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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“The answer is yes. We will definitely do so. Our communication experts advise us that this is not the time to re-start. Let the emotions calm down first. But certainly we will have to do it regularly. For Singaporeans turning 21, they receive brochures on HOTA. We batch it twice a year and send out a lot of materials. I know this because my daughter received them when she turned 21. So there are programmes of that kind. But it is a morbid subject. And I know Singaporeans, the majority of them will say, "I don't want to think about it." But from this incident, let us all be wiser after this and learn from this. And bear in mind that it is your wish; we will respect it. But think about this, that upon death, the body is otherwise useless. But it is not that useless, it can still save lives. I think saving lives is still priority. ASEAN FRAMEWORK AGREEMENT ON SERVICES 3. Ms Lee Bee Wah asked the Minister for Trade and Industry (a) if he will provide an update on the status of the arrangements on Professional Engineering, Architectural Services and Construction Services under the ASEAN Framework Agreement on Services; (b) how have these service agreements translated into actual practice for Singapore’s engineering and construction industries; and (c) how did the Ministry get feedback from local industry players before it entered into discussions to work out these service agreements.”
“At the appointed time, unfortunately, the family said, "We want more time." But the organs were deteriorating, and if the hospital were to allow more time, then even the kidneys would become useless. These are the circumstances behind this incident. I do not want to go into further gory details because it may not be fair to the family. I for one can fully understand what sort of trauma they were going through. This person was only 42 years old - sudden death. It is not easy to be put in that kind of situation. Let me come back to the basic point - respect the wishes of the dead. At 42, that means he was around 21 or 22 when HOTA was introduced in this House. I remember there was widespread public debate. He was an educated man and I am sure he was fully aware of HOTA and the fact that he did not opt out means that he wanted to save lives in the event of any sudden death, and I think we should respect his wishes. In this instance, I think it is good for the family that at least two lives and a cornea transplant were able to take place. We will learn from this to train our staff to be even more sensitive and compassionate in our communication process. But the bottomline is, it is a difficult task to do. Dr Lim Wee Kiak: Sir, I want to thank the Minister for the comprehensive explanation. I guess that the most important issue is that of public education. I am wondering whether the Ministry will consider embarking on a publicity campaign to explain the HOTA again. They will have to do it probably in a recurrent manner, almost like a "Celebrate Organ Donation Day" every year. I hope the Ministry can consider this.”
“If everybody opted out, then of course, the possibility of saving lives and the opportunity to do so will be reduced. The key point about our HOTA policy is that it is not compulsory organ donation. We respect the individual's decision. If they want to opt out, no question is asked and we facilitate it. And we respect that because who are we to say that it is right or wrong of them to opt in or to opt out? But we have a job to try to explain to Singaporeans as often and as thoroughly as we can to think about that, upon death, the body is otherwise useless but you can still perform a useful role to save a few lives. And it has happened a few thousand times in the last many years that we have had HOTA. But we understand that, yes, it is traumatic experience for the family and we try to be as patient and flexible as we can. In this instance, it was rather unfortunate. Of course, the sudden death was traumatising to the family but they knew that the patient had died. They did ask for more time, and often, we allow that. In this instance, the family said, "Please do not go in yet. Give us another 24 hours", so that they can perform their various Taoist rituals. The hospital was flexible and allowed them an extension but explained to them that there was a time limit, because when all the cells had died, there was nothing to talk about in terms of organ donation. Indeed, in this instance, after the 24 hours' extension was given, the liver which was useful was no longer useful. I forgot now how many people are on the liver waiting queue. We prepared the patients and they were waiting for the operation. Unfortunately, we had to go in and say, "Sorry, the liver is now useless." But the kidneys were still useful, and there were two patients being prepared next door.”
“Dr Lim works in the hospital and he knows that one of the most difficult tasks in running a hospital is to convey bad news, particularly of premature death or sudden death, to family members. But I think more difficult than this task is telling the family members that their loved one has died, the brain has died, and that the organs can be used to save a few lives and that we are going to do so. It is not the easiest of things to do. Very rarely do we have family members who come forward and say, "Yes. Please proceed." Fortunately, the vast majority of family members are understanding and they accepted the sudden death and they try to compensate for the sudden loss by knowing that, at least, the death will now be able to save a few lives. But occasionally, we do get family members who are probably traumatised by the sudden death, becoming pretty aggressive and, sometimes, even abusive. But we try our best to explain, be as patient as we can and as compassionate as we can. But the bottomline is that we need to be firm with this opting out policy and respect the wishes of the dead that they had not opted out of HOTA. HOTA was fully explained. Of course, we will continue to periodically explain it. People have a choice to opt out and if they do not opt out, we assume that they must have had no objection if, upon sudden death, to have their organs used to save lives. It will be good for them and for society at large because if you try to look it from the donor's point of view, do not forget that there are a few hundreds on the waiting list. It is often the luck of the draw. You never know which side you will be on. Will you be a possible donor or a possible recipient?”
“The question is how to achieve such an outcome. On and off, there have been suggestions that organs be traded, ie, be bought and sold, to address the issue of organ shortage. Recently, the idea has again generated much debate among Singaporeans. Some support the concept, citing the effectiveness of such a market mechanism in increasing the supply. However, even from a purely practical point of view, the matter is not so simple. Thus, we have a voluntary blood donation, but not sales of human blood, because allowing sales of human blood encourages the wrong sort of people to come forward. Furthermore, many people, in Singapore and elsewhere, instinctively find the idea of trading human organs degrading and repulsive. Organ trading is not purely an utilitarian issue, but also one that raises very difficult ethical problems. One of these is its likely impact on the poor, both as donors and recipients. That is why hardly any country in the world has legalised organ trading, although a grey market often exists. We will continue to monitor developments in other countries, including the feasibility of ethical trading. This is a term used by some people, thinking that trading of organs can be done in an ethical manner. But how is it going to be operationalised has yet to be seen. However, as these difficult problems are not likely to be resolved soon, the Ministry has no plan to change our rule.”
“Sir, the first kidney transplant was carried out in Singapore in 1970. This was 37 years ago. As at the end of last year, 1,778 kidney, 83 liver, 27 heart, 7 lung and 2,356 cornea transplants have been done in Singapore. The Human Organ Transplant Act (HOTA) was enacted in 1987. So it was 20 years ago. From 1987 until the middle of 2004, 222 patients with kidney failure have benefited from cadaveric kidney transplants under HOTA, giving an average of 13 patients per year. This was an improvement as prior to HOTA, cadaveric kidney transplantation only averaged five per year. So before HOTA, only five lives were saved each year. After HOTA, it almost tripled to 13. In the middle of 2004, HOTA was amended to cover the liver, the heart and the cornea, and to include all causes of death. I took this Bill through in this House and I was glad for the full support from the House. From then until the end of last year, 103 kidney patients benefited from cadaveric transplants under the amended HOTA - an average of 41 patients per year, which is a significant increase. So before HOTA, five per year; now, 41 per year - more than an eight-fold increase. So we are saving lives, just for kidneys, almost one per week. In addition, 115 patients have benefited from 11 cadaveric livers, 10 hearts and 94 corneas. HOTA is therefore a very important policy in saving lives. Nevertheless, there remains a shortage of organs for transplantation. At the beginning of this month, there were 541 patients on the waiting list for kidney, 10 for liver, 2 for lung and 1 for heart. Each year, some patients die while waiting for an organ. Society as a whole has an interest to increase the supply of donated organs so that such premature deaths can be avoided or reduced.”
