Koh Poh Koon
Singapore
“In 2025, for walk-in patients, the median and 95th percentile doctor consultation waiting times were eight minutes and 72 minutes respectively. However, the Ministry of Health (MOH) does not track waiting times by peak versus off-peak hours, but it is likely that 95th percentile waiting times happened during peak hours.”
“The offences and penalties for importing, supplying or abusing SPS products are similar to those in the MDA, to ensure similar level of deterrence. Mr Speaker, with your permission, may I ask the Clerks to distribute a handout that summarises the changes in legislative penalties for key offences.”
“So, if you are a Singaporean student, you will expect that there will be some subsidies to the fees. The third question on how can the public, who may want to seek psychological care, know who is legitimate.”
“Sir, I thank the Member for his question on audiologists. In general, a qualified audiologist in Singapore needs a higher level of certification because a diploma level may not be quite enough to perform the task. So, we will look and see whether there is a way to actually find an in-between.”
“We are starting with registration to give formal recognition to those who are practising in higher risk sub-sectors in psychology and making sure that the quality, the standards and the support is given to them to deliver the care that the clients and the patients need.”
“It takes a bit of, not just system change in the providers, in the doctors and the care teams, but also, a gradual shift in the mindset of our population as well. So, it is something that we have to continue to do. There is no magic bullet to this and it is not something we can achieve overnight. 12.15 pm”
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“And the degree of grading or staining is what we call a semi quantitative method. It means it is not a "plus" or "minus", "yes" or "no". It is a gradation of degrees of staining just like when you look at your iPhone photos, and you try to adjust the contrast. Between two sets of persons looking at the adjustment, to you, this may look pleasing enough, dark enough, but to another person, this may be too light. So, there is some degree of inter-observer variation which trained pathologists must then make the judgement call and say is this dark enough stain to be deemed as a positive 3+, 2+, 1+ or 0. So, it is semi-quantitative in that sense. Therefore, you can appreciate that this being a very complex test, as in most other immunohistochemistry tests, will require multiple levels of validation. But I will also say that the reason why this issue was discovered is because the institutional processes within KTPH have allowed this to be picked up. Because being a multi-step process, if we depend on one single point to validate its accuracy, then it will be at a very, very high risk of failure at some point of time. But fortunately, because there is an institutional process through the Tumour Board – a multi-disciplinary review board looking at tumour outcomes, specimen and treatment, it was flagged up at the point of review that the positivity rate seems to be higher than expected. And that was what triggered the review. I would say that the processes are there. We now need to look at which part of this process could have been strengthened further and that is the on-going review that the expertise team is looking at, at the moment.”
“KTPH has informed that any costs, as well as investigations that are done as a result of Herceptin treatment will be borne by the hospital and refunds will be given. So, I think that will go in some way to relieve some of the financial pressures and stresses that a patient has undergone. On the second question of whether other immunohistochemistry tests would be reviewed; I think we must understand that immunohistochemistry testing is classified in most laboratories as a highly complex test. By highly complex, what I mean is that it is a test that is not quite the same as you drawing a blood test – pop it into the machine and the result comes up within a few minutes. It is not as simple as that. It is a multi-step process that has multiple steps of human intervention in the process. First, as a tumour specimen is removed, what we call cold ischemic time – how soon the tumour, after it is removed from the body – gets put into a fixation, that means to fix the tissue in the chemical, usually it is recommended to be less than one hour. So, how the operating team in the Operating Theatre, not even the pathologist, just how the operating team handles the tissue – when do they take a specimen out, when do they call for the team to put into the solution; you must also put into the correct solution, otherwise if you put in the wrong chemical to fix the tumour tissue, that sample cannot be used for IHC staining. Then, when it goes to the laboratory, how thick the specimen is sliced, what kind of stains are used, what kind of temperature that is done, what is the concentration of the stains being used, what is the choice of antibody and subsequently after staining, how the pathologists themselves grade the degree of staining.”
“Mr Speaker, I thank the Member, Dr Tan, for raising these two questions that I am sure, must be on the minds of many patients and relatives who are cancer sufferers. First, I must say that Herceptin treatment for HER2 positive patients usually is not so much of a monotherapy, that means on a standalone basis. Usually, it is in combination with other chemotherapy drugs for breast cancer. So, in other words, even in a HER2 negative patient, where you do not need Herceptin treatment, you will still require some chemotherapy to overcome breast cancer, and therefore, you will still have to come for recurrent visits, treatment, monitoring and testing by the managing oncologist. But we know that some of these can create a lot more anxiety, maybe a few extra visits that will be required for monitoring of side effects. KTPH and the managing oncologists and doctors will take a compassionate approach to reassure, to also help these patients to overcome their disease and anxieties by keeping close communication with them through a more dedicated care team, especially those who are affected by the change in result status. But I must also say that in this situation where the issue is more of a false positive, it does mean that some patients would have perhaps, over treatment. I think it is probably a preferred state than to have under treatment, especially when you have cancer. In this situation, HER2 testing has shown that some of them should have been classified as HER2 negative, meaning that actually the patient does have a better prognosis compared to those who are HER2 positive. Overall, it is not necessarily a bad thing for the patients to be actually reclassified as HER2 negative on testing.”
“NHG will provide an update when more information is available and these findings will be shared with the other healthcare institutions for improvement.”
“Of these, eight patients were treated at private hospitals and 192 patients at Government hospitals. Eight patients are still pending retests. Joint care teams have been formed, comprising KTPH surgeons, histopathologists and the treating oncologists, to review the individual care plans for these affected patients, based on the change in their HER2 status. KTPH and the treating oncologists are in the process of actively reaching out to these patients to conduct open disclosure and assess these patients for any potential side effects due to unnecessary treatment. The more common side effects include diarrhoea, chills and fatigue – these are usually short-lasting. About 3% to 4% of those who underwent HER2-directed treatment, for example, using Herceptin, may also experience heart problems. KTPH is also reviewing the bills of these affected patients. The portion of the bills which arose from the unnecessary treatment will be fully refunded. KTPH is also ready to provide any clinical and financial support to the affected patients including on-going or follow-on treatments, if any, which may be needed as a result of this over-treatment. The National Healthcare Group has convened an independent review committee, comprising external experts from multiple relevant disciplines in the healthcare industry. The objective is to conduct a thorough evaluation of the incident, to understand better the lapses that have occurred and recommend appropriate measures to improve the process. This ensures that any system gaps are identified and addressed swiftly to prevent recurrence of similar incidents. The committee's investigations are on-going right now and more time would be required to ensure a thorough review.”
