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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“That is why, as soon as I went back to the Ministry of Health three years ago, I got them to compile and publish hospital bill sizes. I am very pleased with the outcome. I am now ready to push this initiative further, in two ways. One, I will extend the exercise to private hospitals. They have so far joined the initiative voluntarily, but the submitted data is often incomplete and sometimes misleading. I am considering getting their fullest participation, to disclose their hospital bills on a fully comparable basis when they submit Medisave claims on behalf of their patients. This will be welcome by their patients, I am sure. Such transparency will also help convince their foreign patients that Singapore offers very competitive pricing for healthcare services. Next, in response to the call by Mdm Halimah, I will expand the initiative to include qualitative outcome data, eg, surgery complication rates, surgery success rates, etc. Like the bill size exercise, I will begin with public hospitals first to gain sufficient experience, before extending it to private hospitals. Last year, I started a study on cataract operations, one of the most common surgeries done in public hospitals, so I wanted them to measure and track down what were the complication rates of cataracts in the various centres in Singapore. We are concluding a study on this, and the data will be released quite soon. Mdm Halimah asked about quality accreditation. All hospitals must comply with the standards that we set under the Private Hospitals and Medical Clinics Act. JCI accreditation is an added external endorsement that our local hospitals are comparable to international standards. All our public general hospitals are already accredited.”
“We will continue to encourage innovations and skunk works and share best practices. Last year, in this House, I mentioned a major skunk works in Alexandra Hospital where it partnered with Microsoft to exploit the benefits of IT. Within a year, they successfully computerised the operations of the A&E Department. The software is intuitive and also very flexible, allowing doctors and nurses to easily make continuous process improvements. I want to record here my thanks to Microsoft for their help. I understand that Microsoft has decided to extend their skunk works to Changi General Hospital and even enlarge the scope of their work to include the community hospitals and nursing homes that partner Changi General Hospital in providing integrated care. Hospitals are expensive resources. To keep cost affordable, hospitals need to use their beds efficiently. For example, once a patient is discharged, they have to quickly get the bed cleaned up so that a new patient can get in. But the entire process is complex, involving many groups of staff. But through standardising policies, streamlining processes and using WiFi technology provided by Cisco Systems and Fujitsu, Alexandra Hospital has reduced the processing times by 30%. This means less waiting for the patients in the admission room. Today, half of the patients admitted to Alexandra Hospital are settled into their beds within 30 minutes. Alexandra Hospital and Cisco Systems are now exploring how WiFi and VOIP (Voice over Internet Protocol) technologies can be used to reduce the time it takes for doctors and nurses to respond to medical emergencies. This can make a real difference in life-and-death situations. Third, the market works best when consumers are well-informed.”
“The Singapore Medical Council (SMC) will be expanding the schedule of recognised medical degrees. Currently, we recognise 71 medical degrees, largely from the British Commonwealth. 2.15 pm I have shared my view before that all the top medical schools ought to be on our schedule, not just from the US and UK, but also from Europe and Japan. We should also include the top medical schools from India, where some of their graduates have gone on to head clinical departments in the US, particularly because we have an FTA with India, where one of the commitments is to open up our medical register. We are not opening up yet, because there is still disagreement with India. India wants every medical school in India to be recognised. I cannot accept that, because we all know there is a wide range of standards and we cannot just open the door to every Indian medical graduate. But there are two, three or four very good medical schools. Entry is so competitive that one must be absolutely bright to be able to enter, and their graduates are proving themselves in the US and Europe. I think there is no reason why we should exclude these top medical schools and their graduates from coming here to help us make Singapore a regional medical hub. The SMC is actively reviewing the subject, and will progressively expand the list. I expect to make the first announcement soon. But medical manpower is not just about doctors. It is also about nurses, pharmacists, radiographers, other health sciences professionals, even patient care assistants. We should make sure that supply keeps up with demand. Second, I agree with Dr Lily Neo and Mdm Halimah that we should push our hospitals and clinics to be more efficient. There is really no ground for inefficiencies, wastages or duplications.”
“But some medical inflation is to be expected as medical and nursing staff, like other workers, receive some wage increases too. I think they deserve it as well. Last year, general wages in Singapore rose by 3.5%. This must, in due course, flow down to impact on medical inflation. In any case, inflation control cannot be decreed by law or achieved through moral suasion. It never works. The most effective way is through the market. First, we should ensure that wage increases in healthcare sector keep in step with general wage increases. Again, this cannot be decreed. This requires us instead to match medical manpower with demand. If demand rises while we restrict the supply of doctors, nurses, pharmacists and therapists, their wages are bound to go up sharply. That is why we watch over the supply and demand of doctors. At present, we are slightly short in some specialities although the situation is tolerable. But I see significant shortages going forward, if we succeed in our drive to promote Singapore as a regional medical hub. I noted Dr Lily Neo's comment that we should move faster on SingaporeMedicine. I will, and I believe in that. In fact, our efforts in the last three years have shown very promising results. Foreign patients coming here for treatment in Singapore increased by an average of 20% per annum in the last three years. Wonderful! I am sure Dr Loo Choon Yong can testify to this. We will press on with this. I know that this will increase staffing pressure on our public hospitals. But we can try to achieve both objectives, raising Singapore as a medical hub and at the same time trying to ensure that medical inflation is acceptable. How? We are ramping up the recruitment and training of medical specialists.”
“I would never accept such an approach for Singaporeans, for the simple reason that the poor cannot afford the private hospitals. My job is to ensure that the poor and the very sick get a good standard of healthcare. I therefore agree with Mdm Halimah that we should not allow medical cost to escalate beyond our ability to pay. Mdm Halimah noted that medical inflation was 5.9% in 2004, higher than general inflation rate of 1.7%. When it was published, I noted this figure too. I was personally a bit upset because this is during my watch in year 2004 and, after having made it one of my top priorities on managing medical inflation, I probed and discovered a number of things. Medical inflation is computed based on a basket of medical services that you get. It includes doctor's consultation, hospital charges, dentistry, payment to TCM, Chinese sin seh, tui nai, drugs, both generic as well as vitamins or supplements, perhaps even tongkat ali, and things like that. When I probed for the year 2004 about this sudden blip of 5.9%, I found the culprit - TCM consultation fees, Chinese physicians. It doubled from an average of $4 in the year 2003 to $8, average, in 2004. So even though TCM is a small part of our total healthcare system and the weightage is low, but because the increase is 100%, it has skewed the total calculation of medical inflation. If you remove TCM from the calculation, our medical inflation would have been 1.3%, lower than the general inflation of 1.7%. Mdm Halimah would be pleased to note that last year, 2005, medical inflation was 0.4%, again lower than the general inflation of 0.5%. I do not think your Health Minister has been sleeping.”