“The key is more information - better, relevant and timely information - because healthcare, as we know, is highly complicated. On the other hand, you can also have information overload if we publish too much information and nobody would read it. So you have to be able to, in a smart manner, pick up the key trends and then publish them in a way which people can use and understand. Frankly speaking, I doubt patients go to our website and check before they decide to go to hospitals because very few are as well-informed. But I do expect their referring doctors, whether they be GPs or polyclinic doctors, who understand the subject better, to regularly look at our updates so that when they have a patient in front of them requiring specialist attention, they know which hospital and which doctor to refer to, in order to get the best value for money on behalf of their patients. That is why, besides bill sizes, I also publish information like waiting time and queuing time. The whole idea is to give more information to the marketplace, to the players, so that we can help level the patient load and along the way, hopefully, it will be better service all round. HUMAN ORGAN TRANSPLANT IN SINGAPORE (Update on status) 2. Dr Lim Wee Kiak asked the Minister for Health (a) if he will provide an update on the status of organ transplant in Singapore; (b) how many people have benefited from the Human Organ Transplant Act since the opt out system was introduced in 1987; and (c) whether there will be a review on the legalisation of sale of human organs by his Ministry.”
“Mr Speaker, Sir, public hospitals set their treatment prices based on their operating cost and the prescribed subsidy policy. After my Ministry published the hospital bill sizes for the 70 most common medical conditions, the hospitals were then able to more systematically compare their cost performance with the others. This has allowed the cost-outliers to review why their patients ended up with larger hospital bills. A significant factor is the way doctors undertake their clinical practices and treatment processes. For instance, there are several ways to treat patients requiring gall bladder surgery. One hospital used to admit such patients for pre-surgery preparation a day before surgery. However, most hospitals prepare their patients on an outpatient basis and admitted them only on the day of surgery. This avoids one day of hospitalisation and led to cost-savings for both hospitals and patients. There are also ways to save cost for patients by using more cost-effective but equivalent substitutes in the treatment process. Staying on the example of gall bladder surgery, patients used to be given antibiotics through intravenous drips until their discharge a few days later. Now, they take the antibiotics in pill form from the day of surgery, which cuts costs as intravenous antibiotics are many times more expensive. The publication of hospital bill sizes has pushed our public hospitals to compete to bring better healthcare services at lower cost and also to learn best clinical practices from one another.”
“Through public education campaigns, Police intends to solicit public assistance to act as its eyes and ears to deter such crimes. In addition, SPF has engaged stakeholders, such as PowerGrid, HDB, Town Councils, Singapore Cable Vision and NParks, to improve their respective crime prevention measures. As a result of this collaboration, useful measures, such as the embossing of metal items with organisational identification, replacing of metal with alternative materials such as concrete, and beefing up patrols by their own personnel, have been implemented. Let me assure Members that Police will do its best to keep the metal theft situation in check. Let me also urge the public to play a part by being more vigilant. Some culprits are able to steal in broad daylight as witnesses assume that they are legitimate workers engaged to remove the metal items. If Singaporeans see such suspicious activities, they should immediately call the Police or town councils for verification or assistance.”
“Other items include metal pipes, bars, strips, dry-riser lugs, signs and drain covers. Of these theft cases, items made of copper accounted for about some 62%, followed by those made of aluminium (13%). The remaining cases involved other types of metals, such as stainless steel, steel, brass and bronze. This trend reflects the price increases of both aluminium and copper compared to steel. The total value of metallic items stolen last year was estimated at about S$4 million. Sir, the Singapore Police Force (SPF) has adopted a three-pronged strategy to combat this phenomenon, encompassing, firstly, enforcement; secondly, creating awareness; and, thirdly, prevention measures. Towards this end, Police has stepped up enforcement efforts against both thieves and errant dealers. Hence, last year, Police arrested a total of 200 persons for committing 150 cases of metal theft. MHA also recently amended the Secondhand Dealers Act, introducing a more focused approach to specifically provide for the inclusion of "cables and wires made of copper" in the Second Schedule list of secondhand goods to be covered under the Act. Other key changes include requiring the buyer’s details to be amongst details required to be submitted by the dealers to Police, and also increasing penalties for greater deterrence. In this way, we will more effectively deal with the disposal of such stolen goods by secondhand goods dealers, otherwise known as "fencing". To create awareness, SPF will conduct briefings and issue crime advisories to licensed scrap yard dealers to alert them of this crime trend and the consequences if they are found to have transacted in stolen metal items.”
“Mr Khaw Boon Wan: I reminded Members just now that Medisave was designed for a specific purpose and we should not forget that. Medisave cannot solve all medical problems. It is highly focused and for it to be effective, we should stay focused. We started it 22 years ago specifically to look after hospitalisation needs and that is why the contribution rates are designed that way. If, however, you want Medisave to be also used for other purposes, then, clearly, the contribution rate of 6% has to be raised to a higher level, which I do not think is advisable. I hope that answers the Member's question. THEFT OF PUBLIC PROPERTY 10. Mr Seah Kian Peng asked the Deputy Prime Minister and Minister for Home Affairs whether there has been an increase in the incidence of theft of public property such as lightning strips and metal railings and, if so, what measures are being taken to minimise them. The Senior Minister of State for Home Affairs (Assoc. Prof. Ho Peng Kee) (for the Deputy Prime Minister and Minister for Home Affairs): Mr Speaker, Sir, the number of theft cases involving metals increased considerably last year. About 1,100 such cases were reported, representing an increase of some 570 cases (or about double the number) as compared to 2005. This increase can be attributed to opportunistic criminals capitalising on rising metal prices by stealing various metallic items for sale as scrap metal. Fuelled by the high demand in countries such as China and India, the price of metal is expected to rise even further in the next few years. As to the types of goods stolen, they comprise cables and wires (44%), raw materials (9%), lightning conductors (6%) and urns (5%). These were among the most common items stolen last year.”