“Sir, on 19 November 2020, Khoo Teck Puat Hospital (KTPH) was informed by its laboratory that its immunohistochemistry (IHC) tests for Human Epidermal Growth Factor Receptor 2 (HER2) were producing higher-than-expected rates of positive results for breast cancer patients. Preliminary investigations by the laboratory suggested that some of the HER2 results may be inaccurate. Following the incident, MOH has been working closely with KTPH to ensure that affected patients are provided with adequate support. KTPH has sent the samples of all patients, who have been tested HER2 positive since 2012, when HER2 testing first started in KTPH, to external laboratories for re-testing to determine how many have received inaccurate results. Preliminary investigations by the KTPH laboratory suggest that the inaccurate results could be due to a suboptimal staining process. The KTPH laboratory has since stopped in-house testing of HER2. MOH has also issued an alert to our other public healthcare institutions to conduct a quick review of their laboratory-developed IHC tests to ensure that positivity rates are within the acceptable range. Thus far, we have not received any reports of similar risks from other healthcare institutions. KTPH's Department of Laboratory Medicine is subject to regular inspection by MOH as part of regulatory processes under the Private Hospitals and Medical Clinics (PHMC) Act to ensure that its laboratory facilities, systems and processes are in place to meet patient and personnel safety standards. In addition, the laboratory is accredited by the College of American Pathologists (CAP), where the last biennial inspections by peers were conducted in 2019. As at 23 December 2020, 200 patients have been reclassified from HER2 positive to HER2 negative.”
“Mr Speaker, Sir, may I have your permission to take Question Nos 17 to 21 together, please?”
“Sir, I think such outlier bills will be unusual and I think it is useful if the Member can perhaps share the information through an email with the data. Because the policyholder has a deductible a year and the deductible, usually, is in range of $3,000. Anything beyond that, MediShield Life kicks in. So, for the policyholder to have to pay $9,000 in cash, I think it is quite unusual. So, we do need to take out a look at the specifics of the case whether they have required very esoteric or specialised treatment even though they may be a C Class patient where certain treatments would not fall within the scope of the usual subsidies, for example. I think that is something we can do. And if the person does have difficulties paying the bill with cash, then this is where we need to get a medical social worker involved and see if MediFund can be a way to help defray the cost and help this person to settle the hospital bills and continue the treatment.”
“The MediShield Life Council has recommended further adjustments to the claim limits for daily ward and treatment charges as part of the ongoing MediShield Life Review. And we will also review MediSave limits in tandem with this. These adjustments will help to cover more of the inpatient or day surgery bill. In addition, the Council has also recommended to raise the policy year claim limit from the current $100,000 to $150,000 for that year. This will help older patients with exceptionally large bills due to long or multiple periods of hospitalisation within that same year. We will continue to review the MediShield Life and the MediSave limits regularly, to ensure they remain adequate in protecting Singaporeans, while keeping the premiums affordable. MediFund, as I said earlier in a previous reply, is available for needy Singaporeans who require additional financial assistance to pay for their healthcare bills after subsidies, after MediSave and after MediShield Life. No Singaporean will be denied appropriate healthcare due to their inability to pay. So, I want to emphasise that point again – no Singaporean will be denied appropriate healthcare.”
“Sir, surgical procedures may be undertaken as part of an inpatient or day surgery episode. The Government provides significant subsidies of up to 80% for both the surgical procedure and the daily hospital charges, which include any number of tests, scans and rehabilitative services which may be required as part of the treatment episode. MediShield Life is targeted at helping patients with more costly bills. For hospitalisations involving a more complex surgical procedure, it will cover about 15% to 20% of the total bill in a subsidised ward on average, while MediSave pays for about 5% to 10%. About 3% of the bill is then paid for in cash. For example, an average subsidised bill for a heart artery bypass surgery, a much more complex surgery, would cost probably about $33,000 before subsidies, where MediShield Life pays for about $7,300, MediSave covers about $1,600, and the patient pays the remainder of about $200 in cash. The bulk of it is still taken care by subsidies and the remaining by the other components I just illustrated. Overall, for all treatments, including less complex surgeries, eight in 10 of all subsidised hospitalisation bills incurred by Singaporeans were paid $100 in cash or less. So, eight in 10 Singaporean subsidised bills cost less than $100 in cash. The MediShield Life and MediSave claim limits for surgical procedures are pegged to the complexity of the surgery required, as indicated in the Table of Surgical Procedures. The MediShield Life claim limits for surgical procedures were recently increased in January this year to keep pace with rising healthcare costs and provide better coverage for more complex surgical procedures.”
“Today, we are trying to fight the war of diabetes because we know diabetes leads to many more downstream consequential problems. A person may claim for an amputation of a left leg today. There is no telling tomorrow next year that he will have amputation of the other leg. Following, year after that, he may have one kidney failure or two kidney failures and going on to dialysis and following that, a transplant of the kidneys as well. Some of these things will have to evolve. It is not as if is hard-coded in science. It is a dynamic process. You cannot just predict so well ahead of time when a person lose his second leg or will have a kidney transplant. When we talk about stress, I think it is important to remember my emphasis that this is universal, this is for life and importantly, no Singaporean will be denied coverage if you cannot pay premiums. We will find means to subsidise, to cover with MediFund or additional payment support if needed. Twenty-odd years as a doctor in the hospital, I have not seen a single patient who has been declined treatment on the account of inability to pay. And many of these predate even the era of MediShield Life. I can tell you, with MediShield Life, this will provide an even greater cushion and hopefully a lot more comfort to many of these patients.”
“Sir, if the Member were to listen carefully to what I said earlier, I already said that 35% of the contribution within a fund came from Government subsidies and all sorts of premiums contribution by the Government as well. So, that itself is a sizeable commitment from the Government. Today, there are already about $7 billion or so inside, of which 35% of it comes from the Government. That is way more than $800 million that he was talking about. We are contributing in the billions here. The second thing is we do welcome ideas from experts who can actually help us to also refine the Scheme as we go along. But bear in mind this is a very new Scheme and we just started for the last four to five years. As we go along, we will try and share more data as possible and involve more actuarial consultants to try and help us to look for new possibilities and new ways to look at some of these things. But let me just say that for the purpose of transparency, the Member must note that this is not proposed by Government. This is an external consultant who proposes the premiums, audited by an external auditor and report this yearly in Parliament where Members get a chance to question about the proportioning of the Fund and the usage. I think transparency is not an issue here. We will try and work with the actuarial consultants to see whether some of these publications can go on to the academic circles, for people to take a look as well. But bear in mind that what you do in academia, what you look at, has to marry with the actual reality. As I was explaining earlier to Ms Foo Mee Har's question, some of these conditions are always evolving. They are changing. We know we have an ageing population so the dynamics will change.”
“Sir, this is where we need the help of all the Members in this House. As Members of Parliament, as Advisors to the grassroot organisations, as key touchpoints within the community, we hope that all Members in this House, having understood what is being said earlier, would help to communicate this to your residents. The Ministry will also push out a series of communications through case illustrations, through engagement with the public, through press releases and perhaps also through write-ups in the media to help share some of this information to the public. So, we look forward to your support and continued partnership.”
