Lily Neo
Singapore
“Thank you, Mr Speaker. May I ask Minister for Health on MOH's capacity in coping with serious cases of COVID-19 in terms of adequacy in respirators and in our ICU beds. Am I correct to say that already half of NCID's ICUs are taken up? What will happen when it reaches its full capacity?”
“But even so, with the right measures of social and medical assistance in place to assist them with their daily living, they can still age gracefully in the comfort of their own homes.”
“Thank you, Mr Chairman. Yes, I will keep it short. Minister earlier said that MSF will proactively reach out to families in HDB rental homes to assist them, to possibly buy their own HDB flats. Many of these families lamented that they cannot afford it. How does the Minister plan to do it?”
“Thank you, Mr Chairman. May I ask the Minister whether there is a possibility of more widespread community spread of COVID-19? And will MOH be able to cope with this? And whether does our Government have more specific measures in place to cope with this scenario?”
“Thank you, Mr Chairman. Earlier in my speech, I asked whether there are assessments by HDB for applicants of Joint Singles Scheme (JSS) to ensure that they are free from mental illnesses and medical conditions before compelling them to stay together.”
“Many of them have lived in rental housing for more than six years and some more than 10 years. Thus, there are signs of entrenchment. What are the schemes in place and the success rate of such schemes, to assist them in looking for better options in their housing needs and to help them get out of their predicaments?”
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“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn. The sum of $1,950,477,220 for Head O ordered to stand part of the Main Estimates. The sum of $1,593,924,500 for Head O ordered to stand part of the Development Estimates.”
“Sir, I beg to move, That the sum to be allocated for Head O of the Main Estimates be reduced by $10 in respect of Code OE 3100. Sir, a recent World Health Organisation report said that depression is poised to become the second largest cause of disability worldwide after heart disease by 2020. Close to one in 10 Singaporeans suffers from depression or anxiety that is bad enough to affect his everyday tasks, such as going to work and interacting with family members. This is probably the tip of the iceberg as the stigma attached to mental conditions stops people acknowledging the conditions and seeking medical help. In Singapore, a study in 1998 showed that 9.3% of adults suffered from anxiety disorders and 7.8% suffered from depression. This incidence must have increased lately with the economic downturn and the record high unemployment in Singapore. Anxiety disorder is a condition where sufferers are excessively worried about everything all the time. Depression sufferers feel a deep sadness and lose interest, sleep and appetite for prolonged periods. Those who are depressed are often dismissed by family members as attention seekers and they are often misdiagnosed because they tend to complain to doctors about physical pains, like backache and headache, instead of saying what they really feel. Other depression cases seek treatment in hospitals; frequently doctor-hopping from one specialist to another and thus wasting a lot of personnel and public resources. Sir, may I ask the Ministry of Health whether it is about time we have more public awareness on mental illness? And what are the preventive measures taken to cushion this impending disability problem?”
“I am glad he changed his tune. I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, can I clarify? I have never suggested that we should give rewards to blood donors. In fact, it was the Ministry's policy all along. Why should the Minister of State now accuse me of suggesting this?”
“Sir, Singapore's birth rate today has sunk to a historic low of 1.42, way below the required replacement rate of 2.1. It has been reported that one in five married couples in Singapore now finds it difficult to conceive. The 20% figure shows Singapore moving into the upper end of infertility rate in the developed countries, which ranges between 15-25%. The infertility rate here has risen steadily since the early 1980s when it stood at around 10%. The best productive age for men and women is in their 20s and early 30s, but more men and women are postponing marriage and procreation. The reasons are varied, and they include the emphasis on careers, choice of lifestyles and economic considerations. Couples seeking fertility treatment often undergo a lot of anguish and stress, physically, mentally as well as financially. I feel that more help should be rendered by the Ministry of Health to such couples. Apart from raising the amount of Medisave that can be used, could the limit of three treatment cycles be further increased because fertility treatments are often costly? Would the Minister for Health consider subsidising fertility procedures and drugs to ease the burden for patients at all fertility clinics in the public hospitals? Sir, is the Ministry of Health doing anything with regard to our low birth rate? Should there be more public awareness raised with regard to the various aspects of reproduction, highlighting especially the marital aspects that are detrimental and other aspects that are favourable to procreation?”
“Sir, I beg to move, That the sum to be allocated for Head O of the Main Estimates be reduced by $10 in respect of Code OD 3600. Sir, last year, the Health Sciences Authority changed the blood donor recognition programme for all new blood donors with effect from 1st July 2002. This ruling removed the scheme that subsidises certain consultations, hospitalisation and day surgery charges for regular donors. For example, if hospitalised, there is a 50% discount on ward and meal charges for up to $200 per day. Also, all consultations at polyclinics are free. I believe this costs the Government about $1.7 million each year. The Health Sciences Authority said that the discount system was stopped to ensure that donation is truly altruistic. Nonetheless, this ruling has now created two groups of donors - the old donor group that is still enjoying the discount system and a disadvantaged new group that does not. Sir, may I ask the Ministry of Health whether other methods of encouraging altruism could have been adopted rather than taking away the discount system? May I also ask whether this ruling has caused a decrease in the number of new donors? Will this ruling further exaggerate the perpetual shortage in our blood bank.”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, may I ask the Minister of State about non-traditional source doctors. He said earlier that those doctors who showed poor performance and poor command of English had been sent back. May I ask him whether it was fair to have subjected our patients to their care before they were sent back? On mammograms, could I ask the Minister of State whether the Ministry of Health will consider waiving the charges for retests for the less well-off women?”
