview, half of my time is spent working out solutions to ensure that our seniors can age with grace and dignity, free of pain if medically possible. Part of my mission in life is "老者安之" or "help the seniors achieve peace of mind". I cannot do this alone but do require Singaporeans to join me in maintaining a healthy lifestyle, saving regularly for a rainy day, subscribing to our insurance policies and accepting that we are mortals and there are limits to the medical science.”
“Paulin Tay Straughan asked the Prime Minister in light of the sustained low fertility rate and increase in the proportion of singles (a) what are the Government's plans for managing an ageing population where family support may be absent; and (b) what initiatives are in place to facilitate ageing for singles and those who may not have strong family support.”
“Patients requiring a new medical consultation belong to one of three categories. First, those who require immediate attention typically present themselves at the hospital Emergency Department. They are attended to immediately by the relevant specialists. There is no waiting time. Second, those who are suspected of a serious illness, such as cancer or severe heart condition, require specialist medical attention as soon as possible. There is an arrangement between polyclinics and hospitals to fast-track their appointments with the specialists. Currently, the median waiting time for such private patients is within a week. For subsidised cancer patients, it is within two weeks. For subsidised cardiology patients, it is within four weeks. While this is acceptable, we will try to reduce it further. Finally, patients whose conditions are not urgent but who may benefit from a specialist consultation. Overall, the median waiting time for this category of patients is within one week for private patients and within four weeks for subsidised patients. This is so for most specialties including, for example, general surgery, ophthalmology and orthopaedic surgery. However, for some specialties like dermatology, gastroenterology and renal medicine, the median waiting times for subsidised patients exceed six weeks and will cause such patients unnecessary anxiety. We have been stepping up specialist training in order to meet the rising demand. MANAGING AGEING POPULATION 29. Assoc. Prof.”
“Importers and local distributors will be given a grace period of 12 months from the date of Gazette to effect the change; (e) Clauses 9 to 10 which include the term "distribution" alongside "import", "sale" and "offer for sale", to cover the entire supply chain and ensure that distributors are also held accountable for compliance with the Act; (f) Clause 13 which clarifies officers' roles when they carry out their enforcement duties, so that they are deemed as public servants for the purpose of the Penal Code; (g) Clause 15 which further defines the scope and hence the penalty of obstruction to these officers during their work, so that the officers can perform their duties more effectively; (h) Clause 16 which refines the maximum composition sum of any offences under the Act, to align it with the provisions in other Acts; and (i) We are reducing the maximum allowable tar and nicotine yield levels of cigarettes from 15 mg to 10 mg for tar and from 1.3 mg to 1.0 mg for nicotine. This will align us with international best practices. Tobacco manufacturers will be given a grace period of 12 months from the date of Gazette to effect the change. Mr Speaker, Sir, tobacco is harmful and it kills. We have kept our smoking rate low, relative to other countries. But it is a constant battle with the tobacco companies which are savvy and innovative. Our law and our control strategy must keep pace with the developments in the industry. I seek the Members' support for this Amendment Bill. Sir, I beg to move. Question proposed.”
“The proposed ban will cover these categories of new products: (a) nasal and oral snuff, of which snus and smokeless cigarettes are sub categories; (b) dissolvable tobacco, often referred to as "tobacco pellets" or "tobacco candies" and which may also come in strips and sticks; (c) e-cigarettes and other nicotine-based cigarettes or similar which deliver nicotine but may not contain tobacco; (d) tobacco and nicotine gels; (e) nicotine water, drinks and food products; and (f) fruit and candy flavoured cigarettes and other tobacco products such as cigarillos, beedies and "anghoon". The proposed amendment to section 15 will also cover some future variations of emerging products by prescribing powers to the Minister for Health to allow prohibitions of future innovative products if they do not fit within the current categories. In making this amendment, we will not be alone. The proposed prohibitions are in line with bans already imposed in several countries including Australia, Canada and the European Union. Finally, we are taking the opportunity to make a number of technical amendments to improve the clarity of the Act and to enhance its implementation. They include: (a) Clause 3 which amends the title of the Act from "Smoking Control", which is obviously outdated, to "Tobacco Control", as many new products are now smokeless; (b) Clause 4 which introduces new definitions for "emission", "packaging", "premises", "tobacco product", "tobacco substitute" and "use"; (c) Clause 6 which introduces the term "services" alongside "goods", to extend the coverage of prohibition to sales promotion of tobacco products; (d) Clause 8 which extends the prohibition of cigarettes sold in packs less than 20 units to miniature cigars or cigarillos.”
“If they contain tobacco, whether they are smoked, chewed, inhaled, sucked or topically applied, then they are potentially harmful as tobacco is carcinogenic and causes cancer. If they contain nicotine, then they are still harmful as nicotine is toxic and highly addictive. There is a misconception that tobacco substitutes can be used as cessation aids when they have not been approved for such use. The nicotine level in some of these new and emerging products is actually higher than that in the cigarettes. With regular use, addiction can occur, leading to smoking and even dual use of both cigarettes and the substitutes. This is particularly observed in the west, as office workers find it very hard to smoke because most offices are now smoke-free. Here comes the smokeless alternative. During working hours, they take the smokeless products and when they go home, they take the real cigarettes. This is what the industry call "dual usage". My Ministry has studied the evidence available internationally and locally, on the harm of tobacco use and nicotine addiction, and the appeal these new and emerging products may have to vulnerable groups, such as young people and young adults. The evidence is substantial. Almost all these new products have not yet reached our shores. Members will not be able to find them yet in Singapore. Hopefully it will never surface here. Let us take a pre-emptive step to ban them and prevent them from coming here and harming our people, especially the young. The amendment of section 15 will allow us to prohibit them.”