“At the extreme end of the age range, at more than 90 years old, the MediShield Life premium for Singapore citizens more than 90 years old before any form of subsidies is S$2,055. The Hong Kong one equivalent is S$3,767. So, even before subsidies, our premiums for universal coverage, for all conditions, for life, no exclusion, is already much cheaper than the one that Hong Kong has. But bear in mind that for the older group, especially those which I said is above 90 years old, they belong to the Pioneer Generation group where there is already additional premium subsidies, premium discounts, MediSave top-ups. Virtually, it is almost a free healthcare insurance for those who are at the extreme end of age range for the Pioneer Generation. I hope that gives the Member a clearer idea of the comparisons that we have.”
“Again, "for life" is another important feature because many private insurance plans do not cover you beyond a certain age because they know once you reach a certain age, your disease prevalence goes up, your risk of claim goes very high and your chance of a severe illness is very high as well, and nobody wants to provide coverage. So, private insurance plans tend to cherry-pick. If we look at how MediShield Life is constructed, therefore, it is a very unique pervasive universal health coverage plan. If I were to make a comparison to, say, a healthcare plan from another country, I think it is very hard to find something that is exactly the same. But for purpose of comparison, if I can share some premium data from Hong Kong's VHIS, which is Hong Kong's government-backed Voluntary Health Insurance Scheme. So, first it is Hong Kong, which is an Asian country, pretty much similar to Singapore in terms of social construct and healthcare system, which is quite similar, in the British-base kind of healthcare system. But bear in mind, this is a voluntary healthcase system. Theirs is not universal. Even then, for a voluntary healthcare system, the premiums compared to the revised MediShield Life premiums coming on stream before subsidy add-ons – that means just the raw premiums after the revision – the premiums range from being 34% to 143% higher than our MediShield Life. Or you can work it out – it is about 76% higher on average across the age bands. So, Hong Kong's healthcare insurance system which is voluntary, on average, at least 76% higher than our premiums. At the lowest end, at the one to 20-year-old age range, our revised MediShield Life premium before subsidy is S$145 a year. The Hong Kong premiums is S$352. So, it is easily close to two times or more.”
“Sir, I thank the Member for this very important question. As a doctor who has been practising for about 20-odd years, I can tell you what is the saddest thing we see in the clinics. The saddest thing we see is when you see a poor patient or family who has limited means coming to a hospital for a catastrophic illness and they are devastated by the worries of healthcare bills. And the sad thing we always talk about in the doctors' tea room is that, sadly, the people who needs the insurance the most are the ones who cannot afford it. This is why MediShield Life was conceived to be a universal Scheme to make sure that no single Singaporean will be left behind, even the poorest and the lowest of income; through whatever means: MediSave contributions, through MediFund, through additional premium support. We will make sure every Singaporean patient has a basic medical insurance to cover them for catastrophic bills. The second kind of condition which we see many private insurance exclude are actually congenital conditions. The moment you are born with a congenital condition, you are already disadvantaged for life. No insurance will probably take you on unless you are prepared to pay an arm and a leg for a very high premium to get that coverage. Many of us who have insurance plans will also know that later on in life when you have the means to buy an insurance plan, but you already have a pre-diagnosed condition, the insurance will take you on but exclude those conditions from coverage as well. I think these are the important features of MediShield Life that we got to take into account that is different from any other insurance plans out there, especially in the private sector. So, pervasive coverage, all Singaporeans, all disease, conditions, for life.”
“So, over time, we could perhaps engage different consultants to take a look to challenge the assumptions to do another calculation at the appropriate time, to make sure that we are still on track. We can also speak to the consultants and see if they are able to publish some of these data in an academic way. But again, this will not be something that most lay people will understand. Nonetheless, the key information that is available are already published transparently on the MOH website and those who are interested can take reference from there.”
“Sir, I thank the Member for his question. I think the answer should be do not just take the Government's word for it. Take the words of the professionals who are experts in this field. I think very few people are actuarial experts who can understand the nuancing and the very complicated calculations that goes behind the scenes. I would say that MediShield Life premiums are, first of all, proposed and calculated by external actuaries. That means, they are independent of the Government, they are a set of actuarial consultants who craft up the series of premiums that they think, based on data and assumptions that they made, that would be fair for to charge to the policyholders. That is the first thing. Secondly, the size of the funds, the amount we collected and the amount we pay out are actually also externally audited. So, it is not the Government's word, it is an external auditor who takes a look at the funds and calculate the loss or the surpluses. Finally, whatever the report is, it will be reported to Parliament on an annual basis for the purpose of transparency. So, I think this is not just the Government's words, this is based on external experts, external auditors and transparently reported in Parliament. But I take the Members point that, over time, we may have to have a better system of looking at how these assumptions, calculations, need to evolve. But this Scheme is a new Scheme. It has only been about four to five years running and we are collecting data as we go along. Much of the outcomes will have to depend on how the claims have been paid out, what is the actual lived experiences of patients and how much claims and the percentage of bills that are incurred as well.”
“You can give vouchers, for example, or give some form of incentive for people who clock 10,000 steps a day, who have good diabetic control and sugar intake; you can give them some incentive like maybe $100 NTUC vouchers a year or something like that. So, there are other ways to incentivise good behaviour without distorting the actuarial calculations for a fund that needs to be sustainable and needs to be solvent.”
“But today, there is drug on the market that one pop of a pill – it costs about $600,000 a pill, a dose of treatment – can potentially eradicate Hepatitis C. That magnitude of inflation is something you cannot predict ahead of time and the pervasiveness of the disease prevalence that requires you to use this treatment is again very hard to scope into one formula that addresses a broad spectrum of needs. So, I think it will be very, very hard to have a single formula to have that level of clarity. But the actuaries that use some of these current data to project will make adjustments over time and this is why we need to review our premiums on a regular basis, yearly, if not, every couple years, to take into account new treatment on the horizon, new changes in clinical practice, new utilisation patterns, so that we can reflect the premiums accurately. The second question on how to incentivise better behaviour. Well, actually the flip side is true. Today, if you have no good behaviour, you actually have premium loading, which is what most insurers in practice would practise. If you have a diagnosis and you want to continue to be covered for the condition or you want to add on a condition that was previously not covered, the insurer will do a premium loading to add on the coverage for the condition. In that sense, it is an incentive to be healthy, so that you do not have a premium increase on the individual basis; not necessary a premium rebate, but you do not want to have a premium increase, by keeping healthy. In order to encourage our people to adopt a healthy lifestyle and be healthy, there can be other schemes that the Government can do outside of the scope of insurance to encourage good behaviour.”