“We have almost three million account holders of various demographics. It is hard to generalise. But, as I said, as a nation-wide policy, I can only set broad rules that cover the majority. Whether you are under-saving or over-saving, it also depends on your health conditions. You could be from the lower-income group, but if you stay healthy, and you hardly use hospital treatment, your account may be sufficient. Or, as you said, you could be contributing $100 a month but, let us say, bad luck, you have a lot of illnesses, you are depleting your Medisave account, then you will be under-saving. The critical point for Singaporeans is this: when you work, save in Medisave. And when you have Medisave, please buy MediShield both for yourself and for your family (children and spouses), and then for those who, despite Medisave and MediShield, still drop out of the safety net, we have Medifund. And in a couple of hours' time, you will hear the fourth pillar to our social security system. The key is to make sure that every Singaporean gets into these social security pillars. That is the key. If you are not in, you decide to stay out, then I think that will be rough for the family. Assoc. Prof. Kalyani K Mehta (Nominated Member): Mr Speaker, Sir, would the Minister consider the use of Medisave of the individual or a family member for respite care in a nursing home, for a short-term period, say, for example, the caregiver (the child) wants to take a holiday or take a break and the elderly person is in need of supervision in relation to medical care? Right now, as I understand, it is the policy to pay cash upfront for respite care and this is sometimes quite tough on the family caregivers.”
“For somebody who is contributing $100 per month, he must be earning a few thousand dollars. For such account holders, his Medisave account would have been quite sizeable, and I have been liberalising Medisave for this group of patients. But your point is about such account holder who has a terminal illness. Are you saying he is under-saving or over-saving? I do not quite follow your point.”
“Sir, for terminal illness, there is a wide range of illnesses and, therefore, the treatment requirements vary and the consequential funds that they need also vary. So we have to look at each case. But as a policy, we apply certain general rules. I have been liberalising, the last few months, the withdrawal quantums and, by and large, my sense is that the measures are adequate. On average, these patients, when they die, have about $3,000 in their account. You cannot drive it down to zero because we are talking about average here. If we drive it down to zero, then there will be many accounts which are below zero, that means, they run out while alive. We have to take that into account. But for patients whose hospitalisation was their last hospitalisation, I changed the rule last year to allow the whole bill to be paid off for those who died in hospital. What is the Member's second question?”
“Routine kidney dialysis is best carried out at neighbourhood kidney dialysis centres. This reduces running cost and is also more convenient for the patients. It is not necessary for such treatment to be carried out within acute hospitals. (Some hospitals do provide kidney dialysis but for patients with serious or complex conditions.) There are many such neighbourhood kidney dialysis centres in Singapore, run by public, private and charity sectors. The Civil Service medical benefits do cover kidney dialysis treatment at private dialysis centres. The patients will be subsidised according to the provisions of their medical benefits schemes, capped at $190 per dialysis. This is similar to the subsidy that they currently enjoy when they visit charity-run dialysis centres. It is therefore not necessary to set up dedicated dialysis centres in general hospitals for use by retired civil servants. Column No : 1323 AVERAGE BALANCES IN CPF MEMBERS' ACCOUNTS (Figures) 5. Ms Sylvia Lim asked the Minister for Manpower if he will provide data on the average balances in Central Provident Fund members’ accounts upon their reaching 55 years, broken down by 10 percentile income intervals, for the last three years.”
“The waiting time for new appointments at restructured hospitals for polyclinic referrals will depend on several factors, including the medical condition of the patient and the hospital to which the patient is referred. For emergency cases, there is no waiting time as the polyclinics would refer the patients to the nearest Hospital Emergency Department. Non-emergency patients who are assessed to require early attention would be fast-tracked to be seen within, on average, one to two weeks at Hospital Specialist Clinics. For other non-urgent cases, waiting time varies with hospitals. For non-urgent referrals to the cardiac units, the median waiting time in 2006 was 36 days, ranging from 17 days in Changi General Hospital to 89 days in Alexandra Hospital. For non-urgent referrals to the renal units, the median waiting time in 2006 was 91 days, ranging from 63 days in Singapore General Hospital to 205 days in Tan Tock Seng Hospital. Although these are non-urgent cases, the waiting is too long. We have got the SGH to streamline its operation as it has the largest renal unit and sees the bulk of renal patients. For the last quarter of 2006, they have brought the median waiting time down to 23 days. Column No : 1305 NON-PAYMENT OF CPF TO CONTRACT WORKERS 43. Mdm Halimah Yacob asked the Minister for Manpower what measures has the Ministry taken to ensure compliance by employers who do not pay CPF to their contract workers and to enhance these workers' social safety net.”
“There are about 40,000 psoriasis patients in Singapore. Out of this number, about 80 patients or 0.2%, may benefit from biologics treatment. For the vast majority of patients, external treatment of the affected area will be sufficient. Biologics treatment is expensive. Moreover, it is not a cure. The use of biologics for treatment of psoriasis and psoriatic arthritis is still new; their efficacy and effectiveness will take time to be established. As Medisave is largely meant for inpatient use during old age, we should not rush to extend the use of Medisave for such unestablished treatments. We certainly should help to raise public awareness of psoriasis. The Health Promotion Board carries public information on psoriasis on its website. The National Skin Centre offers much more detailed information through print and electronic media. Together with the Psoriasis Association of Singapore (PAS), the National Skin Centre conducts regular public forums on this illness. In addition, PAS runs a patient support group which serves as a useful platform for discussion and sharing of issues related to psoriasis. Column No : 1305 HEART AND RENAL CLINICS AT RESTRUCTURED HOSPITALS (Average waiting time for polyclinic referrals) 33. Mr Low Thia Khiang asked the Minister for Health what is the average waiting time for appointments at specialised heart and renal clinics of restructured hospitals for polyclinic referrals.”
“Column No : 1296 CIVIL AVIATION AUTHORITY OF SINGAPORE (AMENDMENT) BILL Order for Second Reading read. 4.40 pm”
“Finally, Dr Lam highlighted HSA's collaboration with the Australian counterpart and how we can learn from the experience there as well as other countries which he mentioned, Japan, US, in particular, how they manage counterfeit medicines and counterfeit products. In addition, HSA has also signed a memorandum of understanding with US Food and Drug Administration and Health Canada. Over the years, it has also played an active part in various international regulatory forums, such as those organised by La Leche and ASEAN. HSA will continue to explore deepening and formalising its professional links with other key regulatory partners overseas. Today, we live in a globalised world and regulatory issues and solutions are no longer self-contained in local jurisdictions, as highlighted by Dr Lam. Strong international involvement is important to ensure that HSA is engaged in strategic networks that enhance our regulatory framework and continues to be an active partner with major regulators around the world. In this respect, the Health Products Bill will help ensure that Singapore's regulatory system for health products not only fulfils the essential aim of safeguarding public health but also continues to meet our future regulatory requirements in line with international best practices. Mdm Deputy Speaker, I thank once again the Members for their support for this Bill and I invite them to continue to give us their suggestions and feedback on the regulation of medical devices. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Khaw Boon Wan] Bill considered in Committee; reported without amendment; read a Third time and passed.”