“The new section 17A will prohibit the importation, distribution, sale or offer for sale of any tobacco product that has or is accompanied by any false or misleading packaging or labelling. Such a prohibition will allow us to fulfil another obligation to the Convention and align ourselves with many other countries with similar prohibitions. The actual terms to be prohibited such as "mild" or "light" will be prescribed within the subsidiary legislation. We will give tobacco manufacturers a grace period of 12 months from the date of Gazette to effect the necessary changes. New and emerging products Next, let me discuss the emergence of new and alternative tobacco products. As far back as 1993, the World Health Organization and several countries, including Singapore, had already expressed concern over new and emerging harmful tobacco products, and had recommended banning products – such as smokeless tobacco – that were becoming available. We amended the Act and, hence, section 15 of the current Act prohibits chewing tobacco and provides prescribing powers to prohibit other smokeless tobacco products for oral use. Since then tobacco companies have become even more aggressive and innovative, especially in recent years. Today, unconventional tobacco products come in various forms – smoked tobacco such as flavoured cigarettes; smokeless tobacco such as tobacco gels; dissolvable tobacco which resembles candy – this is particularly harmful because it can "con" the little kids; and tobacco substitutes such as e-cigarettes and even drinks like nicotine water. These new and emerging products are being marketed as safer alternatives to cigarettes but they are not.”
“This exemption is in conflict with an obligation under the FCTC which imposes a fully comprehensive ban on all forms of tobacco advertising, promotion and sponsorship. The removal of section 3(2)(a) will allow us to remove this exemption clause. We have consulted the Ministry of Information, Communcations and the Arts (MICA) and they support this move. They have been building up alternative sources of sponsorship. We will give the arts organisations a grace period of up to the end 2010 before we remove the exemption clause. Tobacco packaging The current Act requires graphic health warnings to be displayed on individual tobacco product packages sold here. The WHO FCTC, however, imposes an obligation to display graphic health warnings on all kinds of internal and external packaging. To meet this obligation, an amendment to section 17(1) will extend the display of graphic health warnings to outer packaging, such as the box or the carton that holds the individual packages for retail. Tobacco labelling Under the current Act, we do not regulate on how tobacco companies label or brand their products. Some have used terms in their product packaging or labelling that may give the impression that their product or brand is less harmful to health or less addictive. Such terms include words like "mild" or "light". International and local studies found that consumers are misled by such terms. They believe that these products are less harmful and that switching to these products may help them to quit smoking, when in fact this is not so. There is no such thing as a safer cigarette; all cigarettes kill.”
“This is snus and it contains tobacco sachets and with instructions on how to use it – take one, put it under your tongue and enjoy it. This is a pack of e-cigarettes. "e" stands for electrical – you plug it in because you need the battery to light it up and they look like cigarettes. You have to unscrew it and these are batteries, you put it in and it releases nicotine and even lights up. And there are health warnings, "smoking is harmful for health, e-cigarette is good for health." Many of these products closely resemble confectionary items. Clearly, the intent is for them to act as starter products that get young non-smokers addicted to nicotine. We should expect tobacco companies to want to maximise profits by seeking to grow their customer base. Governments must however be alert to this trend and do their best to protect the people, especially the young, from the unnecessary harm of tobacco and its substitutes. In Singapore, we have to ensure that our legislation and our control strategies keep pace with development in the tobacco industry. We intend to go as far and as fast as other countries in our tobacco control measures, for as long as they are practical and effective. Mr Speaker, Sir, let me now highlight the new provisions that are being introduced in this Bill. First, let me deal with our two outstanding obligations under the FCTC. Tobacco sponsorship of the arts The current Act does prohibit tobacco advertising and promotion but it allows exemption for sponsorship of activities such as arts and cultural events. The Act allows tobacco companies to sponsor such events and activities and their sponsorship be publicly acknowledged.”
“In 2003, the World Health Organization (WTO) developed, what is called FCTC – Framework Convention on Tobacco Control, to get its member states to adopt strategies and best practices aimed at reducing the demand for tobacco and regulating its supply. We signed the FCTC in 2004. Two obligations are now due for compliance: (a) imposing a comprehensive ban on tobacco advertising, promotion and sponsorship; and (b) extending health warning labels to the outer packaging, and prohibiting false and misleading packaging and labelling of tobacco products. The Smoking (Control of Advertisements and Sale of Tobacco) (CAST) (Amendment) Bill seeks to amend the current Smoking (CAST) Act (Chapter 309 of the 2003 Revised Edition). The Bill will allow us to fulfil these obligations. In addition, I am using the opportunity to further tighten our tobacco control measures. There are two reasons for this. First, smoking has increased in recent years, particularly among young adults. Between 2004 and 2007, smoking prevalence increased from 18% to 25% among young men, and 7% to 9% among young ladies. This is a cause for concern. Second, tobacco companies are fighting back, against the global smoking control measures, by introducing new and alternative tobacco products. Many of these products are designed to attract new tobacco users and marketed to especially appeal to the younger customers, including women. A recent article in the Wall Street Journal explained vividly how a major tobacco multinational company was transforming into a company that offers a range of smokeless alternatives, such as strips, lozenges, snus and e-cigarettes. I brought along some samples.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The dangers of smoking tobacco are well established. Tobacco contains more than 60 chemicals that are known to cause at least 20 forms of cancer. It also contains nicotine, which makes the user feel high, causes addiction and adversely affects the cardiovascular system potentially leading to higher risk for heart attacks and strokes. Despite these well-known risks, many smokers find it hard to quit and new smokers continue to join the ranks. The data is depressing. Tobacco use is the leading cause of preventable death, killing more than five million people every year worldwide. To different degrees of success, countries have tried to stem the tobacco epidemic. Singapore was a world pioneer in tobacco control. We were the first in Asia to ban advertising in 1971 and we have been aggressive in tobacco taxation. In 2004, we again led Asia by being the first to use graphic warnings on cigarette packs to deter smokers from lighting up. Last year, we were the first in the world to mark all duty-paid cigarettes sold here with the letters "SDPC", for "Singapore duty paid cigarette", as a means to combat cigarette smuggling. On efforts to get smokers to quit, the World Health Organization recognised only nine countries, including Singapore, for their nationwide network of smoking cessation services. As a result of these proactive efforts, our smoking prevalence, at below 14%, is among the lowest in the world. International alliance in tobacco control is growing.”