“Sir, I thank the Member for the supplementary questions. I think these are important questions that may be on the mind of many people and public as well. Ideally, it would be good to have a single formula that can address some of these various factors that drive inflation and costs, that translates to higher premiums. But the difficulty is that year-to-year, decade-to-decade, it is very hard to predict ahead of time what kind of technology will drive clinical practice. In the early years, when I was a student, CT scan was not ubiquitous. When we see somebody in the A&E, if you get a head injury, the default is just a plain X-ray of the skull. That probably cost about maybe $15-$20 to do a skull X-ray, but it does not tell you very much unless you have a bone fracture. It cannot tell you there is bleeding inside your brains, whether there is traumatic soft tissue injury. Today, it is almost unthinkable, just barely 20 years later, that you do not do a CT scan of the head for somebody with a significant head trauma. But the cost factor for a CT scan is actually in the range of hundreds of dollars. That is easily a 10- or maybe a 100-fold increase in the cost factor. But at that point in time, you cannot really factor in just one single thing, a CT scan, the magnitude of utilisation, the pervasiveness and the cost factor from the technology, how it can be applied clinically, because this also depends on clinical guidelines as well. So, as opposed to a transport fare formula, where the parameters and the variables are a little bit more fixed and more predictable, healthcare inflation takes into account many unforeseen kind of variables that will come along the way. Even medications, for example, Hepatitis C used to have not much treatment except for liver transplant.”
“Mr Leong asked about the formula for computing the Fund’s reserves. The reserves are computed by external professional actuaries in accordance with the Monetary Authority of Singapore or MAS’s requirements and in line with industry standards. For more details, the Member can refer to the Insurance (Valuation and Capital) Regulations 2004. MediShield Life, I must emphasise, is a not-for-profit Scheme. All premiums collected are placed in the MediShield Life Fund which are used solely for the benefit of policyholders and in the administration of the Scheme. Information about the Fund size, reserves and Incurred Loss Ratio is published on the MOH website. The financial accounts for the Fund are also audited by an external auditor and submitted to Parliament every year for transparency. Mr Yip asked whether Singaporeans can pay premiums based on the choice of coverage and illnesses covered. MediShield Life focuses on the basic needs of Singaporeans and apply equally to all policyholders. Those who prefer to have better coverage and are willing to pay higher premiums can consider private Integrated Shield Plans or IPs. Sir, slowing the rise in healthcare costs is key to maintaining the longer term affordability and sustainability of MediShield Life premiums and the overall healthcare system. Everyone has to play a part. Together, appropriate care can remain affordable for all Singaporeans.”
“Premiums collected have to cover potential current and future claims, including amounts set aside to support future commitments as well as provide a buffer against unforeseen contingencies such as unexpected spikes in hospitalisations due to disease outbreaks. As policyholders age, claims are likely to increase and so will premiums. A key feature in the MediShield Life scheme is to distribute premiums more evenly throughout the policyholders' lifetimes. Part of the premiums paid by policyholders during their working ages are set aside to provide for future premium rebates, which will help to moderate premium increases in their older ages. This constitutes the bulk of future commitments set aside in the reserves. As the majority of policyholders are relatively young today, the amount set aside has been increasing. Other commitments include future payouts for diseases currently under treatment and will require multi-year care, such as renal failure and cancer. Between 2016 and 2019, a total of S$7.5 billion in premiums were collected. This comprises $4.4 billion in premiums collected from policyholders, and $3.1 billion from the Government in terms of premium subsidies and other forms of premium support provided to keep premiums affordable, which also went into the Fund. In this same period, a total of $3.5 billion in claims were paid out, while $3 billion was set aside for future premium rebates. Mr Yip asked about the surplus or loss ratio of the MediShield Life Fund. The Incurred Loss Ratio or ILR of the Fund was an average of 104% over the period from 2016 to 2019. This means that the total premiums collected was slightly less than the total monies required to ensure that the Fund is able to meet current claims and future commitments.”
“This includes those who are mid-way through medical treatment or have experienced a recent job loss or a reduction in income, as pointed out by Ms Ng and Mr Yip. Certainly, a concern that many Singaporeans have during this COVID-19 crisis. If approved, Additional Premium Support will cover all outstanding premiums as well as their future premiums. The Government had considered deferring the MediShield Life review and consequent premium increases given the current difficult economic situation with COVID-19. However, I must emphasise that it was important that MediShield Life remains solvent and sustainable so that it can meet its obligations in time to come when policyholders make claims. Its coverage also has to be updated and enhanced to remain relevant to the healthcare needs of Singaporeans. The MediShield Life Council therefore recommended that premiums should be adjusted accordingly. Nonetheless, in recognition of the challenges faced, the Council further recommended that the Government should provide additional subsidies to help Singaporeans during this exceptional period. The Government has therefore provided a COVID-19 subsidy for all Singapore citizens in the next two years, which will pay for the bulk of the premium increase in the first year. Taken together with existing premium subsidies and support, the net increase for all Singapore Citizens will be no more than about 10% in the first year after the MediShield Life review is implemented. The MediShield Life Fund has to be self-sustaining and based on sound actuarial principles.”
“Several financial support schemes are available to ensure that no Singaporean will lose their MediShield Life coverage, or be denied access to appropriate care, just because of an inability to pay their premiums. To ensure premiums remain affordable, the Government provides premium subsidies of up to 50% for lower and middle income households. All Merdeka Generation seniors receive additional subsidies of up to 10% on top of these premium subsidies and all Pioneer Generation seniors receive special subsidies of up to 60%. Taken together, about 35% of the total premiums collected were paid for by the Government through various subsidies and support schemes in 2019. For the elderly aged 65 and above, the contribution from the Government is even higher, at about 50% of their premiums. To illustrate this, the revised premium for a 62-year-old lower income Merdeka Generation or MG senior is $1,020 before subsidies. This is the annual premium, which therefore equates to less than $90 a month. After taking into account the premium subsidies and additional MG subsidies, the net premium payable per year is $663, or about $55 a month. Additionally, the MG senior will receive annual MediSave top-ups of $200 for MGs from 2019 to 2023, which can be used to pay for his premiums. After this additional $200 offset, the effective premium payable for this MG senior will be $463 a year, or less than $40 a month. Premiums can be fully paid for by MediSave and the vast majority of Singaporeans have sufficient MediSave for their premiums. Family members can also utilise their MediSave to help pay the premiums for their loved ones. Singaporeans who continue to face difficulties even after subsidies and have limited family support can apply for Additional Premium Support or APS.”