“Sir, 1 in 4 pregnancies, or 14,000 babies get aborted each year, and almost 60% of these abortions were sought by married women. The reasons given by these women were that they were not ready to start a family, or they did not want to have more children. Would the Ministry of Health consider introducing innovative ideas aimed at reducing our abortion rates? We should certainly have more programmes to teach the various methods of contraception, the responsibility of contraception and the trauma of abortion, targeting especially the married women. Married women should be persuaded to practise contraception rather than resort to abortion as a means of contraception. Could there be even more counselling mandated at the crucial time of decision making? I feel that it is time that we looked into giving these women more genuine alternatives, such as less complicated adoption choices for those who really cannot afford to have more children, and match nanny-services for working mothers to rely on. Teenage abortions are on the increase. Is our sex education in schools adequate? Are our teachers comfortable in imparting sex education to our students? Is there enough emphasis on responsible and safe sex and on the negative impact of unwanted pregnancies, especially the physical and psychological risks? Should there be more support given to teenage pregnancies? Could the Ministry of Health consider studying abortion trauma, which is not much documented?”
“I will proceed to my next cut on breast cancer. Sir, I applaud the mammogram subsidy scheme for breast cancer by the Health Promotion Board. This scheme has been a great success in attracting a big jump in the number of women going for mammograms. However, due to the increased demand, the women have to wait much longer, almost one month, for the results of the mammogram. Sir, I am concerned, especially for those women who were told that they needed to go for a retest. There were 3,500 such women last year, as they had to wait a further six weeks for their results. The long wait, especially after retest, gave the women much mental anguish and anxiety from the suspense of whether they had breast cancer. Although the second test proved to be unnecessary for hundreds of them, they were recalled because the radiologist preferred to play safe. Last year, 8% of the women tested were recalled and all of them had to pay for the retest, and many of the less well-off found the extra cost to be a burden. May I ask the Minister for Health whether our public test centres are able to cope with the demand for mammograms? Do we have enough radiologists? What are the steps taken to minimise errors of interpretation? Could the waiting period be reduced? Why are our post-positive rates for mammograms so high? Would the Minister consider further outsourcing of mammograms to the private sector in order to tap the under-utilised private radiological centres and their radiologists?”
“Thank you. The Ministry currently has a Health Manpower Development Programme (HMDP) to develop skills needed in specific areas of the healthcare industry. Mr Yeo Guat Kwang understands that the Ministry plans to extend the programme to providing training for staff providing step-down care services. Mr Yeo Guat Kwang would like to ask the Ministry how much will be set aside and how many training places will be provided. At the same time, Mr Yeo Guat Kwang would like to ask the Ministry, not just to provide funding, but also to provide a comprehensive training support system of assessments and monitoring for those trained to provide step-down care services. The Ministry should also consider training those without previous relevant background, but who may be keen to enter into this sector.”
“Has the Ministry of Health collected data on mishaps and mistakes in public hospitals because of poor standards of care? Has there been a survey done on the causes of mistakes in the public hospitals? Is there an assessment done for the non-traditional source doctors employed from the neighbouring countries? Is there a comparison and assessment on the standards of the non-traditional sources doctors employed from each of the neighbouring countries? Sir, may I have your permission to take the cut on behalf of Mr Yeo Guat Kwang on training support for step-down services?”
“Sir, I beg to move, That the sum to be allocated for Head O of the Main Estimates be reduced by $10 in respect of Code OA 1500. Sir, in January this year, it was reported in the Straits Times that a doctor was jailed for two months for tax evasion by the Courts and suspended from practice for six months by the Singapore Medical Council. And, in February, a second case was reported. Again, the doctor was jailed by the Courts and suspended from practice for six months by the Singapore Medical Council. Both doctors were ordered to pay penalties of over three times the amount of unpaid taxes by the Courts. The doctors in both instances were rightly punished by the Courts for their offences but they were also penalised by the Singapore Medical Council. May I have the Minister for Health's comments on this kind of "double punishment"? Is the suspension by the Singapore Medical Council, especially the six months, not too harsh? As medical care is a very personalised service and patients under the doctors' care would be affected by the suspensions, do we take into consideration the patients' needs? Rather than suspension from practice, would it not be better to deploy them to work without pay in our public hospitals, community hospitals or VWOs? 5.45 pm Sir, the Ministry of Health has been recruiting doctors from non-traditional sources from neighbouring countries such as Myanmar whose medical degrees were recognised before. According to the Ministry of Health, this was done because there has been a shortage of junior doctors in the public hospitals. May I ask the Minister for Health whether he can assure the House that the standard of care of patients from these doctors is acceptable?”
“Sir, I would like to thank the Minister of State for his answers. I would like to thank the Minister for Health for his good, comprehensive answers and, at times, even over-generous answers. Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, the health of workers is a key factor in influencing their productivity. As the economy of Singapore is heavily dependent on its workforce, a healthy workforce will enhance the country's competitiveness in an increasingly global market. With about 2.1 million or 65% of Singaporeans aged 15 years or more working, the workplace is an ideal setting for the development and delivery of health promotion programmes to the workers. Workplace health promotion programmes should include a combination of educational, organisational and environmental activities designed to support behaviour that is conducive to the health of employees. Would the Ministry of Health help strategise the uptake of workplace health promotion in the private sector with the following four emphasis: 1) As management remains the main driver behind these programmes, there is need, therefore, to secure the support of a company's management with the provision of adequate support of the administrators or health facilitators, preferably facilitators with a healthcare background; 2) There should be an expansion of the local scope of occupational health and safety to include the promotion of workers' health through healthy living; 3) Financial assistance in the form of grants would be of value to help jumpstart health promotion programmes, particularly for small workplaces; and 4) Have in place guidelines on how to organise effective workplace health promotion programmes for workplaces of different workforce and industry sector to adopt. This "cookbook" approach has a place in increasing the uptake, particularly among new companies embracing the programme.”