“It reported that their publicly-funded health system was "gradually breaking down", with public hospitals sending growing numbers of patients, whom they can no longer cope, to private hospitals which are cropping up despite laws against their existence. In Canada, it is illegal to have private hospitals because no hospitals are allowed to charge patients for treatment they would otherwise receive free of charge in a public hospital. But in response to public demand, private hospitals are openly defying the law. This is how one private hospital medical director lamented about their healthcare system: "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years." The Canadians dread the excesses of the private model that they see in their American neighbour. That is why they embrace the public model. But now, they appear to have come to the conclusion that both systems were wrong and a mixed system is more viable. I know Singaporeans worry about healthcare cost. This is a common worry all over the world. I am afraid healthcare cost will continue to rise. Why? Because new technology and new drugs will continue to come out of the research laboratories, at great cost, even as they bring about some improvements in healthcare. It is actually quite easy to run a cheap low-cost public healthcare system. There are many such examples in our neighbourhood, just compare our public hospitals with the standard of the public hospitals there. We can keep our hospitals cheap or low cost by denying our patients of medical advancements, thus pushing patients to private hospitals. But who can afford to go there? Only the middle and upper-income group. The poor are stuck with the public hospitals.”
“As a result, the US spends 16% of their huge Gross Domestic Product (GDP) on healthcare, UK spends half of that - 8% of GDP - but both have very little difference to show in their health status. Instead, there were large-scale disappointments on both sides of the Atlantic. Nearly 50 million low-income Americans go without medical insurance. In the UK, long waiting times for surgeries are very common complaints. In Singapore, our health is not poorer than the Americans or the British. In fact, in some areas, we fare better. We live longer on average than the Americans or the British. Our infant mortality rate is much lower than in the US or UK. And we have achieved this commendable outcome at a lower cost, at only 4% of our GDP. This does not happen by chance. We have over the years evolved our own model of providing and funding healthcare. We have no ideological bias. On funding, we are neither in love with the British taxation-funded model, nor the American insurance-funded model. On delivery, we neither favour public hospitals run by civil servants, nor prefer private-for-profit models run by people like Dr Loo Choon Yong. We have forged a middle way, going for a mixed system of public and private sectors. In that way, we tap and incorporate the strengths of each sector and allow both to co-exist and flourish. Such a mixed system offers the best outcome for our people, giving them choices as public and private compete for patients, in that way keeping the medical standard high. Last month, when I read the New York Times, there was a commentary - a good one - on the Canadian healthcare system.”
“Sir, I thank Members for their comments and especially their suggestions on how we can improve our healthcare system. I will be the first to acknowledge that our system is not perfect. But I think it is not bad. The World Health Organisation (WHO) ranked Singapore number 6 out of 191 countries on overall healthcare system performance. Only two Asian countries made it to the top 10 list: Singapore and Japan. So, obviously, we must be doing something quite right. Singaporeans acknowledge our high medical standard but many hope that it could be cheaper, or even free, at least for the poor. I will do my best to meet their aspiration, but such heavy subsidy has to be highly targeted for the poor and not something freely available to all in a uniform way. Despite good intentions, cheap healthcare for the masses ends up being of low standard, hurting the poor and needy the most, because unlike the rich, they have no alternative. They cannot turn to the higher standard in the private sector. There are two ways that a government can render healthcare free or cheap. One, the government pays the bills out of the taxes it collects from the people. Or the insurers pay for them out of the insurance premiums they collect from the people. But either way, it is the people who pay for healthcare. So the so-called free healthcare is actually not free. But because healthcare in such systems can sometimes appear to be free, it causes two major problems which we are familiar: the buffet lunch syndrome of over-consumption by patients; and the motorcar repair-shop syndrome of over-servicing by providers.”
“" - [Dr Amy Khor Lean Suan]. Question again proposed. Singapore as a Global City”
“Sir, Dr Tan Sze Wee wanted to ask about the adoption rate of Advance Medical Directives (AMD). Since its implementation in 1997, nearly 4,000 Singaporeans had signed on. I am one of those 4,000. From 2001 to 2005, the numbers were 442 in 2001, followed by 265, 268, 350 and 1,328 in 2005. We promote AMD largely through doctors at clinics, nursing homes and hospitals. We have a public information booklet on "Advance Medical Directive - What You Should Know", which is available at healthcare facilities. This booklet also contains the form for making an AMD. Anyone who wishes to make an AMD should discuss it with his or her doctor, including getting the doctor to help complete the form. Singaporeans can also download the form from the MOH website. MOH will make periodic efforts to raise public awareness and support for the AMD. We will leverage on events such as the tragic case of Mrs Terri Schiavo to educate the public on such issues. That was how AMD adoption rate increased sharply last year. But, realistically, we should not expect overwhelming subscription to AMD. Making an AMD is a serious and voluntary decision. Our efforts will continue to focus on increasing access to the AMD forms and providing the necessary education. MOH, together with the National Medical Ethics Committee, is currently reviewing the AMD Act. We will see if any amendments are needed in the light of experience. ESTIMATES OF EXPENDITURE FOR THE FINANCIAL YEAR 1ST APRIL, 2006 TO 31ST MARCH, 2007 (Paper Cmd. 3 of 2006) Order read for consideration in Committee of Supply [4th Allotted Day]. [Mr Speaker in the Chair] Head T - Ministry of National Development (cont.) Resumption of Debate on Question [3rd March, 2006], "That the total sum to be allocated for Head T of the Estimates be reduced by $100.”
“Sir, I personally do not think that is necessary because our AVA is very vigilant. Last fortnight when a case cropped up in Malaysia - kampong chickens were infected with H5N1 - they moved at a fast speed to reduce the risk. For the past two years, they have been inspecting farms in Malaysia and making sure that the chicken farms which export to us are properly bio-secured. The risk therefore is very low, as we only import chickens from these areas. In Singapore, a large proportion of our eggs are locally supplied, and AVA has made sure that our farms in Singapore are properly bio-secured. Unless you start smuggling eggs from I do not know where, I think it is quite safe to continue eating your boiled eggs. Column No : 672 INDIVIDUAL EMAIL ACCOUNTS FOR SINGAPOREANS The following Question stood in the name of Mr Leong Horn Kee - 2. To ask the Minister for Information, Communications and the Arts in view of the announcement made by the Government to provide ultra high-speed broadband and wireless Internet connections for the whole of Singapore, whether his Ministry will consider issuing in future an individual email account for every student, working adult and active Singaporean interested in Internet usage so as to facilitate the conveyance of school materials, business communications, Government information and notices among people.”