“Between 2001 and 2019, the average hospitalisation bill size in public healthcare institutions has increased by about 6% a year on average, and this is affected by medical cost inflation, demographics and medical advancements over these years. This growth in utilisation and payout accounts for about two-third of the premium increases. One-quarter of the premium increase is from refreshing the claim limits to ensure that Singaporeans continue to be adequately covered for the majority of subsidised bills. The remaining portion of the premium increase, which is about just under 10%, supports the benefit enhancements including those implemented since 2018, such as the extension of coverage to inpatient hospices and serious pregnancy complications. As premiums are priced taking into account multiple factors, which inevitably vary from country to country, it would not be appropriate to compare MediShield Life's premium increases with other national health insurance schemes, which Mr Leong Mun Wai suggested. It would also not be meaningful to compute how much premiums a Singaporean will need to pay over his lifetime, simply by assuming a fixed compounding factor each year. Future premiums would depend on how the underlying drivers, which I have just illustrated, evolve. And this depends on many factors including what we can achieve together to manage healthcare cost. The amount of premium subsidies an individual would receive will also vary over his lifetime, depending on his financial circumstances. Several Members including Ms Ng Ling Ling and Mr Yip Hon Weng asked about the support for those who face difficulties with their premiums. I would like to assure Members that MediShield Life provides coverage for all Singaporeans, for life.”
“Sir, MediShield Life is a basic health insurance scheme that provides Singaporeans with universal and lifelong protection against large hospital bills. The key word here is universal and lifelong. It has strengthened our larger healthcare financing framework to keep healthcare affordable, together with Government subsidies, MediSave and MediFund. Again, it is the 3M + S, that I said so earlier, in the previous question. About eight in 10 patients today need to pay $100 or less in cash for their subsidised hospitalisation bills. To ensure that the scheme remains sustainable and relevant to Singaporeans, the MediShield Life Council has recently proposed enhancements to benefits and adjustments to premiums. Ms Foo Mee Har and Mr Liang Eng Hwa asked about the reasons for the premium increases, while Mr Gerald Giam asked about the assumptions behind the premium pricing. Premiums have been kept unchanged for the first five years of MediShield Life, in line with our earlier public commitment. They need to be adjusted to ensure that the MediShield Life Fund remains solvent and sustainable so that it can meet its obligations to all policyholders. Premiums are priced by actuaries based on established actuarial principles, taking into account claims experience such as utilisation rates and cost of medical treatment, scheme benefits, amongst many other factors. There are three key drivers of the premium increases, which I will now elaborate. Since its launch, MediShield Life has been providing more payouts and greater protection for more Singaporeans. The number of claimants has increased by about 30% and the annual payouts have increased by about 40% over the last four years. Mr Xie Yao Quan asked about the growth in hospital charges over the last 20 years.”
“Mr Speaker, may I have your permission to take Question Nos 7 to 14 together, please?”
“We will need a sustained effort over many years and for all stakeholders to play their part and do so together. We will ensure that Singaporeans will always have access to good quality healthcare that is appropriate and affordable.”
“CHAS Green card was introduced last year and MediShield Life coverage to inpatient hospice care was also introduced in April this year, being part of this overall strategy. Moving Beyond Quality to Value calls for all of us to be better informed and to be more discerning in how we consume healthcare. Are we stretching our healthcare dollars by choosing therapies that are cost-effective and well supported by clinical evidence? So, we established the Agency for Care Effectiveness or ACE to evaluate healthcare technologies and issue guidances on drugs and other technologies to share with both the public and private healthcare sectors. The Agency for Logistics Procurement and Supply or ALPS was set up to aggregate demand and secure better prices for drugs and other supplies, as well as streamline and reduce supply chain costs. We continue to put emphasis on raising productivity and tapping on technology where available. We introduced fee benchmarks for common surgical procedures in November 2018 to guide private sector doctors and healthcare providers in charging appropriately and to enable patients to make better informed healthcare decisions. This complements MOH's annual publication of hospital bill sizes. Both the bill size publication and fee benchmarks are available at the MOH website. Finally, we provide substantial subsidies to cushion the impact of healthcare cost on patients. To help patients pay for the remaining share of their costs, we have MediShield Life and MediSave. For Singaporeans who need extra help, there is MediFund. So, this constitutes our S plus 3M Framework – subsidies plus 3Ms. As I have laid out, while there are measures we can take to manage healthcare cost, there is unfortunately, no silver bullet.”
“For example, manpower costs account for about 60% of healthcare costs. Healthcare workers who do important work, must be appropriately recognised and remunerated. Eventually, increases in manpower cost will translate into higher overall healthcare cost. While these factors are likely to put pressure on healthcare cost, we can work together to moderate the increases to ensure our healthcare system remains affordable and sustainable. Managing healthcare cost has been a key priority of MOH. The three Beyonds – Beyond Healthcare to Health, Beyond Hospital to Community and Beyond Quality to Value – are key strategic planks that guide the transformation of our healthcare system to one that is future-ready and sustainable. By looking after our health, we can avoid or delay the need for healthcare, reduce our healthcare bill, and more importantly, we can enjoy a better quality of life. For example, we declared the War on Diabetes, to get all of us, to not only better manage our chronic conditions, but to also choose healthier meals and more active lifestyles. We enhanced Screen for Life subsidies to encourage Singaporeans to go for regular health screenings, to detect and manage health conditions early. These efforts will help us to live long and live well, and avoid future complications that will require much more costly healthcare services. When we go beyond Hospital to the Community, we ensure that we do not overuse expensive hospital care when we do not need it. We have therefore invested in raising capacity and capability in the primary care and the intermediate and long-term care sectors, so as to provide care that better meet the needs of patients.”
“Mr Speaker, Sir, several factors contribute to healthcare cost increases. First, our population is ageing. Older patients tend to have more co-morbidities and complications, requiring more medical attention, more medications, procedures and longer hospital stays. For example, in 2019, the average stay in our public hospitals for those aged 65 and above was 6.9 days, compared to those who are below 65 where the average stay was about 3.9 days. So, it is almost a doubling of the number of days of stay. Therefore, as we grow older, we are likely to spend more on healthcare. And collectively, as we have increasingly more older persons in our population, our overall expenditure on healthcare will also rise correspondingly. For example, MOH's expenditure on the long-term care sector increased from $296 million to $723 million between 2013 and 2018. Or if you work it out, it is a 20% increase per annum. Second, with medical advancement, new treatments will become available. Previously untreated conditions may now become treatable. Older treatments that were less costly may now be replaced by better but more costly new treatments. These advances can improve life spans and the quality of life, but they come at a price. For example, Total Knee Replacement surgeries have become more prevalent among those aged 65 and above over the last 20 years, rising from 187 patients for every 100,000 people aged 65 and above in 1999, to 499 patients in 2019. That is a 2.7-times increase in the prevalence rate over that time period. Previously, when such procedures – this kind of total knee replacements – were not widely available, elderly suffering from knee conditions would have to bear with poor mobility, which can affect their quality of life. Third, operating costs may increase over time.”