“Thank you. Sir, on biomedical research, Singapore is continuing to drive for excellence in biomedical research and development. Whilst this holds the promise of tremendous advantages for mankind, especially in finding new treatments for diseases and promises of vast monetary benefits in a new economy, we must be sensitive to the ethical, legal and social issues in this area, especially in our multi-cultural and multi-religious society. What has the Ministry of Health done to ensure proper conduct in the various aspects of research, especially in clinical trials and human stem research? Are patients and donors able to make voluntary and informed choices? Are there guidelines in place to ensure that donors of research are not under any financial, or therapeutic inducements, or coercions for their donations? What is the Ministry of Health's stand on human cloning? Does the Ministry of Health specify the distinction between surplus embryos and research embryos and the protection of human embryos because there is contention that human life begins from the moment of conception? How do we ensure protection of the human embryo against the scientific value of research embryos and the potential benefits to be reaped from research? Presently, there is no comprehensive legal framework in Singapore governing research on human embryos, except for guidelines, namely, the "Guidelines for Private Healthcare Institution Providing Assisted Reproductive Services". Should not such research be effectively and efficiently monitored and regulated?”
“What has the Ministry done to improve our system to ensure that no adulterated drugs are sold? Has the Health Sciences Authority been more proactive in the surveillance of the available drugs sold over the counter? Should I go on to my next cut, Sir?”
“Thank you, Minister, for the assurance. Sir, in year 2000, the Health Ministry here set up a Group Purchasing Office to buy drugs in bulk at better prices for the entire public sector. This led to savings of $12 million a year, despite the fact that it bought only roughly 700 essential drugs this way. Hospitals and polyclinics bought other non-standard drugs themselves from drug companies. This has resulted in differences in the selling prices for certain drugs at the various public hospitals and polyclinics. May I ask the Minister why the Group Purchasing Office could not extend its service to include buying all drugs for the public institutions? Now that the Government has involved the private sector in the care of subsidised needy patients as in the Primary Care Partnership Scheme, why has this scheme not been extended to include the private sector to save patients' medicine costs? Sir, last year, the liver damaging drug "Slim 10" was brought into Singapore and sold as Chinese proprietary medicine. Chinese proprietary medicines and health supplements were sold over the counter products that could be purchased without prescription. This contrasts with western medicines that are stringently evaluated by the Health Sciences Authority for their quality, safety and efficacy before marketing is granted. "Slim 10" has caused two persons to suffer from liver failure and one person to die from liver failure. What has the Ministry of Health done to-date to prevent such repeat incidents? As most consumers are trusting the local system that the Government has in place to ensure that products available for sale are safe for consumption, are there now more stringent marketing regulations for Chinese proprietary medicines and health supplements?”
“In other words, this means-testing is based on the total income of older family members divided by the number of members in the family. This means-testing is thus unfavourable to small families and will be felt by even more people in time to come, because the trend has been tending towards smaller units of families. Often times, it is difficult to get information on income from all the members of a family, and many elderly fail to get subsidy because of this. Other times, family members of applicants are not willing or unable to submit their documents for a variety of reasons, such as confidentiality or self-employed situations. Would the Ministry of Health further refine this method of subsidy in view of these factors? 4.15 pm The subsidies are only given to those with less than $1,000 per capita family income. Would the Ministry of Health raise this cut-off point so that more elderly can qualify? May I also ask whether there will be a centralised government-run "means-testing" agency to facilitate and expedite applications and services?”
“Sir, 99 patients, or 11%, of the 924 patients admitted to St Luke's Community Hospital in 2000 had to be re-admitted to a general acute hospital within one week. Fifteen died after their return. Another four died before re-admission. These deaths were attributed to early discharge of unstable patients from acute hospitals to St Luke's Community Hospital. It was believed that the medical problems these patients had were not adequately worked out before their discharge from the acute hospitals. Sir, our community hospitals cannot and should not be expected to provide the level of care available in the acute hospitals and, therefore, there should be more caution on discharging patients. Has the Ministry of Health done any surveys on this? What has the Ministry done to improve this situation? With casemix in force, when hospitals are reimbursed on the diagnosis of medical conditions of patients and not on the length of stay, are doctors under pressure to discharge patients even earlier and, thus, exacerbating this problem? Sir, patients in the subsidised wards in the public hospitals now have to pay full price once the doctors certify them as ready to be discharged. But many patients, especially the older ones, may still consider themselves as not fit to be discharged, and also may not be able to leave the hospitals for various reasons. Are they not penalised unduly? With casemix, will there be more patients subjected to this type of discharge? Sir, on my next cut on nursing homes, the Ministry of Health has introduced means-testing to decide on the subsidy to be given to patients in nursing homes, based on a person's per capita family income.”