“In addition, National Parks (NParks) left the southeast Caponier, which is the most significant feature of the Fort, on display. Storyboards and signage were installed to explain the findings. As there are considerable costs involved in undertaking full excavations to expose the structures and long term maintenance of such excavated structures, NParks will keep the Fort buried for the time being. The public can be assured that the PMB will continue to work closely with the agencies involved to address the long term future of the Fort, and ensure that its historical significance is appropriately recognised. Should there be any new developments affecting the site, NParks and the Urban Redevelopment Authority (URA) would alert PMB, which would then decide on the direction for future archaeological investigations and preservation strategy to be adopted. I understand that the then PMB had also met with Member Lim Biow Chuan and members of the Mountbatten Citizen’s Consultative Committee to convey their decision to maintain the status quo for the Fort. WRITTEN ANSWER TO QUESTION BLUEPRINT ON BILINGUAL EDUCATION 1. Ms Irene Ng Phek Hoong asked the Minister for Education if his Ministry has plans to chart a blueprint for bilingual education that maps out its direction for the next 10 years.”
“All invasive procedures carry the risk of transmitting an infection through contamination. Tattooing is an invasive procedure and poses such a risk. However, the risk can be eliminated through proper infection control measures. There were two cases of Hepatitis B linked to tattooing in the 1970s. With enhanced infection control measures, we have since not received any reported case of a notifiable infectious disease linked definitively to tattooing or body piercing. But with more children going for tattooing and body piercing, I understand the concerns of their parents. My Ministry is reviewing the regulatory experience overseas to see if we should also introduce some regulations here, especially with a view to protecting the minors. PRESERVATION OF FORT TANJONG KATONG 18. Mr Lim Biow Chuan asked the Acting Minister for Information, Communications and the Arts whether the Preservation of Monuments Board will consider preserving Fort Tanjong Katong as a national monument. RAdm [NS] Lui Tuck Yew: The Preservation of Monuments Board (PMB), now part of National Heritage Board (NHB), does not plan to gazette Fort Tanjong Katong (Fort) for the time being. Excavation works were conducted in 2005 to ascertain the full extent of the underground Fort. The studies have since shown that part of the old Fort is located outside the Katong Park boundary and extends into State Land that is currently zoned for Residential Use. In 2008, then PMB recommended to keep the archaeological remains of the Fort buried, in-line with conservation practice, to protect it from damage by further weathering or human interference. It was also established that there was no immediate threat to the Fort since there were no plans to develop the neighbouring residential site.”
“In the polyclinics, more than 80% of the doctors can speak Mandarin, Malay or Tamil. For the supporting staff, the ratio is higher at 99%. In healthcare, communication is an important factor. We need to take the patients' history and be able to convey our treatment instructions clearly. The majority of our patients can speak in English and communication is not a problem. But for those who cannot, they will be assigned to the healthcare workers with the relevant language skills. Where a match cannot be found, other staff will be roped in to help interpret. Some of our patients can only converse in a dialect. The same approach is taken to match the patients to the staff with the relevant dialect skill. Most of our staff have, over the years, picked up simple dialects sufficient for their work. MODERATING CAR GROWTH 44. Mrs Mildred Tan asked the Minister for Transport given the opening of the Circle Line and the improvements in public transport over the years, whether the Ministry will study the possibility of a slower car growth of 1% or less.”
“Sir, we did not impose any quota. I think it is up to the University to decide who they want to take in. The main criterion is educational standard – they want the brightest students, wherever they may come from. I am quite glad that we still get about half from Singapore and quite a significant percentage from the PRs. On capacity, it is designed for about 60. Today, we are taking in about 50, quite close to the capacity. The US medical graduate programmes are, as the Member would know, relatively small. The UK Duke Medical School, for example, takes in only 100 per year. 3.00 pm”
“The Duke-NUS Graduate Medical School enrolled its first cohort of 26 students in August 2007 who are now in their third year. Enrolment grew to 48 students in the second cohort and 56 students in the third cohort. It is now in the process of recruiting its fourth cohort. The Duke-NUS programme is a four-year graduate medical programme, modelled after the US Duke Medical School, with particular emphasis on promoting clinical research and nurturing clinician-scientists. The graduates from the programme will be awarded joint degrees from both the Duke University and the NUS. We are pleased with the progress of the programme. A lot has been achieved achieved within a very short span of time. Among the students, 53% (half) are Singapore citizens, 11% are Singapore permanent residents (PRs) and 36% are international students. The average entry age of the students is 24 years old. Forty-one per cent of Duke-NUS students are male and 59% are female. The graduates from this Duke-NUS programme will add to our medical community, contributing especially as clinician-scientists to our growing biomedical science research and industrial development.”
“Sir, I stand advised by our experts. Their recommendation is, yes, it is effective against the two main strains. But whether we should include it in the national immunisation programme, they have not given such a recommendation. But it is a topic that is ongoing partly because it is still a relatively new vaccine. Part of their consideration is: what is the long-term effect of such a new vaccine? For mass immunisation programmes, we have heavy responsibilities. It is easier for a voluntary programme, in which case the doctor would simply sit down with the parents, explain the pros and cons and it is a personal decision whether the parents want to proceed or not. Just like pneumococcal vaccination, the Expert Committee also took quite some time to deliberate, and quite rightly so. We should be careful when recommending any kind of compulsory immunisation at the national level. STUDENT PROFILE IN DUKE-NUS GRADUATE MEDICAL SCHOOL 16. Dr Lam Pin Min asked the Minister for Health (a) if he will provide an update on the Duke-NUS graduate medical programme and the demographic profile of the students; and (b) how it will augment the medical manpower requirements in our healthcare system.”