“Mr Speaker, if we look at what will employer be thinking when he wants to interview and employ somebody. The first thing he is asked is: do you have the skills that I need to do the job, and for the skills that you have, what am I prepared to pay you? If we stipulate a Minimum Wage or whatever wage there is, but the employer feels that this is not worth paying for, or if you set the wage too high, he will say, “Well, with this money, I might as well buy a machine to do this job. Because I will amortise this machine over one year, two years, and my return is immeasurable, beyond the ROI". This worker will never get the job if he is priced too high. On the other hand, if you fix the rate too low, but yet the worker does not have the skills to do the job, no matter how low you price the Minimum Wage, I would not employ the person anyway because there is no skills to it. So, that is why in the PWM construct, it is not just a wage ladder – rising wages across a spectrum, but actually, there is a skills ladder that is tied to it so that as the employee gets the skills that justify the productivity, the work output and the work delivery, the wages commensurate with their skills will be paid to the employee. Because the employer will then feel that these jobs that he can do with these skills are justifiable for the wage and costs that I am going to bear for which I can actually be competitive as a business and recover it through my my business. So, it has to go hand-in-hand. It cannot be de-synced from one another. The problem with a Minimum Wage is that it is not connected to any skills ladder. It is a number, and the employer then has to decide if the employee makes the mark or is too costly for him, and that number can fluctuate.”
“I think the process will be something that we want to do now, talk about it, discuss it, work out some schematics. But when can we implement? Obviously, we have to look at the economic situation as well because this will be probably the wrong time to push for increased wage costs onto our SMEs who are already suffering. Why would the PWM structure be less likely to be politicised? Because it has tripartite negotiations. It is not decided politically by one party. The employers naturally will push back as well if what we are proposing for the sector is not sustainable to them, business-wise. If what is being pushed from just a political base would put them out of business and make them non-competitive, there will be a natural push back. Otherwise, if it is just a single number that is decided based on politics, I think this is where the danger of the slippery slope occurs.”
“I think in my speech, I did explain that different sectors have different eco-systems, different kind of skills requirement and therefore different starting pay even for certain lower job roles. And therefore, if at a national level, it is very hard to decide on one number that everyone can agree to as their starting pay. How would that process be to make sure tat there is convergence on one single number – to have the lowest end of a cleaner and a lowest end of a clerical staff – all having the same minimum wage that is acceptable across different industry sectors? So, that is a practical challenge that cannot be overcome so easily with a single Minimum Wage. How do we help the lower wage workers, maybe the 1.7% that we spoke about? I think when we look at this, wage is only one aspect of helping a lower wage worker. Today, with Workfare, we already top up the wages and that is one way of helping them without having to make employers jump through the hoops, without having to make disadvantaged workers that have to do a lot of heavy lifting to get to the Minimum Wage, for example. Bear in mind that this segment of workers, some of them could have disabilities that may not be able to embark on the kind of jobs without Government support to begin with. So, by giving some of these Workfare supplements, we actually top up the kind of wages because otherwise, an employer may not be prepared to employ someone with a certain disability that may not be able to fulfil the full function of the job scope. This is where you will end up leading to dis-employment for a particular segment of vulnerable workers. So, it cannot be a one-size-fits-all because there are different segments of people, different industry demands. How long?”
“Sir, then the simple process is to make sure that the Town Council when you tender contracts, you have a process of evaluating a competitive tender to assess the points of merit surely, unless you are talking about collusion among various vendors for the same project. Otherwise, there has to be somebody who is prepared to price his service or his product competitively and reasonably.”
“Sir, I think the simple answer to that is that in a tripartite PWM model, the wages are pegged to a skills ladder, that can be verified by either a participation in a course or verified through an industry accredited programme. So, with the skills increase, the person would then be justified for wage increase, based on the larger job scope or a more productive outcome in the work delivered.”
“But it also includes people who are technically "employed" but they could be employed in jobs like hawker assistant, helping a family member. They are drawing a salary, but they are happy to be just getting $700 a month helping the father or the mother or something like that, manning a store, for example. How do you legislate a Minimum Wage to say that the father who runs the store, employing the son as as a worker, as an employee, has to add a cost on and mandate it? Those are the challenges when you go down to the bottom. They will be the challenges of implementation. Research, data, all these are good. If I may use Brother Hock Poh's words again, he said "Wo jiak yam bi li jiak bee zuay" or I eat more salt than you eat more rice; "Tak chek jin ho", but "ai zor jin gan kor" or easier said than done. So, his point is this, reams and reams of data and research is good. But in practice, is always harder to do, because there are practical considerations, there are pushbacks. So, that is why a negotiator approach with stakeholders is the most important. In the area of working with our stakeholders, I believe that that is why when we work on the negotiated outcome, there is always that balance that can be struck. Where the businesses are prepared to absorb the cost; if not, they have a way to rationalise how to pass the cost on to the consumers. I am glad to hear that Mr Singh is prepared to also raise the S&CC charges to justify for higher wage cost when we eventually push up the mandatory PWM for the lift and escalator sectors, to make sure that our brothers and sisters in this sector get get paid a fair wage. And I think collectively we ought to socialise Singaporean consumers to the need to up the wages of those at the lower end and demonstrate social solidarity.”
“Mr Speaker, I thank the Leader of the Opposition for some of his clarifications. I must say it is quite easy to propose a Minimum Wage and then when we ask questions about what it is based on and how they will implement it – does it include foreign workers and all – they say, "Government go sort it out". I think if as Brother Hock Poh said, "If it is so easy to do, we would have done it with any long ago". Proposing it for panel of experts to do, do research and studies, that could be one way, but that is actually also what the tripartite partners do. We look at data, but we incorporate the consensus of all the stakeholders including businesses so that they also must be prepared to price this into their business cost and have a way to also socialise it to the consumers. Indeed, as the hon Member said, when there is a wage ladder that goes up or any cost increase for Minimum Wage, this cost will have to be passed to the consumers at some point. So, there has to be a cost implication in the cost impact. The good news of course is that the PWM, as it stands today, applies only to Singaporean local workforce, Singaporean workers. So, wage increases for PWM only benefits Singapore workers. That is why I asked the question about proposing a blanket single Minimum Wage across all sectors, which has to necessarily cover all workers. Because in many developed countries, the concept of a Minimum Wage, as it is applied, includes migrant workers as well. So, I think we have to be careful about what we are saying here, because to buck the norm, to be different, there must be a real strong justification. The data, 1.7% percent of the local workforce, it is not a very clean data because it includes a whole group of people across different job roles.”
“Achieving social equality and enabling lower income families to improve their lives is never a simple task. There is no silver bullet. It is also continuous hard work. NTUC and the tripartite partners will focus on this real hard work of uplifting wages of low-wage workers and seek public support for our workers, while hoping to avoid all the possible downsides. [Applause.]”