“Sir, I want to clarify that I did not mention anything on stents or the price of stents which the Minister gave the answer to. Sir, on my cut on doctors, in June last year, strict new limits on work hours for American medical residents were imposed by the American Accreditation Council for Graduate Medical Education. It said that up to 120-hour work-weeks were harmful to young doctors and could endanger patient care. In America, thousands of people die annually from medical mistakes. Under the new rules, the normal resident work-week would be limited to 80 hours. The standards also imposed mandatory rest periods of 10 hours between shifts, one day a week off, restrictions on moonlighting, and close faculty supervision. It was reported in the Straits Times four months ago that junior doctors here work on a 34-hour shift. May I ask the Minister if such long shifts are not affecting their concentration and standard of patient care? Are our junior doctors not subjected to long, unhealthy work-weeks? Morale has been low among junior doctors for many years. Lately, there had been another issue contributing to this. It seems that there was favoured-treatment of Singaporean medical graduates from overseas, as compared to locally-graduated doctors serving under bonds. Could the Minister enlighten us on this? Sir, there is a need to pay attention to the training of our junior doctors to ensure the competency of future generations of our healthcare providers. May I ask the Minister for Health what steps have been taken to ensure this? May I also ask whether our hospital doctors are too preoccupied with daily routines that require them to manage maximal numbers of patients and leave the seniors with little or no time to teach the juniors who, in turn, have no time to be trained?”
“Sir, Primary Care Partnership Scheme (PCPS) is a scheme set up to provide outpatient medical services at polyclinic rates for those who are 65 years and above and have a per capita income of $700 per month or less. May I ask the Minister whether it is correct to say that, to-date, only 50%, or thereabouts, of those eligible have registered for this scheme and, that being the case, is his Ministry planning to better promote this scheme in order to benefit the rest of those who are eligible? May I ask the Minister why is there restriction on the type of medical conditions that can be treated under the scheme? I find it odd that chronic diseases, such as hypertension and diabetes, are not eligible for the scheme as it is chronic diseases like these that are more prevalent in the elderly. They are the ones that most crucially call for good treatment and follow-up to prevent the complications which usually require hospitalisation and incur higher healthcare costs. Allowing patients with chronic diseases to be cared for under this scheme will provide more convenience, better compliance and the achievement of secondary and tertiary prevention of illnesses and problems. I believe that the resultant cost need not be much higher than by limiting such treatment at polyclinics. The price of medicines can be pegged to polyclinic rates.”
“Are doctors under pressure to discharge patients earlier to make more C class beds available? Are patients sent home or transferred to the community hospitals prematurely? Is there a system in place to monitor and check on this possible unfavourable outcome, because C class wards in hospitals are bursting at the seams? Sir, may I ask the Ministry of Health on another issue, and that is, what are the extra cautions that have been taken by our hospitals with regard to the latest highly contagious atypical pneumonia, which had been given a new name of Severe Acute Respiratory Syndrome (SARS)? It has been reported that some of our hospital providers who looked after the patients with SARS had been infected. May I ask how many of our healthcare providers were affected? Is there special care given to those hospital providers exposed to the infection, but have not shown any symptoms? Is the Ministry of Health taking extra emergency steps to control the spread of SARS, especially in our hospitals, and safeguard our doctors, nurses and other patients? What has the Ministry done to better inform the public of SARS? Is there any collaboration with other Ministries to better contain the spread of the disease? Is the Ministry of Health taking extra effort to identify the causative agent of SARS?”
“Sir, I beg to move, That the total sum to be allocated for Head O of the Main Estimates be reduced by $100. Sir, the demand in our hospital services can be over-prescribed by the suppliers themselves. By setting our public hospitals into two clusters, it has been noted that each cluster has taken more efforts to publicise and woo as many referrals and patients to their respective clusters. In other words, they are trying to outdo each other. Is this not creating unhealthy demands on our healthcare system? Sir, as consumers cannot exercise their sovereignty in purchasing the appropriate amount and level of medical care in most cases, they are invariably dependent on the expert judgement of the providers. Are our hospitals and doctors incentivised to effect higher demands for our healthcare services? Should our healthcare providers not be subjected to the ethical codes of conduct and to the audit of an effective watchdog body with a system of checks and balances? Sir, due to the economic downturn, C class hospital wards are in great demand as patients opt for the cheapest beds to save medical cost. Of late, our hospitals have frequently run out of these highly subsidised beds and have been temporarily putting patients up in a higher class ward while waiting for C class beds to become available. Thus, may I ask the Minister for Health whether there should be a further revision upwards on the availability of C class beds, which should form 18% of all hospital beds provided, by the year 2010, according to the White Paper on Affordable Healthcare? Have we achieved the 18% target yet? In view of the higher demand for C class wards, are hospitals deploying more personnel, nurses and doctors to cope with this increased demand?”
“Thank you, Sir. The Inland Revenue Authority of Singapore (IRAS) collected about $83.5 million in estate duty last year and this accounted for less than 0.5% of all taxes collected. Estate duty usually adds to the pain suffered by mourning families. While grieving from the loss of their loved ones, they also have to cope with the hardship created by the seizing of assets until the members have raised the cash to pay for the estate duty, including interest on late payment also. Estate duty penalises the frugal who have passed wealth on to their children, thus having the effect of reducing the incentive to save and invest. A lot of time and effort are spent evolving schemes to legally avoid estate duty by transferring wealth outside Singapore to countries, like Malaysia, Australia and India, where estate duties have been abolished. Sir, as the amount raised by taxation is very small compared to other forms of revenue, would the Ministry of Finance consider abolishing estate duty? Abolishing estate duty will not only attract foreign investments but also encourage hard work, saving habit and also strengthen our family values.”