“Sir, our age-standardised incidence rate of cervical cancer has been dropping steadily, especially in the last decade. The latest available data for the period 2003 to 2007 reported a rate of 8.8 per 100,000 women per year. Ten years ago, it was 10.6 and 20 years ago, 15.1 per 100,000 women. Survival of these patients has also improved over the years. The five-year age standardised relative survival rate was 65% for the 1998 to 2002 cohort of patients. It was less than 50% in the 1970s and 1980s. Our survival rates are comparable to that of other developed countries. Cervical cancer is treatable, especially if detected early. Pap smear screening is the main prevention measure. We have a national cervical cancer screening programme for all married women to go for pap smears once every three years. Pap smear screening is easily available in general practitioner (GP) clinics, polyclinics and hospitals. We have recently also launched a specially customised bus that brings such service to the housing estates. As a result, three in four women (74%) aged 25 to 69 years had undergone a pap smear test, with six in 10 (59%) within the past three years. I think the take-up rate is not bad but we will continue to promote it. Vaccines against two strains of Human Papilloma Virus (HPV) are now available. They are effective against these strains, but there are other strains that can cause cervical cancer. So vaccination itself does not eliminate the need for regular pap smear screening. Our Expert Committee on Immunisation has recommended that young girls should be vaccinated against HPV. However, it has not recommended compulsory vaccination.”
“Mycoplasma pneumoniae (MP) is a common cause of community acquired pneumonia which is seldom severe. Most patients do not need to be hospitalised and will fully recover after treatment with antibiotics. We do not track the incidence of this disease. Routine screening for MP is also not done as currently there is no test which can easily diagnose it. In any case, persons infected with MP will usually display pneumonia symptoms. Hence, screening persons without penumonia symptoms will not pick up many patients. The correct approach is to promote good personal hygiene practices and to encourage those who are unwell to seek medical treatment promptly. UPDATE ON TEACH LESS, LEARN MORE PROGRAMME 13. Dr Fatimah Lateef asked the Minister for Education (a) what findings and results have surfaced following the introduction of the "Teach Less, Learn More" programmes in schools; (b) what lessons have been learnt from these findings and how will these lessons be implemented in the curriculum; and (c) whether sharing sessions have been organised to share best practices across institutions.”
“In the past three years, 1,246 foreign-trained doctors were recruited, while 685 graduated locally. Of the foreign-trained doctors, 176 are Singaporeans. The doctor-to-patient ratio will depend on the clinical setting. However, the most commonly cited statistic is the doctor-to-population ratio. We are currently at 1:600. We expect to improve it further to at least 1:550 within the next eight years. TREND IN MYCOPLASMA PNEUMONIA 12. Mdm Halimah Yacob asked the Minister for Health (a) whether there has been an increase in people suffering from mycoplasma pneumonia and, if so, what are the causes; and (b) whether it will help to have foreign workers screened through blood tests for this chest infection.”
“NHB has also been engaging a wide variety of Indian community organisations – including religious groups, cultural bodies and educational institutions – to ensure that a representative and diverse narrative of the Singapore Indian community will be presented to future visitors of the centre. SUBSIDIES FOR AUTONOMOUS UNIVERSITIES 19. Mr Lim Biow Chuan asked the Minister for Education (a) if he will explain the amount of subsidies given by the Government to each autonomous university and clarify how these universities decide on any increase in university fees; and (b) in view of the expected increase in university fees each year, whether the Government can assure Singaporeans that the fees will remain affordable in the future.”
“The centre's gardens will be re-designed to provide more space for outdoor programmes and facilitate interaction with the surrounding community. The Chairman of the Malay Heritage Foundation, Senior Minister of State for Foreign Affairs Mr Zainul Abidin Rasheed, will announce the full details of the development plan in July this year. I am confident that these renovations will make the centre more relevant and attractive to visitors. On the Indian Heritage Centre, plans for the construction of the centre are underway. The Indian Heritage Centre's Steering Committee, chaired by Senior Minister of State Dr Balaji Sadasivan, was formed in January 2009 to oversee the development of the centre. As in the case of the Malay Heritage Centre, NHB has been appointed to manage and provide programming and curatorial direction to the Indian Heritage Centre. A site at Campbell Lane in the heart of Little India has been identified for the location of the centre. This is an ideal site, since the centre will function as a focal point for the showcasing of the rich history, traditions and culture of the Singapore Indian community. The centre, when ready, will house exhibition and performance spaces as well as public areas for visitors and members of the community to interact and mingle in. An architecture competition will be called in October 2010 to select the design for the centre and construction is expected to commence in late 2011. For its part, NHB has been developing content for the displays and permanent exhibition spaces. NHB has been meeting and interviewing Indian community leaders for their valuable memories and contributions.”
“Since 2009, the National Heritage Board (NHB) has been tasked with operating the Malay Heritage Centre (MHC) on behalf of its owners, the Malay Heritage Foundation (MHF). As the managing agent for the centre, NHB manages the centre's operations, and provides curatorial and programming direction. NHB recently commissioned a museum design and planning consultancy study to explore ways through which to boost the centre's programmes, operations and profile. The study resulted in two key recommendations. The first calls for the MHC to better leverage its location in the bustling and vibrant Kampong Glam neighbourhood to reach out to and connect with the increasing numbers of young visitors and tourists who regularly visit the area. The second recommendation involves coming up with more engaging ways to celebrate and showcase all facets of Malay arts, culture and heritage to maximise the centre's appeal to local and international audiences. In light of the study's findings, the MHC will undergo a major re-development to increase its accessibility and visitor appeal. The re-development will be carried out in consultation with the board members of the Malay Heritage Foundation as well as other leaders and representatives of the Malay community. The MHC will close in phases from November for the renovations and work is expected to be completed within one year. Please allow me to briefly share with you some of the exciting plans in store. A new permanent display will highlight the cosmopolitan nature of the Singapore Malay community and emphasise the rich urban history of the Kampong Glam neighbourhood. A theatre will be built to provide performing space for artists and community groups.”