“In expanding the PWM, we should also consider studying other approaches to complement the existing PWM efforts, such as setting a sectoral wage benchmark as a first step for companies in sectors where there are currently no regulatory levers to mandate a PWM. The benchmarks would be a good way, a good starting point, a first step towards empowering workers with greater awareness of wages in their own occupations and their sectors. This can be done through leveraging various sources of data that we currently have, such as the Occupational Wage Survey Data. In sectors with a more variegated employment landscape such as Food Services and Retail, sectoral wage benchmarks may help catalyse more companies to embark on uplifting the livelihoods of our lower wage workers. This, of course, in time to come, can evolve into a PWM. The Tripartite Workgroup could also study lower wage occupations that cut across multiple sectors to see how best to help improve their wage prospects. Some job roles, clerical job roles, for example, do not neatly fall into one particular sector and it is horizontal across many sectors. Having employers, Government and union at the same table would enable us to have frank and deep discussions on policy innovations to move the way forward. Mr Speaker, Sir, there is much work to be done to uplift more lower wage workers, many of whom provide essential services for all of us. We should recognise what the Government and the tripartite partners have achieved in providing a genuine uplift for the workforce, especially our lower wage workers, and be willing to adopt new approaches. Indeed, the PWM and Workfare Income Supplement have major new approaches in recent years and we, of course, remain open to new ideas.”
“NTUC will continue our conversations with our tripartite partners via the newly convened tripartite Workgroup on expanding PWM, to ensure that we take into account the concerns of all our stakeholders for a sustainable implementation of the PWMs, even as we work collectively to help ourselves to get out of this economic recession. In the interim, the PWM Mark that was recently introduced by Minister Josephine Teo in Parliament as a potential means of recognising firms that voluntarily pay progressive wages, is something that we welcome. We welcome such ideas as it would enable consumers to choose whether to support progressive-minded firms. While introducing a PWM Mark is a good first step, voluntary schemes on their own may not be attractive enough for companies to come onboard. Government must be prepared to use regulatory levers to help incentivise firms to adopt the PWM Mark, such as requiring companies that access Government schemes or bid for Government contracts to come onboard this voluntary Mark. That way, we can also raise the awareness of consumers and service buyers to price the contracts fairly, and build trust towards eventual mandatory PWM for other sectors. Beyond the lift and escalator PWM becoming mandatory in 2022, NTUC had also submitted a proposal to the Government to form a Tripartite Cluster for the Waste Management Industry to introduce a PWM focusing on the waste collection sub- sectors. We look forward to the Government’s strong support and will work closely with our tripartite partners to bring about better wages, welfare and work prospects for the low-wage workers in this sector.”
“So, perhaps, Mr Singh should also take this chance to explain to Singaporeans what the position of the Workers' Party is when you advocate for Minimum Wage. Now, if businesses cannot bear the resulting cost, is there also a "moral imperative" to help our SMEs? This is a particular pertinent consideration at this time, when we are in a deep COVID-19 crisis. Many companies, especially our SMEs, such as those in the construction sector, are suffering and not quite out of the woods. What is Mr Singh's views on this? I do note that in his Facebook post, the very first line and I quote, "A universal Minimum Wage for the Singaporean worker is not just a moral imperative, it is an act of national solidarity, one that is even more relevant in today's economic environment". I have been listening to some of the speeches of many of the Workers' Party's Members in the House yesterday and today, and I must thank them for sharing the Government's view on improving career coaching, reforming our education, supporting our workers, helping our SMEs. And the Member Jamus Lim's earlier speech talked about supporting SMEs, which I am sure will be welcomed. But if we juxtapose this together with his speech at the last Sitting about raising Minimum Wages, how does it square away? Are we supporting SMEs or are we adding more oil to the fire, so to speak? Perhaps it will be better explained in Chinese, we call it 雪上加霜. With the companies in a deep economic freeze now or economic recession, is what is being proposed by the Workers' Party – raising wages through a Minimum Wage legislation – going to add more frost to the snow in companies in deep winter right now? Mr Speaker, Sir, I seek the support of this House for us to continue to push for PWM.”
“And the jobs of our more vulnerable sisters and brothers in these sectors will be threatened with the risk of unemployment. So, I am not so much concerned by what Mr Singh and the Workers' Party is proposing for now, but what it portends for the future – the possibility of a political auction that will price out our lower skilled workers, our brothers and sisters, and disadvantage our smaller enterprises, our SMEs. This is not an academic issue. We are seeing this kind of political processes, this political auction, happening in other countries. What is a better way? At NTUC, we believe the PWM is one way of doing so. Under PWM, we can engage the different stakeholders of each industry, work out how to address their concerns and challenges, and arrive at a consensus with a basis that they can all actively support. With this sectoral tripartite consensus building approach, it is much less likely for a political auction to happen. We can and should do more to help the lowest paid in our society but we must go about doing it in a way that ensures the upside while minimising the downsides. The cure surely should not be worse than the problem it tries to solve. A third complication, and this is a major one, is the question of migrant workers. In most developed countries, the legal Minimum Wage applies to all workers including migrant workers. If the Minimum Wage is driven simply by a "moral imperative", then the natural question to ask is whether it should include non-Singaporeans such as migrant workers, including our foreign domestic workers. I do see an online petition going on now in the honour of Mr Singh's name, with all the text he put into his Facebook on the page calling for people to petition to support Minimum Wage for foreign domestic workers as well.”
“There must be a basis for setting the Minimum Wage that reflects the realities of each sector, including the profile of the low-wage worker sin that that particular sector so that it is sustainable, it benefits them and it avoids any unintended costs. Veteran union leaders with long experience on the ground understand the importance of working this out and arriving at the tripartite consensus, so that “low wage” does not inadvertently become “no wage”. If I may share what my good brother in the unions, Brother Toh Hock Poh, will always say when it comes to complex issues, "Ah nay kan duah, wa nang za teo zoh liow, ko tan li la kong" in Hokkien. Sir, if you do not mind I have to do this to justify the charisma of Brother Toh Hock Poh and show his charisma – what it means is; "If it was so simple, we would done it long go." So, a single Minimum Wage is no panacea. The second risk – with a single blanket Minimum Wage is the inevitable politicisation of wage setting. What do I mean? Today, let us say we can all agree to $1,300 Minimum Wage proposed by the Workers' Party, a “moral imperative” as Mr Singh puts it in his recent Facebook post. But what next? What happens next? How will this number change from this year to the next and on what basis? In a political contest, a political party will surely come along and say, "Well, $1,500 will reflect higher 'moral imperatives'". Yet another will come along and say, "$1,300 is good; $1,500 is better, but $1,700 must surely be more 'divine' moral imperatives". It can become a political auction. When this process, this political auction gathers momentum and becomes detached from market realities, the Minimum Wage escalates beyond what employers are able to pay.”