“The complainants felt this was distasteful and unethical. Sir, the concerns arising from relaxing advertisement locally by individuals will be the creation of unhealthy demands for certain services by locals rather than attracting foreign patients. The possibility of boosting unnecessary local consumption and over zealous advertisements may also mislead the public. Liberalising advertisments locally may degenerate into enticement or persuasion of the public to use medical services for maximising profits of the doctor. Sir, I do hope that the Finance Minister would consider my suggestions on making Singapore the regional hub for healthcare. EXEMPTED BUSINESS (Motion) Resolved, That the debate on the Budget Statement be proceeded with beyond 4.30 pm and the proceedings thereon be exempted at this day's sitting from the provisions of Standing Order No. 1. - [Mr Mah Bow Tan]. ANNUAL BUDGET STATEMENT Debate resumed. 3.40 pm”
“Innovative packaging with other products such as insurance, travel arrangements, hotel and shopping needs should be facilitated to make it more attractive for consumers to come here. The various service sectors will no doubt benefit when the consumers decide to come. A coordinating body that plans and complements the different services to meet the needs of end-users in a mutually consistent way should be formed. Sir, while I am supportive of most of the Economic Review Committee's recommendations on promoting Singapore as the regional medical hub, I do have a differing view on their recommendation on reviewing the regulations in the Public Hospitals and Medical Clinics Act, with a view to relax restrictions on responsible institution-based advertising locally and abroad. Sir, ethical issues have always been of paramount importance in the conduct of our medical profession, especially with regard to advertising or medical services. There is already provision for limited and responsible advertisement locally by individuals and an even wider provision for public institutions. Advertising abroad is restricted by the enacted laws of the foreign countries, thus forbidding others to advertise in their countries. The gamma-knife incident a year ago is a good case in point. The Malaysian doctors viewed the promotion of this new modality to a group of doctors and the public in Kuala Lumpur by a Singaporean doctor to be ethically unacceptable and indeed lodged a complaint to the Singapore Medical Council. Indeed, there were formal complaints lodged with the Singapore Medical Association in the past by neighbouring medical associations that Singapore doctors and private hospitals advertised their medical services in the newspapers and the Yellow Pages of the neighbouring countries.”
“Research activities on the world-wide prevalent diseases should be expanded expeditiously. One good example is the research on prevention, early diagnosis and drug therapies to combat coronary heart diseases. Sir, in order for Singapore to remain competitive, we need to pay attention to the training of the future generation of our healthcare providers. Only by continuing to invest heavily on our undergraduate and postgraduate medical education will we ensure that our doctors will be competent and conversant with the new developments in medical sciences. Thus, our investments on the Health Manpower Development Programme ought to be enhanced. The learning of medicine is an apprenticeship; one cannot be a good doctor just by reading textbooks. We must encourage those who are willing to teach and those who are willing to learn by providing them with the opportunities. Sir, it is worthwhile to include the extension of the service hub to become a training hub, as this will boost our aim of being a medical hub in the region. This will have the effect of promoting collaboration with doctors in the neighbouring countries and of gaining their acceptance of us. Training is a great professional relationship creator. The goodwill and mentorship will continue long after the training period is over. Word of mouth is the most effective form of advertisement of our medical capabilities. It would be far more effective than any advertisement campaign, which might earn the wrath of the authorities in our neighbours. There is also a need for the public sector to involve the private sector as partners of the training and service hub. Only then could we have optimised our strengths as a medical hub in the region.”
“Other areas worth considering should include offering incentives and recognition to healthcare professionals, strengthening international professional associations and enhancing networking with regional healthcare providers. China is a country with a huge potential demand for healthcare services and is a new market that needs our immediate attention. Sir, in order to have the upper edge, there is a need for innovations and an ability to predict future trends. For example, with the trend towards an ageing population, there will be an increase in the incidence of chronic diseases. Thus, a greater focus on strategies in eldercare and health promotion as well as development of treatments for chronic diseases should be encouraged. A good example would be the recent improved surgical procedure by our local doctors on reshaping the heart to give patients with chronic heart failure a new lease of life. For nearly two-thirds of patients who are waiting, often in vain, for a new heart, this new procedure is a solution. This procedure costs a third of the price of a heart transplant and thus gives us the extra advantage with regard to foreign patients. Sir, our "research culture" had not been great and "clinical research", especially, was never the emphasis. Our public hospitals' priorities are driven by maximising immediate returns. Clinicians, especially the specialists, are incentivised to treat as many patients as possible; they become too preoccupied with the routines and are required to tend to maximal numbers of patients. That leaves them with little or no time to teach the juniors, let alone spend time on research. A lot of changes at our institutions are required to promote, identify and support the different aspects of clinical research.”