“This is because there are already a set of well established laws for regulating food in Singapore, for example, the Sale of Food Act which is administered by AVA under the Ministry of National Development. The controls on food do include certain restrictions and requirements on the claims made about the food products. HSA does work with AVA, especially where it involves products that fall into the grey area between medicines and food. Let me now address some broader aspects of a regulatory system starting with post-marketing surveillance. I agree fully with the points made by Dr Fatimah and Dr Lam on the vital need for post-marketing surveillance. There is a continuance in regulation that extends from what is done in the pre-marketing stage to what continues to be done after a product enters the market. No matter how stringent the assessment is before a product is granted approval to be marketed, effective regulation is never complete without a robust post-marketing surveillance system. HSA's health product regulatory programme currently comprises the two key elements of risk assessment before the products enter the market and ongoing management of any evolving risks for as long as the products continue to be marketed and distributed. This approach will continue to be applied for other categories under the Health Products Act. Mdm Halimah asked about violations under existing medicine controls laws, such as the Poisons Act and Medicines Act. If I recall correctly, there are about 100 such violations every year, a very stable number. Last year, there was a significant increase mainly because of Subutex abuses which we assume will be one-off.”
“There is less urgency as medicines are already regulated under the current legislation but we certainly want to subsume the existing medicine legislation under the new Act. We will do so not in a mechanical way but take the opportunity to review the existing provisions to see if we should not update the provisions. This would require some time for public consultations. But I hope to be able to do so within two years from now. In the process, we have taken note of Dr Fatimah's two suggestions on how to refine the registration requirements for medicines. Let me now touch on the subject of health supplements, whether we should regulate health supplements and, if so, how to regulate them, a complex issue. This afternoon, we heard two different views from Mr Sam Tan and Dr Fatimah on whether we should indeed rush to do the regulation of health supplements. We should carefully discuss the pros and cons and, in particular, study the experience in other countries. It is not a straightforward subject. We do note the comments by Dr Fatimah and Mr Sam Tan about the need to look into such products, especially with respect to claims and advertisements, and we will bear that in mind. As I said earlier, we have not made a decision on this yet and we certainly should not rush to do so. In the meantime, aside from legal controls and prohibitions, Mr Sam Tan's idea of having more consumer education is certainly something we can look into. Increasingly, we should try to educate people to be more savvy and discerning in making choices about the products they use and consume. As a rule, consumers should always be wary of wild claims. Mdm Halimah noted that this Bill does not cover food products.”
“Having a risk-based classification system for medical devices, we allow HSA to better calibrate the extent of controls that need to be imposed, ie, the higher the degree of risks, the tighter the control. Let me now discuss regulating other categories of health products. Dr Lam suggested using the Global Harmonisation Task Force's regulatory principles for medical devices in regulating other categories of health products. As it stands, the basic principle of risk management is already applied in regulating those health products that come under existing laws and will continue to be applied in future and certainly the experiences learned from regulating medical devices will be reviewed and applied, where appropriate, in shaping the regulatory framework for other categories of products as and when they may be added in future. There are likely to be specific issues in each group of products that will require some degree of customisation, and this is what the future Health Products Act will allow. For example, the regulatory controls currently in place for pharmaceutical-type medicines are not necessarily suitable for regulating other categories of health products which may have different risk profile. I have noted Dr Lam's suggestion to rank the degree of regulation for the different types of health products. But I prefer not to commit myself or to predetermine their risk classification now and their ranking at this point in time. Let me now touch on pharmaceuticals. Mdm Halimah asked when we would include medicines under the new Act. We would do so as soon as possible after we have completed the regulation of medical devices.”
“Clause 61 holds a principal or an employer responsible under certain circumstances for offences committed by his agent or employee. For example, if an employer has encouraged or allowed his employee to commit the offence, then he will also be held accountable. Whether employees, like factory operators, will be held liable for offences will depend on how culpable they are. The Attorney-General will have to assess each case individually but the Act will be enforced sensibly and judiciously. Mdm Halimah suggested that HSA work closely with the medical technology industry to help them understand the requirements of the Act before it comes into effect. I agree. HSA has been engaging the medical devices industry in dialogue over the past many months and will continue to do so. Once the current public consultation phase is concluded, HSA will have further dialogue to communicate impending controls to the industry before those controls are implemented. As far as possible, HSA will try to guide those who are not familiar with the controls to understand the regulatory framework and requirements when this is finalised. However, we are not in a position to provide financial assistance to companies to help them comply with regulations as compliance cost is part and parcel of the cost of doing business. Mdm Halimah asked about HSA's voluntary product registration scheme. This was introduced in 2002. So far, more than 4,000 products have been registered by over 250 companies. Dr Lam spoke in support of a classification system for medical devices. I agree. The proposed regulatory framework envisages a risk-based classification system. This is in line with the Global Harmonisation Task Force's regulatory principles and is practised in many other countries.”
“Mdm Deputy Speaker, I thank the Members who have spoken in support of the Bill, and in particular the approach of regulating the different categories of health products in phases. As Members have noted, this will provide flexibility in customising the regulations to suit the different risk profiles of the products. The key objective is to be able to balance the need to protect the safety of consumers and the need of the industry to remain innovative and financially viable. Let me touch on the specific issues raised. First, let me discuss medical devices. This will be the first health product category which we intend to regulate under the proposed Act. I thank Members for their support of our proposals to regulate medical devices. Mdm Halimah cautioned against over-regulation, and indeed several other Members mentioned that too - to keep registration requirements simple and fees at an appropriate level. I fully agree. We should not over-regulate, not only medical devices but also for other health product categories that may eventually be added. There is a cost to regulation, whether in terms of licence fees or other costs in compliance with regulatory requirements. We must strike an appropriate balance between consumer protection and business viability. That is why we are taking a risk management approach to regulating health products - doing the minimum for low-risk products and applying stringent regulations only on the high-risk products. Mdm Halimah wondered if clause 61 of the Bill may be too broad and onerous on employees, like factory operators, as they may be held liable despite not knowing what the production process is all about. Let me assure the House that this is not the intention.”
“Beyond these health products, we will study other categories of health products, such as biologicals and health supplements. We do not intend to rush this but will actively monitor and learn from the experience in other countries. Cost of compliance and consultation We are mindful there is a cost to regulation and we should not impose unnecessary cost on businesses. Furthermore, even the most stringent controls will not be able to eliminate all accidents or stop irresponsible behaviour. So, it is important that we find a suitable balance of how much regulation and controls there should be. To achieve this, we consider it important to consult with the stakeholders, both industry and consumers, to understand their concerns and desires, and we will continue to do so before adding new categories of products into the First Schedule under the future Health Products Act. Furthermore, whenever we need to consider adding a major new category of health product into the First Schedule, we will bring the proposed amendment before this House, to explain why and how we intend to regulate that category of product. Our current legislation has not caught up with advances in new health products and, in particular, medical devices. The Health Products Bill will provide greater clarity for the health products industry with a single law as the reference point. More importantly, the Bill will permit customisation of legal requirements and controls for the different categories of health products through the more flexible rule-making process written into the Bill. I ask all Members of this House to support this Bill. Sir, I beg to move. Question proposed. 3.49 pm”
“In particular, we have applied the concept of risk management in designing the proposed regulatory framework for medical devices. For example, for product registration, higher-risk devices, such as those to be implanted in the body or with an active power source attached, will be required to show more evidence and scrutinised more closely, while lower-risk devices like syringes can be registered through a simple notification process. The Health Sciences Authority (HSA) is currently conducting a public consultation on the proposed regulation of medical devices, using a draft Health Products (Medical Devices) Regulations. I hope all stakeholders – industry, healthcare professionals and consumers – will contribute their inputs and let us have their views. This will help us refine the regulatory framework before we formalise it for implementation. Other categories of health products Meanwhile, pharmaceutical medicines will continue to be regulated under the current medicines laws and not yet brought under the Bill. This is to enable HSA to conduct a thorough review of the existing medicines laws to see if we need to refine or update any provisions. This may take a couple of years. When pharmaceutical medicines are eventually brought under the Bill, we will repeal the Medicines Act, Poisons Act and Sale of Drugs Act. Chinese Proprietary Medicines (CPM) are currently regulated under the Medicines Act, though using a slightly modified regulatory regime from Western medicines. Similarly, we will see if CPM should be regulated under the new Bill as a separate category of health products or together with other types of traditional and complementary medicines.”