“Sir, although I eat very little meat, I continue to occasionally eat Kentucky fried chickens. This H5N1 reminds me of the SARS virus. While it is fearsome when it spreads, it is easily killed outside of a host. At a temperature of 60 degrees, I think, the virus is killed. Therefore, if the chicken is properly cooked, eggs are properly boiled, the risk is almost zero. Therefore, when Singaporeans travel overseas, just stay away from chicken farms and wet markets where slaughtering continues. When we stopped the slaughtering of poultry in wet markets 15 years ago, there was a lot of unhappiness coming from housewives. But what an important contribution it has made to our public health. It has reduced significantly this risk.”
“Sir, preparations take the form of the Flu Pandemic Preparedness Plan which, by now, practically all countries would have it. We have been refining our Plan for a couple of years now, and it is fully published in the website. Like all plans, you can never be fully prepared, because while the risk now is H5N1, when it happens, will it actually be H5N1 or some other virus? Nature has a way to surprise. But there are certain generic principles which we can follow to gear up as much as we can. And we will continue to refine our plan. We have, in fact, discussed it in this House not too many months ago in response to some Members' query. My own assessment is this. I think our own domestic preparation plan is as good as one can get. But in the last few months, we have devoted our energy to work upstream, on the preventive aspects. And it is possible to prevent it. The world has a window to prevent this disaster from happening, but it requires cooperation from many countries, especially those with large agricultural sectors. That is why we work with our neighbours. In fact, Members would have read and I have spoken about it in this House that we are doing a major project helping Indonesia, working not just between our two countries but involving America and many other countries. In fact, they are right now in town to discuss this pilot project, and I am meeting them tonight.”
“Sir, I wonder where did Mr Chia get his anecdotes from because, fortunately, there is no H5N1 yet in Singapore. He may have friends in Indonesia or Vietnam, but most of them who got it have died. The symptoms are the usual flu and severe pneumonia with many complications. The fatality rate is high. I think the recorded cases in about seven countries is more than 100. The fatality rate is more than half. So this is a serious problem. Fortunately, for human beings, the problem remains one that largely affects the animals. There is now a world pandemic. We see it in Germany, Turkey, Africa, among the birds. It remains among the birds. The risk is that one day, the virus will mutate and become much more infectious - spreading from human to human. And that is why all of us have to quickly gear up and we have been doing so, like any other country.”
“Mr Speaker, Sir, in Singapore, influenza viruses circulate all year round. But over two periods every year, there would normally be an increase in influenza incidence: April to July and November to January. They roughly correspond to the southern winter and northern winter respectively. Influenza A is the predominant circulating influenza virus here. In the last three months, its incidence peaked in the first week of January 2006, when 5.7% of all patients who presented with Acute Respiratory Infection (ARI) tested positive for Influenza A. This rate of 5.7% is, in fact, lower than the corresponding figure of 17.9% in 2004 or 7.0% in 2005. So far, H3N2 - this is the Hong Kong flu that caused an epidemic in 1968 - and H1N1, the infamous Spanish flu which caused a major problem for the world in 1918, have been the influenza virus subtypes in circulation. To date, H5N1 has not been identified in Singapore, whether among humans or birds.”
“NATIONAL RESEARCH FUND BILL "to establish a National Research Fund and to provide for its proper administration, and to make consequential amendments to the Agency for Science, Technology and Research Act (Chapter 5A of the 2002 Revised Edition) and the Standards, Productivity and Innovation Board Act (Chapter 303A of the 2002 Revised Edition)", presented by Mr Raymond Lim Siang Keat; read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. ELECTRICITY (AMENDMENT) BILL "to amend the Electricity Act (Chapter 89A of the 2002 Revised Edition)", presented by the Minister for Trade and Industry (Mr Lim Hng Kiang); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. ANNUAL BUDGET STATEMENT Order read for resumption of Debate on Question (17th February, 2006), "That Parliament approves the financial policy of the Government for the financial year 1st April, 2006 to 31st March, 2007." - [Prime Minister and Minister for Finance]. Question again proposed.”
“And I am glad that at least one of them decided to come to Singapore and after many years, they are still around. I think along the way, hospital maintenance today is quite different from 20 years ago. So I think we have made some contribution in this area. BILLS INTRODUCED SUPPLEMENTARY SUPPLY (FY2005) BILL "to provide for making supplementary provision to meet additional expenditure for the financial year 1st April 2005 to 31st March 2006 (both dates inclusive)", recommendation of President signified; presented by the Second Minister for Finance (Mr Raymond Lim Siang Keat); read the First time; to be read a Second time after the conclusion of proceedings on the Estimates of Expenditure for FY 2005/2006, and to be printed. SUPPLY BILL "to provide for the issue from the Consolidated Fund and the Development Fund of the sums necessary to meet the estimated expenditure for the financial year 1st April 2006 to 31st March 2007 (both dates inclusive)", recommendation of President signified; presented by Mr Raymond Lim Siang Keat; read the First time; to be read a Second time after the conclusion of proceedings on the Estimates of Expenditure for FY 2005/2006, and to be printed. PRIVATE LOTTERIES (AMENDMENT) BILL "to amend the Private Lotteries Act (Chapter 250 of the 1985 Revised Edition) and to make related amendments to the Betting and Sweepstake Duties Act (Chapter 22 of the 1999 Revised Edition) and the Inland Revenue Authority of Singapore Act (Chapter 138A of the 1993 Revised Edition", recommendation of President signified; presented by Mr Raymond Lim Siang Keat; read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.”
“Sir, the experts in Ministry of Health assured me that there have been local studies periodically done indeed by NUS as well as the former Environment Ministry. The current Environment Minister may have an interest in this area too. As for hospitals, in fact, this is an interesting subject. Many years ago, when I was new to hospital administration, I made it a point to visit many hospitals. I must have visited about 100 hospitals all over the place and was struck by the extensive use of carpets in US, for example. I got to meet many people, not just doctors, nurses, microbiologists, infection control people, but also housekeepers and people who have a special interest in this area. And I got to learn a lot about this subject. Two things struck me. First, the floor maintenance of hospitals - because hospital is such an unhealthy place - is a science by itself, it is a specialised subject, and you need intensive knowledge and study into this area, coupled with scientific studies and research. In the US, for example, there are firms who specialise in hospital maintenance and nothing else. After extensive discussions with them, I decided on two things at that point in time: one, how little we know about other things - that in hospital administration, it is not just doctoring and nursing care but there are a lot of non-clinical areas where expertise is needed. That was when I decided firmly that we should outsource non-clinical activities to specialists. When I became the CEO for NUH, we were the first hospital that outsourced non-clinical activities, including hospital maintenance. Secondly, we need to upgrade our standard of maintenance of hospitals in Singapore. So I persuaded the specialist firms in US to explore Southeast Asian market, including Singapore.”