“Last year, Singaporeans withdrew a total of $660 million from their Medisave accounts to pay for the direct medical expenses incurred in hospitals, clinics and other healthcare facilities. This was an increase from the $590 million withdrawn in 2008. These figures do not include withdrawals for MediShield and ElderShield premium payments which were $745 million in 2008 and $875 million in 2009. Fifty-two per cent of the withdrawals in 2009 were to pay for the members' own direct medical expenses. The remaining withdrawals were to pay for family members: 17% for spouses, 18% for parents, 12% for children, 1% for grandparents and others. The breakdown in 2008 and previous years was similar. VISITOR NUMBERS AT MALAY HERITAGE CENTRE 17. Ms Audrey Wong Wai Yen asked the Acting Minister for Information, Communications and the Arts (a) what are the visitor numbers to the Malay Heritage Centre for the past four years; (b) what can be done to increase its public visibility; and (c) whether an update on the progress of development of the Indian Heritage Centre can be provided. RAdm [NS] Lui Tuck Yew: I would like to thank Ms Audrey Wong for her interest in our Community Heritage Institutions. The Malay Heritage Centre received more than 418,000 visitors over the last four years. These visitors comprise Singaporeans and foreigners, including members of the Malay diaspora. It is especially encouraging that in FY 2009, the centre had more than 127,000 visitors, a 37% increase over the FY 2008 number. These figures indicate a strong and growing interest in Malay culture and heritage among Singaporeans and foreigners alike.”
“Serious economists are all coming to the same conclusion that the only way to tame this beast – ie, runaway healthcare cost – is health savings account coupled with a high deductible insurance scheme. Drop the comprehensive first-dollar coverage and all other means which have been incentivising wrong behaviour.”
“The beauty of our system is diversity, so I have heard of different packages from different general practitioners (GPs). They package it up – some patients pay in advance or at the end of the year or by instalments or other ways. There are all sorts of packages in town. I will advise the Member to advise whoever who gave her the feedback, to shop around in the neighbourhood. I am sure there are different GPs and they should be able to respond to that. I want to stress that this packaging is not to get around the deductible. The packaging serves a purpose. A package for chronic disease is no different than our motorcar maintenance package. Many motorcar workshops have maintenance packages for their customers – 5,000 kilometres do this; 10,000 kilometres do that; 20,000 kilometres please come back to check engine. The maintenance of motorcar and of the human body is similar. The package deal serves that purpose and the problem that the Member mentioned can be easily overcome with this package scheme. As for the person who hand wrote the note on his problem with $30 deductible, I vaguely recall the incident. But as I said, the right solution is to get a suitable package. Chronic disease is not a one-off acute attack. Payment is not just one visit for $30. The patient has to do it for the rest of his life. Very importantly, the programme has to be packaged, to ensure compliance. With the capping of $300, the Member asked why there is an additional need for deductible. I have explained that just now. The deductible is a very important part of controlling this morale hazard we talked about. I would advise or suggest that the Member read up on some of the commentaries which are floating around on the Internet in US over their healthcare reforms.”
“The hotline for IMH is for their ex-patients. There is no problem, because we know the patients on our database. Whether they also respond to new fresh calls, I have got to check. As the hotline is 24 hours, and if somebody calls up and explains what is the problem, I am sure they will be able to, there and then, provide the necessary counsel and advice. But I need to check on this point.”
“In January, we have the return of Singaporeans and hence the return of the elective surgery cases. Then in February, we had two weeks of Chinese New Year, and everybody shied away. And in the last two weeks and now, we see the return of all elective surgeries. That is the reason why we have all this sudden big increase. It should ease once Khoo Teck Puat Hospital is fully opened in a few months' time. But, meanwhile, I plead for some patience.”
“Even when a particular hospital is short of beds, I have empty beds in other hospitals. So it is not as if there is a complete shortage of beds nationwide, but there are mismatches. Mondays and Tuesdays are bad in certain hospitals and we are trying to cope. We anticipated this problem three-four years ago. I remember Mr Low Thia Khiang raised this issue on potential bed shortage coming up in Tan Tock Seng Hospital. Somehow he is familiar with Tan Tock Seng Hospital. He had seen some problem there and alerted me to it, which I acknowledged. And that is why in the last few years, we have been increasing beds in every hospital. Over the last four years, we have actually added many beds wherever we can. But we are now coming to the tail end of the construction of the new hospital that is coming up. Hospital construction is lumpy. There is no increase in beds for years, and then suddenly we have a 500-bed hospital. So, what I have done over the last few years is to progressively add in temporary beds in other hospitals while waiting for this Khoo Teck Puat Hospital to open. When it opens, we can then close all those temporary beds. But as we get close to D-Day, that is when the pressure is at the maximum, and that is why we have these temporary shortages of beds on certain days. But, as I said in this House, clinical care is never compromised and we will never compromise it, but I accept that service level is unsatisfactory. Yes, our staff could be better at communication, but I have some sympathy for our staff. They are really working their guts out when there are so many patients in the last two-three months. The problem is this, and we know this seasonal factor. With the school holidays in December, many surgeries were cancelled, as people went on holiday.”