“We have mostly left it to the industry to self-regulate on a voluntary basis, and also depended on healthcare professionals to act as 'gatekeepers' in deciding which medical devices are suitable to use. The current approach is inadequate. First, we now have more new and advanced medical devices coming into the market. Second, many medical devices are increasingly being designed for use by lay persons, instead of just healthcare professionals, and it is important for the presentation and advertisement of these medical devices to be properly controlled. Other countries, such as the US, Australia, Japan and the European Union (EU), have had laws for medical devices for some time now. For example, in Australia, medical devices are regulated under their Therapeutic Goods Act, which requires that medical devices be registered with the authorities and must meet certain technical standards. Medical devices cover a wide range of products, from syringes to artificial hearts. Not all medical devices need to be regulated to the same degree of stringency. Internationally, there is a task force called Global Harmonisation Task Force (GHTF) for the regulation of medical devices. We work closely on a bilateral basis with the Task Force members and also through an Asian Harmonisation Working Party. The GHTF has endorsed a set of principles based on the concept of risk management and recommends that the level of regulation should be proportional to the degree of risk involved. Our proposed regulatory framework for medical devices is based on these GHTF principles, which we find sensible, with just some modifications to suit our local needs. There is no need for us to reinvent the wheel.”
“Another example is clause 66, relating to the protection of "confidential information", which bars anyone who has obtained commercially-sensitive information in the course of administering or enforcing this legislation from disclosing that information except for an official purpose, or else with the consent of the 'owner' of the information. Clause 72 of the Bill allows HSA, with the approval of the Minister for Health, to make subsidiary legislation for the purposes of the Health Products Act. These are needed to flesh out the technical matters and details relating to various aspects of the regulatory framework. The Second Schedule gives an indication of some of those aspects. The intent is for the different categories of products to each have their respective sets of subsidiary legislation catering to their specific regulatory requirements, appropriate to the risks and benefits of each category. We have also included, under Part XIV of the Bill, clauses that will allow the Ministry of National Development and the Agri-Food and Veterinary Authority (AVA) to use the controls in this Bill and to make subsidiary legislation to regulate the health products used for veterinary purposes. These have been put in because some products, like human medicines, are sometimes also used by veterinarians on animals, and AVA may need to regulate them. Phased implementation Let me now touch on implementation. As I said just now, after the Bill is passed, the first category of health products that we plan to bring under the control of the Act will be medical devices. We have therefore included the definition of "medical devices" in the First Schedule. Regulating medical devices Currently, there are no laws to specially regulate medical devices.”
“Under clause 34, there will be a "Register of Health Products" for all categories of products that have to be registered. This Register, which will be made available to the public, can then be used by consumers to check whether a particular product has been registered, as well as find out certain basic information about the product, for example, the declared ingredients or the product manufacturer. Part VIII of the Bill specifies the key duties and obligations of parties who deal in health products: manufacturers, importers, suppliers and registrants. Here, I would like to highlight the important role expected of the industry. Companies and dealers should not only introduce safe, effective and good quality products into the market, but they also have the continuing responsibility to ensure that the products they have introduced into the market remain safe, effective and of good quality. For these reasons, there are provisions, such as clause 40, which require dealers to maintain records of the products they deal with, and clause 42, which makes it mandatory for dealers to inform HSA of any information they receive about adverse effects or defects concerning their products. Part IX of the Bill allows HSA to impose controls, by way of subsidiary legislation, on specified raw materials, or "active ingredients", used in the manufacture of health products. Parts X, XI, XII and XIII of the Bill contain clauses relating to various administrative aspects, such as enforcement and legal procedures. For example, clause 49 describes the rights of enforcement officers when performing their duties. These are fairly standard and in line with those accorded to officers of other regulatory agencies that also enforce public health and safety laws.”
“Parts III and IV of the Bill contain clauses that impose controls on the three key activities of manufacture, import and supply. The controls are similar to the existing controls in the medicines laws. But we have updated the penalties where appropriate. Here, I would like to highlight the prohibitions against dealing in adulterated or counterfeit products, in clauses 12(5), 13(5) and 16(1). Anyone doing so would be committing an offence and, if convicted, would be liable to a fine of up to $100,000 or imprisonment for up to three years or both, for each offence. Items like counterfeit medicines, which might not contain the essential life-saving drugs they are supposed to contain, or traditional medicines that have been adulterated with potent drugs, are especially dangerous. They threaten public health, and we have singled them out to make clear that we take such offences seriously. Part V of the Bill covers controls on the advertising and promotion of health products. Again, these controls are similar to those in the medicines laws. This aspect of regulation is important because accurate and truthful information about a product is essential in helping consumers, as well as healthcare professionals, make sensible and well-informed decisions in choosing which health products to use. We have also included, in clause 23, the power for Health Sciences Authority to direct an advertiser to publish a "corrective advertisement" if he is found to have published a misleading or offending advertisement. Parts VI and VII of the Bill contain provisions that describe the general steps in the licensing and registration processes. They are also similar to the provisions in the medicines laws.”
“Second, we will build flexibility into the Bill. This will allow us to apply different levels of control for different types of products, taking into account their different risk profiles. Given the wide spectrum of health products, we cannot use a "one-size-fits-all" regulatory solution. We have instead structured the Bill such that the controls could be tailored according to the special regulatory requirements of each particular group of health product. Main features of Bill Let me now go through the main features of this Bill. First, in Part I, clause 2(1) defines "health product" and "health-related purpose". We have defined it widely so as to describe the potential scope of this Bill. However, we are not committing to regulate all these health products. Clause 4 makes it clear that, after the Bill is passed, the Health Products Act will only apply to those categories of health products that are specified in the First Schedule. In other words, not all health products will come under the immediate control of the Health Products Act when it is enacted. In fact, we will start with only medical devices in the First Schedule. Over time, we will, as required, add other categories of health products that need to be regulated under this law into the First Schedule. In the meantime, existing laws will apply to the other categories of health products. Part II of the Bill describes the various parties involved in administering and enforcing the controls under this piece of legislation. The main party is the Health Sciences Authority which is the regulator of health products in Singapore and they will be responsible for its administration and enforcement.”