“In this respect, I applaud the Economic Review Committee's recommendation to ensure adequate supply of land at institutional rates for medical hub developments. Singapore may have lost the edge to Malaysia and Thailand for many low-end medical treatments and Singapore should aim for high-end medical treatments such as transplant surgery, complex heart surgery and other complicated or advanced surgeries. There must be concerted efforts by service providers to contain and keep healthcare prices more competitive. Sir, I feel that integration of the private and public sectors is the way forward to maximise our resource pool, to have better economies of scale, to contain costs and to avoid duplication of services. Sir, there is a need for mindset change here by the Government to treat these two sectors as one entity to achieve our aim of being competitive globally. I therefore welcome the Economic Review Committee's recommendations on the establishment of a responsible healthcare consumer forum for greater transparency on pricing and clinical practice norms and the introduction, selectively, of subvented healthcare at private facilities to help generate economies of scale in the private sector and enable them to provide more cost-competitive services. Sir, Singapore has a very good reputation as a centre of medical excellence and our healthcare professionals are recognised for their high quality and efficiency. We need to have more structured aggressive marketing of this fact. Both the private and public sectors must undertake this in a coordinated manner. Remembering that there is increasing protectionism of local healthcare services in other countries, joint-ventures with reputable big names within the region to form strategic alliances may be necessary.”
“Sir, the real reasons for our inevitable rising healthcare costs are the increasing expectations of patients, the Government's assurance that our public healthcare system is the best, the demographic variables of population growth and age structure, the changing epidemiological patterns of diseases with a shift towards chronic degenerative conditions requiring intensive and longer-term care and the rapid advances of complex capital-intensive technology. On the point of perception of inequality, consensus must be reached through more informed discussion and public education. Assurance must be given on good affordable and basic healthcare to all Singaporeans. Sir, the demand in medical care could be moderated by the suppliers themselves. Since consumers cannot exercise their sovereignty in purchasing the appropriate amount and level of medical care in most cases, they are invariably dependent on the expert judgement of the providers. Hence, to address this issue, healthcare providers can be subjected to the audit of an effective watchdog body with a system of checks and balances and healthcare providers should be bound by ethical codes of conduct. Public hospital A-class beds should be limited to not more than 13%. A further measure may be the requirement of the public hospital providers to follow prescribed fair allocation of time for local populace as against foreign patients. What are the challenges facing this path of being the medical hub of the region? Sir, I feel the following areas are worth elaborating. Singapore's healthcare services are high in costs and fees in comparison to about half in Malaysia and about one-third in Thailand.”
“On the point of spiralling costs, having more full-paying foreign patients, apart from giving a spin-off effect for our other services by having more visitors to Singapore, may be a source of subsidy rather than a cause of rising healthcare costs for local patients. Sir, there is a need for a mindset change here. Getting more foreign patients paying full rates help hospitals in operating costs and may moderate the need for future hospital fees hikes. It is more cost effective and sensible to share expertise and expensive equipment in Singapore, especially in the very specialised fields like liver transplants and gamma-knife facilities. There is not a sufficient pool of patients to support these areas from our population of 3 million people. Super specialists will get more patients to keep their skills and improve on them. This will benefit both the local and foreign patients in the end. Mr Speaker, Sir, the present scheme of blurring the private and public sectors by allowing private specialists to come back to public hospitals as visiting consultants and allowing public hospital specialists to practise in the private sector will minimise the ill-effects of doctors leaving the public sector for more lucrative returns in the private sector. There are enough specialists, especially in the private sector, to cater for both local and foreign patients. Private hospitals today are running at less than half capacity. Spiralling healthcare costs are inevitable the world over. Having foreign patients here will have a cushioning effect rather than a worse-off effect in this respect.”
“Mr Speaker, Sir, I stand in support of the motion raised by the Minister for Finance. I would like to especially welcome his Ministry's acceptance of the recommendations by the Economic Review Committee on focusing to make Singapore the regional hub for new areas like healthcare, education and creative industries. Sir, I have some time ago raised the notion in this House that Singapore becomes the regional medical hub. This idea is not new; the implications are not unknown. We have, indeed, been there, but balked each time. I hope that this time this idea will not be thwarted again, lest we lose the chance. Sir, Malaysia and Thailand have been making up ground in healthcare services by leaps and bounds. In 2001, the Thai's Bumrungrad Hospital alone saw 225,000 foreign patients; much more than all the hospitals in Singapore put together. Treatment like open heart surgery, once considered beyond the abilities of many hospitals, is something most hospitals in Malaysia and Thailand offer today, at a fraction of the costs charged here. Both Malaysia and Thailand have declared their intention to go for a bigger slice of the healthcare pie in the region. Both these countries have the advantage of lower costs and the marked difference in costs is driving large numbers of cost-conscious patients from the region away from Singapore. What are the serious questions encountered from this idea of making Singapore into the regional medical hub that caused key players to abandon it in the past? First, the fear of spiralling cost of healthcare. Second, "the demonstration effect", which is the effect of increasing demand from the local populace expecting the services being offered to foreign patients at full-fee paying prices and perception of inequality.”
“Mr Speaker, Sir, am I correct to say that our abortion law was enacted in 1970 and reviewed in 1974? Is it not overdue to relook into this abortion law to keep up with the changing times and circumstances? Mr Lim Hng Kiang: We review the Abortion Act regularly internally, and I remember two years ago we had quite a vigorous debate on this issue too. So this is always on the agenda.”
“Mr Speaker, Sir, could I ask the Minister whether he could enlighten this House on the possible reasons why about one in four pregnancies or about 14,000 babies get aborted in Singapore each year? And in view of the declining birth rate, what has his Ministry done to look into this matter?”
“Mdm Deputy Speaker, could the Minister enlighten this House on the possible reasons why the Malaysians are using the word "war" so loosely? Can they be seriously considering waging war on Singapore? Do they not realise the catastrophic and destructive effects of war on both countries? How can they be treating war so lightly? And how can they be so irresponsible?”