“I thank Dr Neo for her comments and compliments. The national health expenditure in our case is less than 4% of GDP. I have discussed this in this House before. Four per cent is not sustainable, because there is a correlation between GDP growth and health expenditures. As we become richer, we are prepared to spend more on healthcare, and that is why the national health spending will grow. How much will this 4% grow up to? It is hard to say. A lot depends on how well we manage the cost escalation and medical inflation. My own personal target is this. As long as we can keep it to a single digit percentage of GDP, that should be quite an achievement. Many European countries are now at double digits. The US is the worst – 17%, and projecting 20% in a matter of time. And once we go over a tipping point, it is almost uncontrollable. So we must try to keep it single digit – 4% eventually will become 5% and then 6%. Even at the most advanced of ageing, if we can keep it to 8%, I think that would be a huge achievement. How to do it? The key, as I said just now, was to control expenditure. So long as we can keep costs low overall, then who is the one who is responsible for payment is a secondary question. And the way to control healthcare spending is to cut out abuses. The problem in the US and the European system is abuses – what we call "buffet syndrome". The more we can control moral hazards, the more we are able to keep the cost inflation down. On bed shortage, we had a short discussion last month at a parliamentary sitting. I quoted figures to show that, overall, we are not short of beds, but there are mismatches. Of course, when the media played it up, they will play on those days when it is very high in a particular hospital.”
“When I saw them, she explained to me how she coped with great difficulty, but she coped. At the end of the visit, I told her, "You are a good person." She was all right but when I said, "You are a good person", that was when she broke down. She said, "We knew each other since school. I love him for so many years. We have been married now for 20 years. How can I forsake him, desert him?" And that is how people cope. And for people like that, I will go all out to support them and make sure they can deliver.”
“Sir, I find that a meaningful commentary. To respond to it with full justice, I think I will need two hours, which I do not have. But, clearly, it is a major issue that all societies are trying to cope. We are lucky in that our population is still young and we have a few years to strengthen the system, which we will. The bottom line is this. I do not think it is whether you are sandwiched or otherwise. There are barriers, yes. Whether you are rich or poor, there are barriers. But if a person is in the middle-income or higher-income group, in fact, he has more personal resources compared to the lower-income group. I do, as I said, home visits to patients and, most of the time, I visit the lower- income group. These are people much less endowed than the sandwiched groups. But what always struck me was how they still manage because the love is there. They have limited resources, yes, but that did not prevent them from going the extra mile. On the other hand, I have come across people who are clearly pretty well endowed, but they just assume that they can delegate and outsource their love and compassion for their parents away. So, at the end of the day, it is attitude. I am not trivialising – the word the Member used – the barriers that people are facing, but they can be overcome once the attitude is right. "Yes, this is my mother (or this is my father) and I am going to go all out with whatever resources I have, topped up by whatever society is able to supplement." I visited one couple in my house-to-house visit in Sembawang. She is a Malay lady in her early 50s. The husband, heavily diabetic, both legs amputated, on wheelchair when I visited them. She has been looking after the husband for more than 10 years.”
“But when they lose their mobility, I will still be working and there are many, many sandwiched families like that. Can the Minister share with us his thoughts on how to free the sandwiched family? Many of these will be dual-income families. How do we free these families so that they can take care of their dependent elderly at home and rise to the challenge that the Minister has posed to Singaporeans – that we must be filial and we must oblige our moral obligation to our parents.”
“As I said, we can only point the way forward, but the patients must cooperate with us. Unless they are engaged, it is very hard for us to really bring about true change in health outcome. 2.45 pm Under the additional mental health programme, we have funds set aside to work with VWOs, because we know we cannot do this alone, and on the ground, there are many willing VWOs. I have visited some of them in Mdm Cynthia Phua's constituency, they are passionate people. She asked about the Many Helping Hands approach. We could easily say, "All right, we take over, we nationalise it and do everything ourselves as civil servants." But remember the story of Sister Geraldine – no paid employees can deliver that kind of service. So, it is not a matter of we do it without them or they do it without us. I say, let us do it together. Our objectives are the same, which is to help Singaporeans stay well, live well and, hopefully, end well. But the patients have to play their part too. Assoc. Prof. Paulin Tay Straughan: Sir, I would like the Minister to elaborate on the point that he had just spoken on. I watched "Money No Enough 2" as well and few local movies moved me as much as that movie did, particularly the scene when the elderly mother was moved from one child's home to the other as her health failed. But within the movie, we were also shown the constraints that each of the three sons who clearly loved the mother, I thought, but they were consumed by their own family and work demands. It is easy to trivialise these kinds of barriers in the movie but I think in real life we are going to see a lot more of such families. Everybody seems to be sharing their age today. So, I am 46. My parents are pushing 70 and, thank God, they are mobile.”
“Because we cannot really translate it into an algorithm which we can just plug into the computer and decide, yes, somebody deserves it, or somebody does not. Home-care, yes, the intention of scaling up, for example, Home Nursing Foundation (HNF) is to make sure that it is a service that will be useful and meaningful to the patients and their families. And we do subvent HNF and I intend to increase the subvention to them. I accompanied the HNF teams on some of their visits to their patients at home. I observed them. Truly, they are doing very good work. Two months ago, I visited two of their patients who happened to be in Mr Shanmugam's constituency in Chong Pang. These are diabetic patients, one leg already amputated and the second leg will soon be amputated, wheelchair-bound, and with diabetic kidney failure requiring dialysis. Fortunately, there is a NKF Dialysis Centre nearby. But nearby for an able-bodied person is truly nearby, but for a disabled person, even 200 metres is like a mile. And the spouse is the one who has to push the wheelchair all the way to NKF. So, these are the problems that we can see. But we cannot bring dialysis to the home. Of course, we can go with ambulatory dialysis, but in her case it was not suitable, as she has other problems. So the home nurses visiting her have been very useful. They come, check her blood sugar everyday or every other day, and then remind her to comply. I was a bit sad that day when I visited her. They checked her blood sugar, it was high. So, the nurse asked: "Why? You know your diet discipline, you can eat this, but you cannot eat that." And she said, "Yah, I know." That morning she had some unhealthy breakfast, she thought it was just one meal.”