“For example, we think that we should regulate medical devices or biotechnology products differently from the way we regulate medicines. Another way is to introduce separate legislation for the different health products, say, one for medicines, one for medical devices, another one for biologicals, etc. However, this is also unsatisfactory as some health products are combination products, eg, a drug-coated stent is both a medicine and a medical device. At the same time, my Ministry and the Health Sciences Authority (HSA) would like to consolidate and streamline the existing medicines control laws. This is because having separate, and sometimes overlapping, pieces of legislation makes it cumbersome for the industry to understand and comply with the controls. There are currently four different pieces of legislation on medicines. Given these considerations, we think the most practical approach is to draw up a single law to cover the regulation of different types of health products but structure it in a way which can allow different categories of products to be regulated to different degree based on their risk profile. The idea to have a single encompassing law for a range of health products is not new. This approach has already been adopted in other countries, including Australia and the US. Based on this approach, we have drafted the Health Products Bill which is now before this House. [Mdm Deputy Speaker (Ms Indranee Rajah) in the Chair] 3.35 pm Regulatory approach In drafting the Bill, we adopted two principles. First, we will preserve the control elements in our existing medicines laws, which have served us well. They are fundamentally sound and will still be applicable in the future. We have therefore included the provisions for such controls in the Bill.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." Our current legislative framework regulates western medicines and, to some extent, traditional Chinese medicines, but it does not cover the other health products, such as medical devices, leaving them largely unregulated. Meanwhile, as medical science continues to advance, new varieties of health products are being added to the market, both in diversity and complexity. These new products are no longer limited to external applications but include devices to be implanted in the human body, often for long term or even for life. Examples include cardiac pacemakers and coronary stents. Rapid developments in biotechnology have also produced a new category of health products called biologicals, such as cultured chondrocytes for repairing joint cartilage injuries. There is a need to regulate some of these new products to protect public safety. First, we need to prohibit such products from containing harmful substances, at the very least. Second, we need to evaluate the more complicated health products for their quality and effectiveness. Third, we need an effective post-marketing surveillance programme to detect any problems early. But we need to regulate them in a practical manner given the wide diversity and different risk profile. Review of legislation One way is to extend the existing legislation on medicines to cover the other health products as and when we decide that they should be regulated. But we do not find this option satisfactory as the existing medicines laws were crafted with orthodox pharmaceutical-type medicines in mind, and their provisions are not entirely suitable for the regulation of other types of health products.”
“Mr Low wanted to know the number of polyclinic doctors who originated from non-traditional sources, presumably those countries other than Singapore and Malaysia. There are currently 31 such doctors serving in our polyclinics: 12 from India, 11 from the Philippines, four from Myanmar, and one each from Hong Kong, UK, Taiwan and Thailand. They make up 12% of the total number of doctors working in the polyclinics. So this gives a ratio of 1 to 7. Communication between doctor and patient is an important part of doctor-patient relationship. Our polyclinics have therefore exercised care in the recruitment process. The Singapore Medical Council also requires foreign doctors from medical schools, where the medium of instruction is not English, to pass an international English proficiency test before they can be registered. In addition, our polyclinics have regular language lessons for all our doctors, both from traditional and non-traditional sources, to pick up local dialects, Mandarin and Bahasa. Nurses are also on hand to help serve as interpreters between doctors and patients, when necessary. In this way, we minimise the risk of any miscommunication between doctor and patient. Column No : 1237 ARTICLE 5(2A) OF THE CONSTITUTION (Operation of constitutional provisions) 10. Prof. Thio Li-ann asked the Deputy Prime Minister and Minister for Law whether Article 5(2A) of the Constitution which entrenches the elected presidency will be brought into operation soon and, if not, whether the Government will consider bringing into effect Article 5(2A) insofar as it entrenches basic constitutional provisions relating to general elections and fundamental liberties.”
“But they were also quite clear that, having identified these five areas, when bids are submitted from researchers for grants, it has to be based on competitive bidding, peer review, internationally reviewed. In that way, we do not waste taxpayers' money. That is how I see clinical research going forward under the Ministry of Health, together with our partners, over the next five years and, if necessary, I can elaborate further during next month's COS. Column No : 1236 DOCTORS FROM NON-TRADITIONAL SOURCES SERVING IN POLYCLINICS 9. Mr Low Thia Khiang asked the Minister for Health (a) what is the number of doctors from non-traditional sources, according to nationalities, serving in polyclinics; (b) what is the current ratio between traditional and non-traditional sources of doctors in each of the polyclinics; and (c) whether communication problems due to language barriers between doctors and patients at polyclinics pose potential risks to patients.”
“55 billion new money to be spent on clinical research over the next five years. And Dr Tony Tan quite wisely noted that for this to succeed, you need all the stakeholders to be committed to it because it is a long-term mission and therefore he insisted that this project should be co-funded by the key players. For Ministry of Health, we are the poorer cousin, so we contributed $350 million over the next five years, which is still a lot to me because we were spending only $10 million a year, now we will be spending $70 million a year, a seven-fold increase. The National Research Foundation would chip in $550 million and A*STAR, the biggest chunk, $650 million. $1.55 billion to be spent over the next five years. But of course, it is not something that you can create overnight because you need to build up capacities and capabilities and we need expertise from outside. In the last few months, we had been engaged in this whole exercise on what to do and to set up the infrastructure. The first thing we did was to rehash the National Medical Research Council which was responsible for allocation of funds and we brought in Prof. Ed Holmes, a very distinguished clinician and scientist internationally, to chair this Committee. The last few months, they have been discussing. Obviously we need to focus because $1.55 billion is not unlimited. So they have also decided, after consultation with the medical and scientific community, on the five key areas, ie, heart, cancer, infectious diseases, ophthalmology and neurosciences. These are the five key areas as they affect most patients in Singapore and also where we have some expertise.”
“But having now attracted so many world-class researchers and doing very good bench work, they wanted to go to the natural next stage which, in our trade, we call it "translational and clinical research". So Biopolis and A*STAR look at the Ministry of Health and say, "Let's work together." Of course, the Ministry of Health is ever-ready for more research money so that we can do a lot more clinical research than we have traditionally done. So very quickly, there was a consensus of opinion that for the next stage of life sciences development, we should put serious money into translational and clinical research. Because without serious money, the rest is just words and that only frustrates the doctors because if you do not give them money and resources and you ask them to do research, it is just humanly impossible. The end result of it all was a series of very serious papers, after extensive discussions among the scientists, researchers and experts, both local and foreign, who are familiar with this subject. The series of papers culminated in several recommendations that went up to the Life Sciences Steering Committee, chaired by Dr Tony Tan, and of which I am a member. Some time in the middle of last year, we then took a strategic decision that for the next stage of development of biomedical sciences, we should emphasise translational and clinical research. We went to Cabinet for endorsement and approval of this strategic direction and I also went to Cabinet to ask for an inclusion of a mandate in the Ministry of Health's charter that clinical research is also one of the mandates. Together with that, there is a commitment of sums of money, not huge sums like in the US because we cannot afford it, but based on what we can afford, something like $1.”