“But there are actually risks to jumping onto this single blanket minimum wage. First, there is the question of its effectiveness in helping our lowest skilled and most vulnerable workers and not inadvertently putting them at a disadvantage. It is difficult to find the right a single minimum wage for all sectors. If it is not set too low, then the benefit to workers in many sectors will be limited and defeats the purpose of having a minimum wage in the first place. For example, the starting salary for a cleaner in Town Councils today under the mandatory PWM is already $1,442. With overtime pay, Workfare Income Supplement and Annual Wage Supplement or bonuses, this would be much higher than the $1,300 a month that the Workers' Party proposes as a minimum wage. Indeed, because of the mandatory PWM, the Workers' Party Town Councils' cleaners are being paid based on the PWM and not based on their Minimum Wage! But if the Minimum Wage is set too high, then businesses especially the SMEs, cannot afford to pay. They will have to pass the costs on to consumers if they are able to or cut back on employment of workers of lower educational standards or skills, or, in the worse case scenario, go out of business. In an ideal world, of course, a high Minimum Wage will force industries to invest more in technology, invest in items that can raise the productivity and favour the most efficient firms without lowering overall employment. But in practice there will be winners and losers and it is our SMEs who are the most vulnerable and our most vulnerable workers will also be at risk of losing out. Sir, we all want to help low-wage workers to earn more. But in practice it is difficult to arbitrarily prescribe a single higher salary for all sectors and all industries.”
“According to MOM, the residual number of low-wage workers who earn below $1,300 is about 100,000 workers. About a quarter of them actually are self-employed so they would not have benefited from any minimum wage, to begin with. With Workfare and employer's CPF contribution included, only about 56,000 across a variety of job roles earn less than $1,300. Of these, only about 32,000 are full-time employees. So, what the Workers' Party wants to achieve with the proposed minimum wage of $1,300 a month, we have already achieved through PWM and many other policy measures, such as Workfare Income Supplement. With this latest tripartite move, we will further reduce this number. We have, in fact, actually made tremendous strides over the decades. But as I said, it is still unfinished business. The Workers' Party have called for a Minimum Wage of $1,300 a month to be applied across all sectors, as a quick way to cover everyone else. As I have just highlighted, this is a very small number of 32,000 to over 50,000-over, about 1.7% of our local workforce. Let me state that we are not ideologically against a minimum wage. In fact, the first rung of the wage ladder in the PWM is a form of sectoral minimum wage. Senior Minister Tharman has also called the PWM a “Minimum Wage Plus” – Minimum Wage plus a ladder for wage increase through upskilling. So, the idea of having some form of a minimum wage is not new and we share the same objective to uplift the incomes of low-wage workers. Where we differ though is the approach to getting there. All programmes and policies have pros and cons and so too a single blanket minimum wage. Its appeal is that it is seemingly a quick way to raise the wages of workers who have to benefit from PWM – and maybe many other initiatives.”
“Bus drivers’ salaries jumped by more than 20% since 2015 with the new bus financing framework supported by the labour movement and National Transport Workers’ Union or NTWU. In the last five years or so, we have pushed hard on our ITM efforts as well. This brought together tripartite partners integrating skills upgrading together with business transformation, productivity enhancement and innovation to catalyse change as a whole of eco-system to also create better jobs and better job prospects for our workers. Raising the income of our less skilled and low-wage workers is, therefore, a holistic and a continuous effort. Through Workfare, the PWM and our efforts involving various stakeholders to boost skills and productivity in every sector, we are demonstrating exactly what Mdm Halimah spoke about in social solidarity. Our low-wage workers get an uplift in incomes through Workfare, supported by our taxes through the PWM and by productivity improvements. The upshot is that we can achieve higher incomes for low-wage workers without putting their employment at risk and minimising cost increases for our consumers. How about the coverage of PWM? The Government has committed to working with its tripartite partners to extend the PWM to all sectors in a manner that is appropriate to each and every sector's unique conditions. I should point out also that the PWM in the existing sectors have also helped lift wages in the other non-PWM sectors as well. If we look at the occupations that are traditionally deemed as comprising workers with lower income – clerical support, service staff, tradesmen, operators, cleaners, labourers – there are, perhaps, about slightly over 850,000 workers doing these jobs in Singapore. The vast majority of them actually earn above $1,300 a month.”
“This was a big lift and faster than for those higher up on the wage ladder. It has also helped moderate income inequality in Singapore which is now at its narrowest in almost 20 years. The Gini coefficient calculated using the widely used OECD methodology, fell to 0.35 in 2019 after accounting for Government transfers such as Workfare Income Supplement. All these did not happen just by itself. It is not by chance. It was brought about by sound economic policies, and the tripartite partners working actively to intervene to support workers. We implemented the “Triple Uplift” formula comprising the PWM, Workfare Income Supplement or WIS, and the National Wage Council or NWC recommendations. The PWM lifted the wages of close to 80,000 cleaners, security officers and landscape workers. Their wages have increased by 30% in real terms in recent years without the loss of jobs. The PWM also enables them to climb the skills-ladder, improving their future employability and their wage progression at the same time. This has been a significant achievement because the workers in these sectors tend to be older or with limited education and, therefore, are at a higher risk of this employment. It required very involved negotiations and firms, companies have to undertake changes of many of their practices to do so. Workfare is another significant intervention. It acts like a form of negative income tax. The Government tops up the income of our workers earning less than $2,300 per month. There are many other efforts, all part of the on-going task of uplifting our workers. Skills upgrading and job placement efforts by the NTUC's Employment and Employability Institute or e2i, working with Government agencies help many workers access better jobs, better pay and better job prospects.”
“Mr Speaker, Sir, during the Debate on the President’s Address recently, I spoke as Deputy Secretary-General of the NTUC and urged the tripartite partners to come together to conduct an in-depth study on the implementation of the Progressive Wage Model, or PWM, across more sectors, so that we can move faster in this aspect when the economy recovers post-COVID-19. Various Labour Members of Parliament – from former Secretary-General Lim Swee Say to former Parliamentary colleague Mr Zainal Sapari – have in their Parliamentary speeches over the many years also push for a faster and wider implementation of the PWM. Hence, NTUC welcomes the announcement to form a Tripartite Workgroup for Low-wage Workers to take concrete actions on this very important agenda. Uplifting lower income Singaporeans have been a core mission of the PAP Government right from the outset. The PAP was born from the unions in the 1950s. Taking care of our workers has been a critical part of our DNA as a party. We have achieved what few have done over the last six decades, but the task is never finished. It is something that we must and will keep working on. Under the PAP Government and with the support from the Labour Movement, the lives of millions of Singaporeans have been greatly improved: more than 90% of Singaporeans own their homes; our children get much better education; we invested in upgrading skills of our people so that they can stay employed and improve in their careers even as our economy transforms through the decades. We have made significant progress in the past 10 years. The wages of workers at the lowest 20th percentile have increased by 24% in real terms in the last five years and by 39% over the last 10 years.”