“Sir, when I said that the MediShield changes to include, for example, the mentally ill will have to await better times, what I meant was that if we want to extend payouts, premiums have to be adjusted. So, it depends on how much the premiums will be. If I am taking so long on this subject, it is because, obviously, the premium increases are not small. If they were small, I would have done it yesterday. But because the impact of the payouts on the premiums is not insignificant, that is why I have been sitting on this for so long. I find it hard to commit to a timeframe because there are still adjustments to be assessed, on how to better bring it about. And this is the same for the ElderShield reform that Dr Lily Neo raised. We are trying to make some trade-offs, how to extend the benefits so that it is truly meaningful, without incurring too much burden on everybody else. At the end of day, it is about risk-pooling. It is really the rest of the population supporting the small number with mental illness or with severe disabilities. So, these are some of the things that we are looking at, with the help of actuary consultants. Let me assure Mdm Halimah that it is very much at the top of my head because, as she rightly said, she has raised it several times before, and I have not forgotten. On MAF, I used the word "lower-income". I did not mean low-income. Lower-income is relative. I do understand that even for lower middle-income group, costly medications can be a problem. And that is why I like the Medifund mechanism because that allows us flexibility. This is a group of wise people who will then help us to determine, case by case, who deserves it, who does not.”
“The original SOP would be that each time there is a crisis – and often there will be a crisis – it is a big operation. They have to call the ambulance and that level has no lifts. The lifts are coming but at that moment, there were no lifts. And carrying the patient down was a major operation. So, they were so appreciative when I visited them – the whole extended family was there. Not all the extended family stay there, but those who stay nearby all came to wait for me and expressed how appreciative they were. I think we know now what to do. Our job is to scale it up so that more can benefit.”
“Mr Chairman, there is no elixir, no secret recipe. Technology does help – I colour my hair. But, no Botox. I think the mind is important, the attitude to life. As I quoted Lao-tzu earlier – what is life all about? It is never about ourselves, it is about others. And if we lead a life in that direction, whatever the physical form, I do not think it matters. While waiting for Jurong General Hospital, we will retain Alexandra Hospital. The original plan was to close it down immediately when Khoo Teck Puat Hospital is up. But when I reviewed the situation about three years ago, I decided not to close it. I think we cannot afford to close down Alexandra Hospital while waiting for Jurong General Hospital. So, we will keep Alexandra Hospital running as it is; in that way the addition to our bed capacity is really 555 beds, which will come on stream over the next few months. Like IRs, we will open Khoo Teck Puat Hospital in stages – no gambling tables but there will be operating tables. For the additional $57 million, the emphasis will be on community mental health. We have some KPIs. One will be in terms of additional psychiatric resources (nurses, doctors) that we will be pumping in. I cannot recall the numbers but those are the commitments that we have made to the Ministry of Finance when we secured the additional money. The second one will be making sure that the community home visit teams will be truly effective. I accompanied those teams on some of their home visits. I visited some of these patients and I can see for myself that, truly, the service is well appreciated. I remember there was this dementia patient who happened to be in Mr Low's constituency. The patient has dementia for several years now.”
“5 million to Medifund Committees to enable them to help more patients, especially those requiring HIV medications. This year, I will inject a further $10 million from Ministry of Health’s operating budget to help deserving patients cope with seven high cost medications used for diseases such as breast cancer, colorectal cancer, ovarian cancer, COPD and asthma. This should be helpful to many patients suffering from these diseases. We will leverage on the Medifund mechanism to help disburse this additional financial assistance to deserving patients. This includes means-testing and some co-payment by patients as the hospitals deem fit. If the idea proves useful, we can increase the budget allocation to this new Medication Assistance Fund (MAF). Mr Chairman, our multi-layered protection framework, code-named 3Ms, builds upon and enriches our Government subsidy framework which we inherited from the British. It allows us to combine the best of the British taxation model with the best of the market-based American insurance model. It is not perfect but it has served us quite well. I fully agree with Dr Lily Neo that "we need to continually tweak it so as to cater to the growing needs and expectations of our people". With the support of Members, I will continue to do my best to ensure that all Singaporeans can afford basic healthcare. This is my pledge. Special needs medical screening”
“About 14% of ElderShield policyholders subscribe to ElderShield supplements. It will be a better picture, if another 30% or 40% also join in. In response to Dr Lily Neo, we are looking to further enhance the basic ElderShield by raising its payout to, say, $800 per month. But this will require some premium adjustment. I am trying to see how we can avoid this and I am studying the alternative of maybe bringing forward the entry age from 40 to, say, 35 or 30, which should mean lower premium adjustments. Effectively, this will allow Singaporeans to spread out their larger premium payments over a longer period of their working life, instead of the current 25 years, in return for higher payouts should they become severely disabled. The final layer of protection is Medifund. This is the ultimate safety net to catch anyone who falls through the top three layers. We have been building it up since its launch in 1993. With the proposed top up of $200 million, it will reach $2 billion. Medifund is again unique in Singapore. We consciously set aside budget surpluses during good time, so that our ability to help the vulnerable during bad times is not diminished by the adverse economic climate. Last year, when we anticipated more patients asking for financial help, we increased the Medifund disbursement to $75 million. It was helpful. While the economy this year should be better, I will nevertheless further raise this year's Medifund budget allocation to institutions to $80 million. This will be funded, as usual, using the interest earned by the endowment fund. Separately, I have been thinking about how to help lower-income Singaporeans cope with expensive drugs, over and above our current subsidy policy. Last month, I disbursed an additional $8.”
“They are saying "enough is enough" and are demanding that employees should shoulder future premium increases. Last week, an article in a German business weekly, Focus Magazine, discussed this issue. The article was titled "Saving Money With Singapore" and this is an English translation of their German title. I am sure it is more elegant in German. Its sub-headline read: "The Government is looking at an Asian health regime as a model for the reform of the statutory health insurance system". The article said that they "are looking into one health system in particular – that of Singapore". I do not know if our 3Ms is implementable in Germany as our politics are different, but clearly we must be doing something right. MediShield and ElderShield are not compulsory but, through an opt-out approach, we have achieved good coverage. MediShield coverage has exceeded 93% for all working adults, and the ElderShield per-cohort coverage is about 90%. As noted by Dr Lily Neo, there is room for further expansion, but the current picture is not bad. I have done several enhancements to MediShield and there is scope to do more, for example, to extend it to cover mental illness and congenital illnesses, when the economic condition is conducive. Mdm Halimah and Ms Denise Phua raised these two ideas several times. I have not forgotten them. I have also enhanced ElderShield, but I think further enhancement is necessary. ElderShield now pays out $400 per month for up to six years. This is just about sufficient for the lower-income group who can qualify for heavy subsidy in nursing homes, but it will not be enough for the higher-income group. They should top up their basic ElderShield with ElderShield supplements. Some do.”