“Mr Speaker, Sir, Prof. Png asked if my Ministry would discourage the use of carpets in public buildings. Mr Speaker, Sir, if we do, you will have problem extending red carpet treatment to your counterparts. Presumably, Prof. Png thinks that carpets are unhealthy materials which may be sources of chemical or biological agents, resulting in human allergies or irritations or other ill-health effects. But to-date, studies have not found any conclusive proof to implicate the use of carpets as a source of ill-health. After all, carpets are made of the same materials you find in most clothing. They are commonly found indoors and they have been in use for many years. The main issue is proper maintenance. As with all furnishings and fixtures, regular and proper cleaning of the carpets is essential for good hygiene. As there is no evidence to implicate carpets as a health hazard, my Ministry has no ground to issue any health advisory against their use. Whether carpets or other materials should be used in a particular building will therefore depend on other factors, such as cost and aesthetics.”
“The number of units of blood transfused has increased from 64,869 in 2003 to 72,307 in 2004 and 75,919 in 2005. Elective surgeries accounted for about a third of usage: 31% in 2003, 37% in 2004 and 33% in 2005. Autologous blood transfusion has helped to reduce the demand for homologous blood transfusion. But its contribution remains small. The number and percentage of units of autologous blood transfused in the last 3 years were 1,172 units, or 1.8% in 2003, 1,083 units or 1.5% in 2004 and 866 units or 1.1% in 2005. The percentage of elective surgeries requiring blood in the last 3 years where autologous blood was used was 5.7% in 2003, 4.5% in 2004, and 3.8% in 2005. APPENDICES Section Name: BUDGET Title: ANNUAL BUDGET STATEMENT Filename : Appendix to Annual Budget Statement MP Name: Mr Lee Hsien Loong Section Name: BUDGET Title: ANNUAL BUDGET STATEMENT Filename : Appendix to Annual Budget Statement MP Name: The Prime Minister and Minister for Finance (Mr Lee Hsien Loong)”
“"Accepting responsibility" means that we acknowledge the problems as defined and identified by KPMG, that there were problems of various kinds at different levels, and let us extract the lessons from there. At the same press conference that Mr Steve Chia mentioned, I did apologise because all of us, in different ways, have contributed to this outcome. NKF's mode of fund-raising has been around for quite some time. There were pluses, and now, we have uncovered that there were also minuses. But the key point is for us to get to the bottom of it. And what is the bottom of this? The crux of the matter is that a small group of people deliberately, through various means, misled, in a way, the entire society, including Mr Steve Chia and myself.”
“In that 2004 review, KPMG identified several deficiencies, such as inactive funds, funds with overlapping objectives and some internal control lapses. These deficiencies were duly rectified. Please note that the 2004 KPMG review did not reveal the major problems in the old NKF that it subsequently uncovered in 2005, a few months later, with massive resources after the former NKF Board and CEO had resigned. So overall, there was no deliberate, irresponsible behaviour on the part of the officers who regulated the NKF. But they have learnt a valuable lesson from this episode and indeed we all have. We must continue to develop our voluntary sector and give it ample space to grow. Regulators will tighten rules where appropriate, but no amount of regulation can guarantee that no unscrupulous individual or group will ever attempt to abuse the system. However, such abuses will eventually still be found out, and the wrongdoers punished in accordance with the law.”
“This is a structural issue and we will fix it. Hence, the Inter-Ministry Committee on Regulation of Charities and IPCs has proposed a revised structure, comprising the Commissioner of Charities and six Sector Administrators, with clearly-defined roles and responsibilities. Second, KPMG noted that the appointment of a Ministry of Health's representative on NKF EXCO in 2000 had not helped to uncover the NKF's problems. But that was not her mission, nor the reason for MOH inserting a representative there. MOH was concerned over the rapid promotion of haemodialysis by NKF and thought that a representative on the NKF EXCO could help influence NKF's clinical policies away from that direction. But after four meetings, when she found that the EXCO did not discuss such policy matters and dealt largely with daily operations, she withdrew from the NKF EXCO. Third, KPMG felt that when the National Council of Social Services (NCSS) transferred the NKF to MOH in 2002, the regulators had not conveyed their concerns over the NKF's use of funds and fund-raising expenses. But they did. What were the concerns of the NCSS? The NCSS acknowledged that the former NKF fund-raising expenses were in compliance with the 30/70 rule but wondered if they were unduly high. But as kidney dialysis was medical in nature, NCSS felt that MOH would be more competent to assess this and that was why NKF was moved from NCSS' supervision to the Ministry of Health. After taking over as a Central Fund Administrator, MOH has dutifully checked on the NKF's compliance with the IPC rules. It did so by relying on the NKF's former auditor, Pricewaterhouse. In addition, in late 2004, MOH also commissioned another auditor, KPMG, to conduct a review of the NKF to assess its compliance with IPC rules.”
“Mr Speaker, Sir, Mr Steve Chia wanted my clarification on KPMG's sharp comments on the regulators in respect of their handling of the former NKF. I encouraged the KPMG auditors to take a thorough, objective and critical approach as I wanted the right lessons to be learnt from this episode. Actually, the KPMG had sharp comments on practically everyone who had anything to do with the NKF, from its former CEO, Board of Directors, the auditors and the regulators. But while many were criticised, the NKF problem was essentially created by a small group of people, led by the former CEO, who exploited their Board's weak corporate governance. This was the crux of the NKF problem. If the auditors were more alert and the regulators more persistent in investigating the former NKF, the problem might have been discovered earlier. But of course, it is easy to criticise such shortcomings on hindsight. When you have a CEO who was determined to cover up his unusual conduct and who was supported by a captured board, it would take some time for outsiders to uncover his deeds. The regulators accepted the KPMG criticisms and they have learnt from this incident. But were the regulators responsible for the NKF problem? Remember that the NKF was, and still is, a non-Government organisation, a private company. Was there gross or wilful negligence on the part of the Government officers who regulated the former NKF? Did they fail to take reasonable efforts to look into the former NKF under the prevailing regulatory framework? Let me take Members through the KPMG report where it spoke on the regulators. The KPMG commented on the regulators in three areas. First, KPMG felt that the regulators could have coordinated their duties better and streamlined their regulations for greater clarity.”