“May I ask the Minister what has his Ministry done to improve dormiciliary step-down services, especially in patient care and in the training of personnel? And does he agree that this is an important area to develop in view of the demographic profile?”
“May I ask the Deputy Prime Minister whether he would consider the extension of the ERS CPF top-ups to 3-room HDB dwellers as well, as there are residents in the 3-room HDB flats who also require assistance from the grassroots and the MPs? Could I also ask whether it is a fair proposal for the Community Development Council to come up with matching funds in the respective constituencies to help those residents who have financial difficulties in their CPF top-ups?”
“No, should the doctor be hospitalised, for example, due to unforeseen circumstances.”
“Mr Speaker, Sir, I would like to seek a point of clarification. The Minister did not answer my points on whether there is a provision for doctors who, due to unforeseen circumstances, cannot fulfil the required CME points within the prescribed time. Will he elaborate on the circumstances allowed in such cases? Also, is there any recourse for a houseman to take? The Minister said earlier that the non-traditional sources of doctors are of high quality. Is he implying that there is no need to recruit doctors from reputable universities now, and that there is no necessity to send our doctors to the reputable universities and the best centres to train? Where is our medical health heading then? Is he not risking throwing away the prestige of medical excellence that we have painfully built up over the years? What kind of confidence can we get from our own Singaporean patients and foreign patients, especially from the region?”
“Could the Minister elaborate on how this is being ensured? Sir, these are some of my concerns and I hope that the Minister for Health would address them in this House.”
“If a variation is required, the matter ought to be moved to the High Court for a decision and not remain within the IOC Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee level. Amendment to section 20 (clause 7) proposes to amend that only those who have completed their housemanship satisfactorily can be granted full registration. Sir, under what circumstances would housemanship be deemed unsatisfactory? This could be very subjective and there are assessors with different expectations and standards to demand of their housemen. In any case, I would have expected that doctors coming out of NUS, deemed a world class medical school, would have produced high quality doctors. There is also no stipulated maximum period for this conditional registration. So housemen can be forever in the same position for as long as his seniors think they are not satisfactory in their performances. By the way, will hospitals that are short of doctors now use this regulation to tie these doctors to ease their shortage? How will the Ministry of Health ensure the avoidance of such high-handed unfair practice? What kind of recourse can these housemen seek? Furthermore, the amendments do not address how the Medical Council is going to decide on the procedure of granting conditional registration. Will there be a committee? Who will be on the committee? Is it the whole Medical Council? Will a meeting be convened? There are lots of uncertainties as to the procedure. Sir, now that Singapore Medical Council is to be given sweeping powers, we must ensure that there is a fair representation of doctors from both the public and private sectors and from as many disciplines and groups. We must also ensure that the members of the Council are of a high calibre.”
“As such orders to be dished out by the IOC have grave implications on the doctor in question - being seen guilty even before the finding has been concluded, standing to lose patients and practice and living with the stigma attached to the order - such a provision ought not to be introduced in the first place. The truth is that the circumstances on the charge may be difficult to ascertain and controversial. For example, a doctor that is accused of repeated poor performance may not be entirely at fault. It may be because the doctor was frequently getting bad cases that were not curable. In the event that such a drastic suspension measure has to be taken by the complainant, the matter can be referred to the High Court for an injunction against the doctor in question. An injunction will attract an undertaking from the complainant to pay damages to the doctor in question, if the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee, after its investigation, arrives at the finding that there is no misconduct or incompetence on the part of the doctor in question. This will ensure that there is no frivolous application for injunction, or suspension. As per the amendment, the IOC majority vote will be sufficient to make an order. This may not be equitable given the grave implications. If the IOC is to vote for an order, it should be by way of an unanimous decision. The amendment also gives the IOC the power to vary the order if the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee recommends the same. This again seems to be inequitable.”
“May I ask whether the Ministry of Health will set a certain budget for this Continuing Medical Education yearly? At the end of the day, the quality of CME will depend on the resources put in. Although the pharmaceutical industry may be very willing to generate goodwill by helping the providers of CME with the costs of educational programmes, the curriculum content and the educational event are often-times influenced by the financial support and the quality and value of such CME activities may thus be closely linked with the marketing of a particular pharmaceutical product. May I ask the Minister if there is a provision for doctors who, due to unforeseen circumstances, cannot fulfil the required points of CME in the prescribed time? Will the Minister elaborate on the circumstances allowed in such cases? Mr Speaker, Sir, the Interim Orders Committee (IOC) amendment seeks to put in place an IOC to suspend or order a restricted registration for a doctor under investigation. This amendment applies to a situation when the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee refers the matter to the IOC. However, it does not address the issue as to under what circumstances the matter can be referred to IOC. Furthermore, there can be a possibility that the doctor in question had been suspended but the eventual finding of the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee is in the negative. On the other hand, as suspension or orders had been granted by the IOC, the Complaints Panel, Complaints Committee, Disciplinary Committee or Health Committee may be under pressure to make a positive finding.”