“We will involve more skilled therapists in the delivery of care and establish individual care plans and improved outcome monitoring to help ensure patients receive the care they need. With better treatment, costs will, however, go up and that is why the increase in Medisave withdrawal limit should benefit the patients. These changes to Medisave withdrawal limits will be implemented in June, in a couple of months' time. After Government subsidies and Medisave, health insurance in the form of MediShield, ElderShield and their private supplements, form the third layer of protection. The value of health insurance and the benefits of risk-pooling are well established. Practically all countries have incorporated insurance into their healthcare systems. The Germans under Chancellor Bismarck introduced this innovation a century ago. But we are again unique by insisting on "deductibles and co-payment" in our health insurance framework. We reject comprehensive health insurance based on "first dollar coverage". Many other countries adopt comprehensive health insurance and are now bogged down by abuses, over-consumption, over-servicing and wastages. They are all trying to reform their insurance policies, eg, in the US, by introducing "deductibles and co-payment" but find it politically challenging. Former Health Minister Yeo Cheow Tong incorporated this important feature into our health insurance policies and we were wise to have avoided these pitfalls. Even the Germans who pioneered health insurance are now trying to reform their national health insurance system as abuses are causing massive deficits. Employers have been shouldering the rising premiums but this has affected their business competitiveness.”
“This is largely adequate for patients undergoing rehabilitation. However, we are stepping up the capabilities of the community hospital so that they can also serve sub-acute patients, for example, those with hip fractures, and elderly with kidney and urinary tract infections. Traditionally, such patients are kept in acute hospitals where their Medisave withdrawal limits are higher, at $450 per day. But it makes sense for the patients to be transferred to a community hospital where the total cost is lower. However, current withdrawal limits may deter such patients from moving to community hospitals because of higher out-of-pocket payments, as Dr Amy Khor pointed out. To fix this anomaly, we will do two things. First, we will subvent the community hospitals which partner the acute hospitals to provide sub-acute care, more. The daily norm cost for such cases will increase from $271 to $400 per day. So this is quite substantial. Second, we will (a) raise the daily Medisave withdrawal limit for community hospitals from $150 to $250, and (b) raise the annual Medisave withdrawal limit from $3,500 to $5,000. Together with the enhanced nine-tier subsidy framework for community hospitals implemented last year, these adjustments should make it cheaper for sub-acute patients to move from an acute hospital to a community hospital. I thank Dr Amy Khor for this suggestion. Medisave can also be used to pay for day rehabilitation services, subject to a daily limit of $20. We will also be raising this limit from $20 to $25. We are working with the providers to raise the clinical standard of community-based rehabilitation care.”
“The benefits or cost-effectiveness of such tests are often dubious. I call this unethical screening. Health screening is therefore a complex issue and the risks associated with unethical screening are real. We must not fall into the trap of such commercial practices. As a first step, my Ministry will set up an expert group to review the range of healthcare screening available here and recommend a framework to determine what constitutes appropriate health screening. We will then be in a better position to advise Singaporeans, as suggested by Dr Fatimah, so that they do not get fleeced. She did not use those words, I do. Prof. Lee Hin Peng will chair this expert group. He is a senior public health specialist and has a special interest in cancer screening and prevention. We propose to put this group under the auspices of the Academy of Medicine. Separately, we will study the financial implications of health screening so that should we decide to open up Medisave for it, we will know how to prescribe the necessary withdrawal limits. This was the approach we took when we opened up Medisave for outpatient chronic disease management. It is a prudent approach to exploit the benefits of Medisave liberalisation, while minimising the downside risks of over-servicing and over-consumption. Meanwhile, I have noted the various suggestions by Members and I will try to incorporate them in due course. Another area of Medisave usage is in the intermediate and long-term care (ILTC) sector. Several Members have commented on the need for rational Medisave withdrawal rules to encourage right-siting of patients in the community. And I agree. Today, Medisave can be withdrawn for community hospitals, subject to a daily withdrawal limit of $150, up to an annual cap of $3,500.”
“We must be mindful of such pitfalls. As Dr Fatimah put it, we may be opening a Pandora's Box. A mindless liberalisation of Medisave for health screening may not improve health outcomes, but instead prematurely deplete Medisave balances. 1.30 pm Let me give one example of health screening which is being promoted in the West: genetic screening to predict the risk of a person getting a particular disease later in life. These are sophisticated tests and, of course, very expensive. The clinics love it because it improves their topline and bottomline. Last month, the Journal of the American Medical Association published a timely research finding on the effectiveness of the current gene markers to help doctors predict which women would develop heart disease. The study found that we still do not yet know enough about genetics for health risk prediction. The article concluded that "instead cholesterol levels, blood pressure and family history remain the better indicators for determining who is at risk for having a heart attack, stroke or dying from heart disease". At the moment, the traditional screening methods are still more reliable and very much cheaper. But they are less glamorous and bring in less revenue for the clinics. I am sure genetic forecasting will become more useful in future, as their scientific promises are fascinating. But meanwhile, the results are still disappointing. As one International Herald Tribune (IHT) article put it: "If you want to learn your odds of getting different diseases, consult your family history. Or visit a fortune teller. For most traits, genetic testing is little better than consulting the tea leaves." Genetic testing is one example. But there are many other sophisticated screening tests which are also being promoted. All are expensive.”