“I think the Member is referring to the Medisave contribution ceiling (MCC). Once you hit this ceiling, and if you continue to contribute, the excess will then go to the Special Account. I remember Mdm Halimah, on several occasions, had also argued for the lifting of this ceiling. It is something that we can take a look. But if the worker continues to work and therefore builds up his contributions, once we change the flow rate, and allow greater withdrawals for higher classes, then his balance will come down, below the ceiling. When they work, they will continue to build up their balance again. So it is quite a dynamic situation. But certainly it is an idea which we will take into consideration. DIABETES MELLITUS 14. Dr Geh Min asked the Minister for Health (a) what is the estimated prevalence of diabetes mellitus in Singapore; (b) what is the incidence of new cases annually over the last 20 years; and (c) what percentage of patients with renal failure have diabetes and, conversely, what percentage of diabetics develop renal failure.”
“For Class B2 and C patients, the change will enable practically all of them to have their hospital bills fully covered by Medisave, without their having to dip into their pockets. My next task is to see how Medisave can be used for costly outpatient care, especially for those with chronic illnesses. But even as we liberalise the use of Medisave, I must remind our patients to remain prudent in their choice of hospitalisation class and use of medical services. Medisave is for a rainy day when one is old and no longer employed. So better not deplete it prematurely.”
“Mr Speaker, Sir, from 1st April, patients will be able to withdraw from their Medisave accounts to pay for their hospitalisation at a higher daily withdrawal limit of $400. This is a substantial increase from the current rate of $300. Dr Tan asked if the higher Medisave withdrawal limit would mean patients paying less of their hospital bills out of their pockets. The answer is yes. Indeed, that is the objective of the exercise. Current Medisave withdrawal rules were set with Class B2/C patients in mind and this should remain the primary objective of Medisave. However, incrementally, for the middle-income group who have larger Medisave balances and would normally use Class A/B1 wards or private hospitals, we should allow them to use more of their Medisave balances to pay for their hospital bills. This can be done in various ways. We can raise the daily limit by $X and increase the surgical table claim limits at the same time. Or we can allow a larger $X daily limit but keeping the surgical table claim limits unchanged. Yet another alternative is to have multiple daily claim limits, allowing higher claims for the first few days of hospitalisation, as suggested by Dr Tan. I decided to go for a simple solution by simply raising the daily withdrawal limit substantially from $300 to $400. The impact will be significant. On average, a Class B1 hospitalisation bill would be covered up to 76%, ie, more than three-quarters by Medisave, therefore, reducing co-payment in cash to 24%, while a Class A bill would be covered up to 62%, thus reducing the cash co-payment to 38%. Patients will save hundreds of dollars in their out-of-pocket expenses.”
“I am quite sure that eventually, maybe 70%-80%, and I think we would then reach that logical position of funding dialysis. EMPLOYMENT RIGHTS OF WORKERS (Unfair dismissal) 11. Assoc. Prof. Ong Soh Khim asked the Minister for Manpower since 2002 (a) how many complaints have been reported of unfair and/or unlawful employment tactics used by employers to (i) force workers to resign; (ii) retrench workers; and (iii) dismiss workers; (b) how many of these cases involved older workers in the age groups of 45-54, 55-60, and above 60; and (c) what are the measures to protect the employment rights of older workers who may not be highly educated and hence do not know their rights.”
“We have always studied the different healthcare financing models all over, not just for dialysis. But specific to dialysis, I have my own view about how something like this ought to be funded. Renal failure is a catastrophic event. When it hits, it is very bad - disastrous, but low-risk - in fact, measurable risk. On a per capita basis, you can calculate it and it is quite stable. The way to fund those things is really insurance. That is why I spent a lot of time last year reforming MediShield and part of the things that I tweaked was to raise the dialysis claim rates from MediShield and the private MediShield equivalent. And really, the way to handle renal failure patients, whether it is through transplantation or the various modes of dialysis, is insurance. When you are healthy, young and working, please sign on to the MediShield or its private equivalent, so if you are in bad luck, you are one of those few unlucky chaps with renal failure, you have the money for treatment. And when you have the money, you can shop around. My job is to publish the various charges by these one dozen dialysis centres, and then you can pick and choose. Do you want an aquarium next to your couch or you do not want an aquarium, and therefore, slightly cheaper, and so on. That should be the way. But it does not mean that there is no role for charity or Government subsidy. But the main way of funding dialysis ought to be insurance complemented by Government subsidy and charity. I asked NKF for some data. I said, "Of your patients, how many are on MediShield?" And I was greatly encouraged by the data that I got. Now, 60% of their patients are already on MediShield. Not too long ago, 50% and the trend is looking good.”
“The short answer is yes. But let me again give a little long-winded reply. NKF is not the only game in town. I think public perception is such that they see dialysis is all NKF, and if NKF collapsed, dialysis collapsed. NKF, after many years, is a major player but is not the only player. In fact, its market share is less than 50%. The rough figures are: about half, NKF; one-quarter, public hospitals; the remaining 20%, private dialysis centres; and 10%, the other charities. So this is the rough market share. But 50% is still a large part of the market share. Should it grow or should it just stay put and let the other players expand? Those are issues that we can discuss in March during the Committee of Supply. I have my own view, you may have different views. But I believe in diversity, and I think the whole healthcare model, including dialysis management, will be a lot more robust if we have multiple players. I am quite glad when I look at even the industry structure today, among the private providers, there are about a dozen of them. So my bottomline is: NKF is not the only name in dialysis, although it may be the most prominent name. But back to NKF reserves, I asked the new management this question a few weeks ago: with your $200-over million reserves, assuming you stop completely your fund raising and, therefore, you could shave a lot of your administrative cost, how long can $200-over million last you? More than 10 years.”
“But live donor transplantation is something that we must push. Norway is quite outstanding. Norway's standard operating procedure - once you have a renal failure patient, the doctor would confront him - it is very natural to ask, which of your relative or friend is going to donate a kidney. Therefore, you have this 70:30 split, only 30% on dialysis, 70% on transplantation. We are a complete reverse. Asian culture value is one; awareness is another. And we have to change that. We cannot achieve it overnight, but let us take our time slowly, so long as it is in the right trend, to promote more.”