“Mr Speaker, Sir, all public hospitals claim to do three things - service to patients, teaching/training students, nurses, trainees, and clinical research. In practice, of course, all public hospitals definitely do the first two. In fact, we are extremely busy doing all these two. As for clinical research, it varies between hospitals. Some are a lot more active than the others. But on an overall basis, I will be the first one to admit that we do not do substantial clinical research as we would hope to do, and there are good reasons for that. There are two. First, we are really very busy just on treating patients and teaching, and there is very little time left to do clinical research. The second reason is related to the first. The amount of money set aside by the Ministry of Health and the public hospitals in clinical research is quite limited, very modest. If I recall correctly, say, a few years ago, we only set aside something like $10 million per year for the whole Ministry of Health. So this is a very modest sum. And because of that, the ability to have enough doctors whose patient-load can be reduced so that they have time to spend on doing serious research, is very hard to achieve. At the beginning of last year, we decided to take a good hard look at this, particularly because of the recent years of emphasis on biomedical research. We sat down with the National Research Foundation as well as A*STAR, and there were many man-months spent discussing this. We were pleasantly surprised to find a coincidence of objectives because A*STAR and MTI have been pushing life sciences for several years. Quite correctly, their initial plan was to do basic sciences at the Biopolis, at the bench level.”
“Needless to say, the SMC was disappointed to learn that the British courts had ruled in favour of the GMC. I too am disappointed that the substance of the SMC’s grievance was not fully addressed by the British courts. There are established international rules governing the conduct of research on human subjects, based on the Helsinki Declaration. Under these rules, the welfare of the human subjects is paramount. The research procedure must also be approved by independent Ethics Committees of Hospitals where the research is to be conducted. In the NNI project, Professor Shorvon and his assistant deliberately subverted these rules. I am baffled why the British professional community should choose to condone such a practice. Will the outcome of this case affect Singapore’s reputation as a biomedical research hub? Over the past two years, internationally-renowned researchers and scientists have come to Singapore to lead and conduct key research in their respective areas of expertise. Many of them are settling down here for at least a good stint. Our ongoing success in attracting research talent speaks volumes. If anything, this case has clearly reaffirmed our unwavering commitment to upholding international standards of bio-ethical practice, even as we promote biomedical research. Singapore will sacrifice neither patients nor ethical principles in the name of research.”
“After a thorough inquiry, the SMC Disciplinary Committee found Professor Shorvon guilty of professional misconduct in February 2004. In March 2004, the SMC brought this matter before the GMC, as Professor Shorvon was registered in the UK. It provided the GMC with its findings and all the evidence that it had obtained. In September 2004, the GMC decided that a public inquiry should be held in the UK. It took the view that what Professor Shorvon had done in Singapore would amount to serious professional misconduct if proved. Then unexpectedly, in September 2005 - this is one year later - the GMC reversed its earlier decision, cancelled the public inquiry and closed the case against Professor Shorvon. Two reasons were given. First, the GMC felt that logistical difficulties would make it hard for them to prove the case. Second, it had obtained an expert report that said that what Professor Shorvon had done in Singapore was not wrong according to British standards. The SMC was totally surprised by this sudden change of position. Both reasons given by the GMC were unconvincing. First, teleconferencing could easily solve any "logistical difficulty". Second, the SMC found the expert report substantially flawed. Besides containing serious factual mistakes, it did not explain why Professor Shorvon’s conduct, which clearly violated the GMC’s own guidelines, was not a breach of ethics. The GMC's decision had undermined the integrity of SMC’s findings and cast doubt on the fairness of the SMC’s procedures. It also risked harming Singapore’s reputation as a centre where internationally-established standards of ethical practice are upheld. After consulting legal counsel, the SMC decided to challenge the GMC’s decision before the British courts.”
“The Singapore Medical Council ("SMC") has a practice of notifying its foreign counterparts when foreign doctors practising in Singapore are convicted for professional misconduct. In return, SMC also receives notifications from regulators in the UK, Canada, Australia, New Zealand and the US, just to name a few. The case involving Professor Simon Shorvon was referred by the SMC to the General Medical Council (“GMC") of UK under this reciprocal arrangement. As Members may recall, Professor Shorvon, then Head of the National Neuroscience Institute ("NNI") was in charge of a major research project involving a number of patients with Parkinson disease. The research project was found to involve serious ethical breaches. Three separate inquiries conducted by the Ministry, the NNI and the SMC established these facts: Professor Shorvon breached medical confidentiality by accessing patient records without their permission. He got Parkinson’s patients to omit or change their medication, without getting their consent or telling them about the risks. Their reaction was then filmed. The doctors treating these patients were unaware that all this was being done. In fact, some patients were misled into thinking that their doctors had given approval. It turned out that Professor Shorvon did not seek ethics approval to do any of this testing. All of this put the safety and well-being of patients at risk. What is worse, many were elderly and mentally frail. Many of you may remember this when then Health Minister, Minister Lim Hng Kiang, first described to this House what had taken place during the NNI research project. That was in April 2003 in response to a Question in this House by Mdm Halimah.”
“I can reassure with action rather than words and really the key strategy is to expand capacity. Because if you do not keep on training and recruiting many more doctors and nurses, then, inevitably, as we are not closing our borders, we cannot stop foreign patients from coming in and, services will be affected. So the key is to continue to expand our doctors and nurses. And capacity as well, in terms of physical beds. Right now, I really see a need for at least one or two private hospitals to come up, and I am working very closely with URA to release land for this purpose.”
“Dr Lily Neo asked about our progress to promote Singapore as a medical hub. We are making some progress. Over the last three years, foreign patient arrivals have grown at an average rate of 20% per annum. Last year, nearly 400,000 foreign patients came here for treatment. Our target is to attract one million foreign patients by 2012. We expect the medical travel market to continue to expand as the middle class grows. The competition to be medical hubs will at the same time intensify. Dr Lily Neo mentioned Bangkok’s Bumrungrad Hospital which was reported to have served about 400,000 foreign patients per year. But there are many more such competitors in Thailand, Malaysia and India. In due course, I am sure China too will move into this sector. Currently, patients from ASEAN countries account for about 70% of our international inpatient volume. We have begun to reach out to non-ASEAN countries, with encouraging results. There is a growing trend in patients arriving from further afield, including Russia, Bangladesh and the Middle East. These are new markets with significant potential. To tap these opportunities, we need to increase our capacity, especially in manpower and hospital beds. We also need to raise our clinical capabilities and service standards so as to justify our higher cost premium. We will continue to push these efforts, without undermining the services to our local patients.”