“The fact is that continued medical education is part and parcel of a doctor's life, and when one takes up medicine, continuous learning becomes an inherent life-long practice. I dare say that all doctors do practise CME in some form or other and in varying degrees as a matter of necessity in the course of their clinical practice. Yes, we want medical excellence amongst our medical profession but we must still retain some degree of respect and compassion for human expectations and limitations. For doctors in the public institutions, the CME requirement is fairly easy to achieve. However, for some private practitioners, especially the solo HDB doctors who work long hours on days and nights, the timing and format of CME become an issue. We have to spare a thought and cater for their difficult situations. I hope the Ministry of Health can be the body that facilitates and formulates CME for them and ensures that professional bodies cater to their needs. May I also beseech the Ministry of Health to ensure that the implementation of this programme on CME is flexible, realistic and achievable. Formal CME lectures may not be as effective as it was believed to be. Interactive CME sessions that enhance participant activity and provide the opportunity to practise skills may be more useful to effect change in professional practices. High quality professional learning opportunities online should be readily available for self-directed learning. CME programmes to meet the needs of the nation should be incorporated. For example, in view of our ageing population, there should be programmes to better equip the medical profession here for the care of the elderly in the community and, in their own homes, so that the elderly can avoid tertiary institution as much as possible.”
“Sir, their morale is low and they often leave for private practice as a last resort. And, even if we increase their numbers, more junior doctors in the public sector will still leave in spite of poorer prospects outside if these causes are not addressed. I would like to suggest that, with the new policy in place, our public hospitals should stop employing doctors from non-traditional sources like Burma, Indonesia, China and so on, whose medical degrees were never recognised in the past. Singapore is known for its medical excellence and this had been built upon through years of excellent training of our doctors from the best centres. This prestige status must be preserved at all costs. To me, public hospital's reflex response to recruit doctors in the last few years from these non-traditional sources and to save costs is not acceptable. Sir, may I ask the Minister for Health whether the hundreds of doctors from the non-traditional sources presently in our public hospitals are being tracked and monitored continuously in terms of their performance? On the new regulation concerning Compulsory Continuing Medical Education, most physicians in Singapore are in general concurrence that the desired goal of CME is essential to improve medical practice. But many grouse that this has to come in the form of compulsion. The proportion of doctors who are already keeping themselves updated is definitely higher than the quoted figure of 49.5% for the year 2001 of doctors obtaining the minimum CME points. This figure refers to those who have officially documented their CME activities with the Singapore Medical Council. The CME programme has up till now been entirely voluntary and, hence, many doctors do not formally record or report their efforts in CME to the Singapore Medical Council.”
“As Singapore is emphasising the importance of life-sciences, and as we will need many doctor-researchers, would it not facilitate our future needs better by recognising all of the previously recognised medical schools? Sir, the Ministry of Health's projections for ideal numbers of doctors have been less than satisfactory so far. How sure are we that the Ministry of Health has better projections now to take into consideration our changing needs and trends? It is a known fact that there has been a shortage of doctors in the public sector for many years and this policy change will certainly help solve this urgent problem. Not only can we have the chance to get those Singaporean doctors who have graduated from these foreign universities to come home, we can also very likely attract other non-Singaporean doctors from these reputable overseas universities. This is especially significant when the cost to train a doctor in Singapore is so much higher in comparison to medical schools overseas. Yes, it apparently costs at least $400,000 here as compared to about $170,000 to $250,000 at the universities of Sydney, Oxford and Cambridge. Would the Ministry of Health be circumspect in assessing the shortage of doctors and solving the problem at the root cause of the shortage? Finding and attending to the reasons for shortages would be more effective than merely increasing the numbers of doctors. There is now an uneven distribution of doctors, with an abundance of doctors in the private sector and a shortage, especially of junior doctors, in the public sector. Junior public doctors have been facing problems like unsatisfactory work-terms, long and tedious working hours and poor career path developments.”
“Mr Speaker, Sir, I would like to declare that I am a General Practitioner and I stand to speak in support of the Medical Registration (Amendment) Bill. First of all, I must say that I welcome the good news that the quota on the admission of female medical students to our university is to be removed at long last. The public and many Members of Parliament in this House, myself included, had spoken for the regulation to be rescinded. Sir, I am indeed heartened that our Government has responded to the people's wish and that the Backbenchers in this House had not spoken in vain. Today's announcement removes the quota of 33% on the admission of female students into the Faculty of Medicine which NUS introduced in 1979. The reason for introducing the quota for female medical students was that the attrition rate for female doctors then was 16-19%. Of course, this reasoning is not valid anymore as, currently, the attrition rate for male doctors is 2.8% and for female doctors is 4.2%. This announcement thus removes this rejection of entry to qualify people on the basis of gender, and will go a long way towards our vision of making NUS a "first world" university. Sir, Singapore prides itself on being a meritocratic society and the long overdue removal of this quota is definitely a right step forward for Singapore. The 1993 policy of not recognising the degrees from over 176 previously recognised foreign universities will be reversed. However, I believe that not all the previously recognised universities will be reinstated for recognition. Why is the Ministry of Health half-hearted in reversing this policy?”
“Am I correct to say that the stent insertion procedure can be done as a day surgery, therefore, saving patients hospitalisation costs and is also a good way of reducing hospitals' operating costs? Will the Minister prioritise or encourage patients to have the stent procedure done as a day surgery?”
“May I ask the Minister whether it is correct to say that the stent insertion procedure is used to treat ischemic heart disease and myocardial infarction, and these two conditions caused 3,243 Singaporeans to die last year, and the second highest incidents of deaths in Singapore? In view of this fact, will his Ministry prioritise and allow patients to have full claim from Medisave or even subsidised for such life-saving procedures?”