“Mr Speaker, if you do not mind, I will give a slightly long-winded reply. One thing good out of the NKF saga is it has focused the mind, at least mine, as well as my colleagues in the Ministry of Health, to rethink this whole issue of how we manage renal failure patients. I think, for many years, because of the success of NKF in raising funds, building and expanding dialysis centres, etc, we just assume that the problem is well taken care of. But it is only in the last few months, as I began to gather data, think through all these and compare with other countries, we stood up like an outlier, whether it is in terms of very low transplantation rate or in terms of very high haemodialysis rate per capita. So for various reasons, just spending money, raising money and building kidney dialysis centres is not right. If you have too few, you should build. But there is such a thing as over-built. If you ask me, I think we should rethink, and I am reflecting on those issues. Maybe, during March, when I will be more ready during the Committee of Supply discussions, we can devote some time discussing how we should handle renal failure patients. I have already been asking the new NKF Board to think through, in the long-term, as they put themselves in 10 years' time, what they want NKF to be. Is it still more of the same? I hope not. I do not think that is correct or wise. But, instead, we should be pushing other modalities, peritoneal is definitely in, and, of course, live donor transplantation, including cadaveric. I remember two years ago, I came to this House and with Members' support, we amended the Human Organ Transplant Act (HOTA) which has saved a couple of dozens more lives last year, but those are from cadavers.”
“I quoted 1998 because the Member's question asked about 1998. I did not check the figures before 1998. But my belief is that no one is denied dialysis purely because they have got no money. But there is a small minority of patients where dialysis would not help. Dialysis is not like going for a picnic because the quality of life is very different and you are stuck there every other day for half a day. It is quite miserable. And when you have other co-existing illnesses, especially those which are severe, very often, the patients, after discussing with the doctors, would say that they do not want to go through with it. People die for various reasons, but I can confidently say that it is not because of money. It is never the reason. If you need a dialysis, you will get one. And among the 10% in the NKF data which I talked about, who pay less than $100, in fact, quite a number of them pay less than $10-$20 a month. So those are more symbolic payments.”
“For those who are still unable to pay despite subsidies, Medisave and MediShield, Medifund provides the final safety net. Last year, 14,000 renal patient applications were supported by Medifund, to the tune of about $2 million. In short, no Singaporean will be denied dialysis because of an inability to pay. Nevertheless, is it possible to further improve the outcome for renal failure patients? One answer that other countries have adopted is transplantation. As there is a limited number of kidneys available from deceased persons, those countries have approached this problem through transplants from live donors. It is common for a family member, relative or even a close friend to donate a kidney to the patient. Norway, for example, had about 58 kidney transplants per million population, and the US and Spain both had more than 50 transplants per million population. The corresponding figure for Singapore was only 17, way below 50. In Norway, the vast majority of renal failure patients undergo transplantation. Only 28% of them are on dialysis. In Singapore, it is the reverse: 73% are on dialysis with a small minority going for transplantation. After a successful transplant, the average recipient can expect to survive with a functioning kidney for 21 years for cadaveric transplant, and 32 years for living donor transplant. The experience from these countries suggests that, if we want our renal failure patients to lead better quality lives and to live longer, we should actively encourage transplantations instead of mindlessly expanding dialysis centres.”
“Sir, there are many medical reasons why patients with renal failure die. In addition, each year, a small number of them, usually with other serious illnesses, choose not to go on dialysis, after taking into account the quality of life and the many complications that dialysis brings. The ability or inability to pay for dialysis is not a significant factor in the survival of renal failure patients. The pathology and mechanisms of death in renal diseases can be better explained by renal doctors, but the point I want to highlight is that, even under the UK's health system where free dialysis is available on demand, their 5-year survival rate of renal failure patients at 45% is lower than Singapore's rate which exceeds 48%. Indeed, compared with developed countries, such as the US which has 38% 5-year survival rate, the UK and continental Europe, Singapore has the highest 5-year survival rate in its renal failure patients. In any case, with Government subsidy, Medisave, MediShield and Medifund, all renal patients can access the medical care that they need. Renal patients with financial difficulties are subsidised by the Government. In public hospitals, Government subsidies range from $850 to $1,300 per month, depending on the mode of dialysis that the doctor and the patients decide upon. In addition, Medisave covers up to $450 per month. The reformed MediShield pays up to $1,000 per month, while the enhanced Medisave-approved catastrophic illness insurance plans now cover up to $3,000 per month. At $3,000, it exceeds the highest dialysis charge in town. VWOs also provide subsidies to their patients. Those who are eligible can, in addition, get a Government subsidy, ranging from $200 to $600 per month.”
“Dialysis is a complicated business. Many years ago, when I was in NUH running it, I started the first off-hospital dialysis centre at the SLF building. I think it is still running there. So I got to know a little bit about this business. There are indeed many possibilities of cost savings so that you can try to meet the patient's affordability level. Just now I talked about reuse of reagents. Clinically, it is safe and you have some room to play around. You can reuse two times, or you can stretch a bit, four times, and you can bring down the cost significantly. So a lot depends on the doctor's experience with his patients and he can push the boundary. Of course, there are also other possibilities. In the case of NKF, my own observation is that a big part of the costs, not a major part, but a significant part of the costs are non-clinical activities, in other words, the administrative side, because they have a very heavy fund-raising component. But the new board has reviewed that particular portion and they have significantly reduced the involvement and the headcount and, therefore, the cost. So that is why I have hinted in my reply just now that they have done the first round, but this is not the end of it and, in fact, I received an email last night from the CEO, Prof. Goh Chee Leok, who told me that there is a possibility of another 10% reduction very soon, within days. SINGAPOREANS WHO DIED FROM KIDNEY FAILURE 10. Ms Eunice Elizabeth Olsen asked the Minister for Health (a) how many Singaporeans, since 1998, have died every year from kidney failure because they could not pay for the cost of dialysis; and (b) what is being done to stop this.”
“So for both modalities, the public hospitals' rates are at the lower end of the market range. My Ministry will shortly publish on the MOH website the detailed comparison of the kidney dialysis charges by the various providers in Singapore. Cost comparison with other countries is not meaningful, because different countries practise different levels of service and care. By publishing the dialysis costs, I expect the providers to review their cost structures to see if they can lower their dialysis costs further. I have done this for other illnesses and treatments with quite good results. The new NKF has already made the first round of cost reduction, by reducing its haemodialysis rate from $2,600 per month to $2,106 per month, in other words, from the high end of the cost range to now the lowest end of the cost range. And I understand that there is scope for further reduction by the NKF in the near future. Being the largest provider of this service, it really should have the most competitive cost structure and, in this way, it can stretch its donations to the maximum.”