“But for those esoteric $600 or $700 type of screening, if you feel that it will benefit you, please pay for it yourself and do not look to me for subsidy or for Medisave to be used. NEW HOUSING AND DEVELOPMENT BOARD FLATS (Subsidy) 3. Ms Ellen Lee asked the Minister for National Development (a) whether a 30% subsidy is in fact true of all HDB flats bought direct from the HDB; and (b) how does the HDB explain the magnitude of the loss in value to some first-time buyers of new flats which had a purchase price of $320,000 to $350,000 in 1996-1998 but which value had dropped to $290,000 to $320,000 since 2004. The Minister of State for National Development (Ms Grace Fu Hai Yien) (for the Minister for National Development): All new HDB flats are sold at a subsidised price, below the market value. The extent of subsidy varies with flat-type and market conditions. It is not a fixed percentage. HDB flat prices are subjected to market forces. They move up or down depending on demand and supply factors similar to private properties. It is possible therefore for the prices of HDB flats to fall below their purchase price even with a subsidy. This was what happened when the property market suffered a severe downturn after the Asian Financial Crisis. Without the subsidy, the diminution in value would have been even greater. PURCHASE OF HOUSING AND DEVELOPMENT BOARD FLATS (Review of income ceiling) 4. Mr Zaqy Mohamad asked the Minister for National Development (a) will the Ministry review the limits on the maximum income for the purchase of subsidised flats from the HDB; and (b) whether, in the HDB’s measure of affordability, it takes into account families which have illnesses to bear or aged parents to support, whether living with them or not.”
“Health screening is a most interesting topic. It covers a wide field. There are a lot of self-interested parties with personal interest at play when they push for certain kinds of screening. For one, some of those esoteric health screenings cost hundreds, if not thousands, of dollars to pick up things which often the patient would die before that thing kills him. That means he dies of something else and not because of that. Because the scanning technology is now so advanced, you can pick up all sorts of things. Nobody is perfect and we have all kinds of problems with us in the body but we may not die of those things, but die of something else. But if you pick it up, and the US begins to coin a term called "pre-disease", you are in fact healthy people, but if you are pre-diseased, you are pre-diabetes, you are pre-whatever, it merely caused you so much anxiety and, of course, along the way some of the hospitals may come in to say, "Do this, do that." And because in the US, they allow advertising of prescription drugs, you are just making the population hypochrondriac. And when they go to the doctor, they ask, "Please prescribe this, please prescribe that.", and the money just run out but, at the same time, their health does not improve. So, for screening, please take it with, shall I say, "a pinch of salt". All I know is some of the most effective health screenings which really make sense, which really prolong life and improve health are rather inexpensive, which is, what is your blood pressure, your cholesterol level, and those basic tests are really very cheap which most people can afford. If you cannot afford it, as MPs, as organised by Dr Lily Neo for many years, we do it on a community level and we can help subsidise them.”
“Indeed, I am very concerned about this particular topic because $11,000 or $12,000 is a five-digit figure, but it is not a big number, bearing in mind that you have many years to go. With medical science, life expectancy is growing every decade by a year or two. So, really, people should look at Medisave carefully and try to conserve, and that is the reason I have to be the very unpopular gatekeeper now and then when Members put up their hands and say, "Please, can I use Medisave for this and for that?", I have to always bring them back to the original purpose of Medisave, which is for costly hospitalisation. So when it is for outpatient treatment, a few dollars, or even if it is tens of dollars, please pay for it out of your pocket and conserve the amount in Medisave for the old age, especially at the time when you will not be working. That is why it took us 20 years after we introduced Medisave to decide to make a major change, which is from inpatient to outpatient, but even then to restrict it to 4 chronic illnesses and we have to restrict it carefully. We have started it for four diseases. Implementation so far has been smooth. It is a little bit of leap of faith. If all patients follow, comply with the instructions of their doctors and manage their chronic illnesses while they are still mild, the hope is that we can avoid very costly complications 20 or 30 years down the road. So, on a life-time basis, hopefully, you save money and not just deplete your funds. That is why for the extension of this scheme to other illnesses, we restrict it to those where there are clear-cut disease management protocols and not just for any kind of outpatient treatment. Because if it is purely consumption without any impact on the future health, then I think we should not do so.”
“Mr Speaker, Sir, as at end-2005, Singaporeans aged between 61 and 65, have an average Medisave balance of $11,700. So it is about $12,000. This can cover about 10 normal episodes of Class B2 hospitalisations. On 1st April, 2006, we raised the inpatient withdrawal limit for Medisave from $300 to $400 per day of hospitalisation. The purpose is to help Singaporeans cope with their hospitalisation cost, particularly for those who choose to stay in the unsubsidised wards. Prior to this, Medisave covered, on average, 67% and 52% of the Class B1 and Class A/private hospital bills respectively. After the change, the Medisave coverage has increased to 76% and 57% respectively, reducing the patients’ out-of-pocket expenses. The change has also benefited patients in Class B2/C. They can now use Medisave to pay for more than 95% of their bills. So, it is practically the full amount. Dr Lim asked if the change has led to more patients in restructured hospitals opting for private wards. The evidence based on five months of data does not support such a view. I am glad that patients have remained prudent in their choice of wards in accordance with what they can afford. This will help conserve their Medisave balances for their future needs.”
“I am sorry for missing this out. Yes, I am sympathetic on this particular issue. Mdm Halimah has raised it before. I have voiced my support for this. The ultimate decision lies with the Minister for Manpower because CPF comes under him. But I will continue to lobby for raising it. I think it is still academic at this stage because most people have not quite crossed that level. But we will look at the data and see when it is a good time to raise it, provided there is acceptance by the other Cabinet Ministers as well. MEDISAVE ACCOUNT (Average savings of Singaporeans) 2. Dr Lim Wee Kiak asked the Minister for Health (a) what is the average amount of Medisave a Singaporean has upon reaching the retirement age of 62 years; and (b) following the higher withdrawal limit for Medisave, if there has been a corresponding increase in the utilisation of private paying wards in the restructured hospitals.”
“Only Medisave? I have to refresh my memory on this point. Is the Member quite sure that day surgery is not covered by MediShield?”
“I think the limitations of the current ElderShield have been voiced by Dr Lily Neo and Mdm Halimah and a few MPs before and I have taken note of those criticisms. They are valid and that is why the design of the revised ElderShield will take some time. Roughly, what I have in mind, which we can discuss more next month is this: obviously the society is not homogeneous and there are people who find $300 per month helpful, but there are also people who find $300 per month too little for the premium they have to pay. Like in the case of MediShield, what I have in mind is to restructure it so that there are various plans and, obviously, they come with different prices, and it is up to Singaporeans to choose which plan they think is reasonable, and then subscribe to it. As to the acceptance of ElderShield, I am quite glad that the last few times when I looked at the subscription level - because we have a system now, whenever Singaporeans reach the age of 40, a notice will go out to them to encourage them to sign on - those who objected and said, "No, I don't want to sign on.", I think it is down to about 10%. So, in terms of flow, 90% of Singaporeans who reach 40 are signing on to ElderShield. I think that is good and there is a better understanding of the need of such a severe disability plan. But I am quite sure, after reform, if we do a good job of it, many more will find it even more acceptable. As regards the MediShield for non-hospitalisation or day surgery, I thought it covers.”