“Mr Speaker, like other medical treatments, the cost of kidney dialysis can vary widely depending on several factors. First, patients can be treated using either haemodialysis (HD) or peritoneal dialysis (PD). Peritoneal dialysis, in turn, can be provided using either continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). Each treatment option has its pros and cons, and medical opinion continues to evolve. Second, the patients' medical conditions will ultimately impact on the treatment option and hence the cost. In particular, those who at the same time have other medical illnesses will have to be handled differently. Third, different providers offer different quality of services, resulting in different costs. For example, there is a range of reagents for the doctors and patients to choose. Even the same reagent can cost different patients differently, depending on how often the reagent is re-cycled. Currently, the treatment cost for haemodialysis, without subsidy, ranges from about $2,000 to $3,000 per month. So it is quite a wide range. For CAPD, the monthly equivalent is between about $1,200 and $1,800, while that for automated peritoneal dialysis ranges from about $1,700 to $2,300 per month. Note that peritoneal dialysis is cheaper than haemodialysis. Public hospitals have focused on acute haemodialysis with complicated co-existing illnesses. In other words, our patients are much more complicated. For chronic dialysis, public hospitals offer peritoneal dialysis as it is cheaper for the patients. In public hospitals, their CAPD cost, before subsidy, is about $1,300 per month, while the automated peritoneal dialysis equivalent is about $1,800.”
“Mr Speaker, as I said, the guidelines are there, the code of ethics are there, and if there are wrongdoings, we investigate. And the professional will know that if there is an abuse of such privilege, there will be penalty whether by the employer or by SMC. Of course, in practice, you cannot stop a doctor from remembering the names of his patients. But the point is that patients have a choice. Because at the end of the day, you cannot drag the patient to the clinic. But if a patient decides that he wants to continue the treatment wherever it may be, it is his personal choice. I think, in any case, we should facilitate that. The key point is that medical records belong to the hospital wherever you practise, whether you are in the public or private sector. When you are in the hospital campus, then you have to do as the Romans do when in Rome. EMPLOYMENT OF CONTRACT WORKERS (Trends) The following Question stood in the name of Mdm Ho Geok Choo - 8. To ask the Minister for Manpower (a) how prevalent is the trend of employing contract workers in the various sectors; (b) if any study has been done to find out why employers are turning to contract employment; and (c ) if this trend is a result of the high cost of hiring full-time employees.”
“Mr Speaker, Sir, Prof. Ivan Png asked if a public sector doctor who leaves for the private sector can take his patient records along with him. The answer is "no". In public hospitals, doctors are the employees. When a person is treated in a public hospital, he is a patient of the hospital and not the patient of a specific doctor. A departing doctor therefore cannot simply take along patient records residing in public hospitals with him. However, some patients may choose to continue the treatment by the doctor in his new clinic. In such cases, if the patients express their wishes, the hospital will facilitate the transfer of copies of the relevant medical information to the resigning doctor. This is spelt out in hospital policies and our hospitals have in place processes to guard against any abuse. For example, doctors have to sign out medical records for their use and there are regular checks and random audits to ensure compliance. In addition, the Singapore Medical Council has an ethical code and guidelines governing, among other things, how the resigning doctors should notify their patients of their impending change of practice arrangement. Our public hospitals, as well as the Council, will investigate any complaint of professional wrongdoing.”
“The Ministry will continue to provide free treatment for infectious diseases which are public health threats. These include hospitalisation for cholera in the acute stage and outpatient treatment for tuberculosis (TB) under the national programme administered by the TB Control Unit, Tan Tock Seng Hospital. We will continue to mandate that patients with such diseases be adequately treated, with isolation in the Communicable Disease Centre if necessary. Such mandated treatment will not be charged. This will also apply to patients who are infected with bird flu in the early stages of a pandemic, when all cases will be isolated at the CDC to prevent its spread to the community. However, not all infectious diseases pose a public health threat to the rest of the population. Advances in medical science have changed the management of many infectious diseases, reducing the public health concerns. An example is chicken pox which is treatable and whose public health consequences have considerably diminished. Given significant herd immunity in the community, the isolation of chicken pox patients in the home environment is adequate. The Ministry has hence stopped providing free hospitalisation for chicken pox cases. Column No : 2125 SOCIAL-EMOTIONAL LEARNING (Implementation in schools) 7. Mdm Ho Geok Choo asked the Minister for Education how will the Ministry be (i) implementing the Social-Emotional Learning component that has been highlighted as a crucial skill for students to acquire in school; and (ii) measuring the outcomes of such a learning component.”
“As for Singapore's vaccine manufacturing plant, we have been working on this for two years now, but you cannot rush it as these are multinationals. It must make economic sense for them to want to set up a plant here. We will try to make it sensible for them to want to set up something here but it is something you cannot rush, and I remain hopeful that eventually, we will see a vaccine plant in Singapore. Column No : 1965 POTENTIAL TSUNAMI 7. Mr Ang Mong Seng asked the Minister for the Environment and Water Resources if there is any concern about Singapore's risk from a potential tsunami in the near future and, if so, what precautions, such as (i) early warning systems; (ii) building and infrastructural reinforcements; and (iii) public education measures, will be put in place.”
“Mr Speaker, the pilot bird flu project with Indonesia, as I have said, was agreed to last November at the APEC meeting. And we have moved very quickly. A few days after the APEC meeting, I went over to Jakarta, met up with my counterpart and Vice-President, Yusuf Kalla because President Yudhoyono happened to be overseas at that point in time. We have managed to get the working people together. They have already had two working meetings, one in Jakarta and one in Batam. And the third meeting has already been scheduled. We are hoping to start a trilateral meeting with US early next month, probably during the first week, soon after Chinese New Year, and then progressively, we will involve other partners. It is a massive international project. We want to involve as many partners as possible. US has already come on board but there are many interested neighbours who are keen to join in - Australia, Japan and the other international agencies like World Bank would like to help out too. So it is something that we are working very actively on. We have already identified the province because Indonesia is a very large place. We have decided on one province near Jakarta with a population of about 1.5 million people for us to put in systems and to test them out and whatever work there, we can quickly roll out to the rest of Indonesia. Batam and Bintan would certainly be involved because they are closest to us and also we got to know the people there very well, particularly after the tsunami, when we helped them actively and built up a very strong network of friendship and the experts are all at first-name telephone contact level, which is essential in any public health response system.”
“In the area of bird flu, the REDI Centre has been tasked by APEC last year to draw up a list of resources and experts that could be called upon to respond to an emergency outbreak situation. The REDI Centre will also play a role in the Indonesian pilot project that I mentioned earlier.”
“That is why Singapore decided to join a network called the Global Outbreak Alert and Response Network (GOARN). This network was set up in 2000 to pool together the technical resources of member partners to respond to outbreaks. It provides another useful platform for international collaboration. Last month, we hosted the GOARN Steering Committee Meeting in Singapore, and had a very good meeting. Apart from these activities, a recent initiative is worth highlighting. At the last APEC Summit in South Korea, Prime Minister Lee, President Yudhoyono and President Bush decided to start a pilot project in Indonesia on the control of bird flu. This is still at the planning stage but the objective is to see how we can execute, within a defined area in Indonesia, all the measures recommended by the expert agencies such as the WHO and the OIE. The project can then be a model of preventive and control strategies, which can be extended to the rest of Indonesia. I think the experience should be of value to other countries. We are involving other countries and other partners such as the World Bank, the WHO and the OIE to contribute both resources and expertise. And as pointed out by Dr Lily Neo, our location in Southeast Asia in proximity to many bird flu-infected countries makes us a natural partner in such regional collaborative activities. We certainly welcome international organisations to base themselves in Singapore where it is beneficial for them to do so. One example is the Regional Emerging Diseases Intervention (REDI) Centre at Biopolis. This was jointly established by Singapore and the US, to serve as a regional node for research and coordinating efforts to deal with emerging transnational diseases.”
“Mr Speaker, Sir, Singapore is a small but active player in the global fight against a possible human flu pandemic. In this fight, the best strategy is to try to prevent one from happening at all. First, we need to persuade countries to reform their farming practices and raise the hygiene standard of their wet markets. Calls for reform are now increasingly being heard at international forums like the WHO (World Health Organisation) and APEC (Asia-Pacific Economic Cooperation). We have been adding our voices to such calls. Second, countries must enhance their surveillance and early detection systems, for both bird flu and human flu. This requires strong international collaboration so that essential information can be shared in a timely manner. Some countries will require assistance in expertise and extra resources. Our resources are limited but where we can make a meaningful contribution to global public health, we will. We do this at several levels. Bilaterally, we have been working with our neighbours, to share expertise and experience. For example, we have a collaborative project with Indonesia. This was discussed last year by and agreed to between Prime Minister Lee and President Susilo Bambang Yudhoyono. We are providing Indonesia with training, laboratory testing support, equipment and medical supplies to help them build capacity to deal with this common challenge. At the multilateral level, we work through the WHO and the OIE (World Organisation for Animal Health) to promote early detection and greater transparency. Third, when an outbreak of human flu pandemic occurs anywhere in the world, we need rapid response to investigate the outbreak and if possible, to isolate it. This requires prompt and effective intervention.”
“The risk to human health posed by bird flu is low, unless and until the Avian flu virus mutates into a human flu virus. The risk of such a mutation is real and hence we need to be prepared for such a human flu pandemic scenario. Protecting Singapore against such a disease outbreak and preparing our response to it is a national effort, involving the public, private and people sectors. In the public sector, our response is coordinated and integrated at the national level through the Homefront Crisis Management System. Under this framework, all the relevant Ministries are involved and they are assigned roles and responsibilities in accordance with their domain expertise. Preventing bird flu from infecting our poultry is a key priority at the current stage of development of this possible flu pandemic. The Ministry of National Development has put in comprehensive measures to prevent any outbreaks of Avian Influenza in wild birds and poultry in Singapore. These include bio-securing our poultry farms and stepping up checks on wild birds, imported birds and local farm poultry. As the Minister for National Development will elaborate on the measures pertaining to checks on migratory and other birds in reply to a separate Oral Question, I will not repeat them here. Column No : 1941 PART-TIME EMPLOYMENT (Statistics and incentives) 9. Dr Amy Khor Lean Suan asked the Minister for Manpower (a) what percentage of employment in Singapore is part-time work; (b) what is the breakdown in percentages, absolute numbers and by gender, for the private and public sectors; (c) have these percentages been increasing over the last five years; and (d) are there any specific plans to encourage more employers to offer part-time work and, if so, what are they.”
“MediShield Plus was operated by the CPF Board. Like similar catastrophic illness plans operated by other insurers, MediShield Plus is a long-term insurance plan. Once a member comes down with a chronic illness, like kidney failure or cancer, MediShield Plus is committed to fund part of his medical treatment in the future. For this reason, MediShield Plus has to build up reserves to meet such long-term liabilities. This is to ensure the continued financial viability of the plan. From October 2005, the CPF Board has transferred the entire MediShield Plus portfolio to NTUC Income. NTUC Income was selected through an open competitive tender. As a requirement in the tender, NTUC Income has to continue providing the insurance benefits for all existing MediShield Plus members, regardless of their health status. Members are thus unaffected by the change of ownership of MediShield Plus. In particular, NTUC Income will continue to service the long-term insurance claims from those with chronic illnesses. When transferring the MediShield Plus portfolio, the CPF Board also handed over to NTUC Income the reserves of $26 million. In this way, the long-term benefits of MediShield Plus members are preserved despite the change of ownership. Column No : 1939 AVIAN FLU (Inter-Ministry cooperation and precaution) 8. Dr Amy Khor Lean Suan asked the Minister for Health (a) how is his Ministry cooperating and coordinating with the Ministry of National Development and the Ministry of Environment and Water Resources to safeguard Singapore against a bird flu outbreak; and (b) whether checks on migratory and other birds have been stepped up as a precaution against bird flu.”
“I presume this is the notification that Mr Chia was referring to. Column No : 1807 SUBSCRIPTION OF SATELLITE TELEVISION (Regulations) 16. Prof. Ivan Png Paak Liang asked the Minister for Information, Communications and the Arts if he will relax regulations that prohibit Singaporeans from subscribing to satellite television.”
“Sir, Mr Steve Chia cited a case of fatal dengue infection which was apparently only notified to my Ministry one month after the event. He has rightly asked why this was so, as it would suggest that our monitoring of infectious diseases might have been compromised. Let me assure him that nothing was amiss. Dengue is a notifiable disease under the Infectious Diseases Act. All doctors are required to notify my Ministry within 24 hours after any diagnosis of dengue has been made. This is to enable prompt public health measures, including vector control measures by the National Environmental Agency, to be initiated to prevent further spread of the disease. In this instance, the 49-year-old man visited Yishun Polyclinic on 12th September 2005. He was diagnosed as a dengue suspect and was referred to Tan Tock Seng Hospital's Emergency Department for further management. The polyclinic notified my Ministry the next day. On September 14, after verifyingthe details, my Ministry alerted NEA and vector control activities were initiated. On the same day, the patient made a second follow-up visit to Tan Tock Seng Hospitaland was admitted this time. On September 15, blood test confirmed the case as dengue. Unfortunately, his condition deteriorated and he died on September 17. His death was subsequently reported to the Registry of Births and Deaths. We do not require doctors to re-notify dengue death cases as the necessary public health measures would already have been put in place. Nonetheless, for statistical purposes, the Registry would compile and submit returns of dengue deaths to my Ministry. This is batched and done on a monthly basis. This particular patient’s death was included in the October data which was sent by the Registry.”