Lim Hng Kiang
Singapore
“The company has made commitments to recycle the ash, and as for renewable energy, the gasification project is not an energy project, it is not a generation company (genco). It is to produce hydrogen and carbon monoxide or, essentially, carbon. Because as feedstock to the petrochemical sector, you need more C and more H2.”
“The Government will continue to recover the IIA awarded if the company fails any conditions or breaches the legislative amendments. I would like to highlight that there are no errant cases in the last five years for IIA and the current amendments are, therefore, not reactionary in nature, but are being made for legislative clarity.”
“In addition, the IIA scheme will be extended till 31 December 2022. Clauses 10 to 13 give legislative effect to this change. The remaining legislative changes arising from our periodic review of the income tax system are either administrative or technical in nature.”
“Data on household and individual savings rates by income groups are not available. However, data on the aggregate level of household financial assets can be obtained from the Household Sector balance sheet compiled by the Department of Statistics.”
“The aggregate level of financial assets owned by Singapore’s household sector6 in each of the past five years is provided in Table 1 below. Data on the amount of financial assets owned by households and individuals in the different income percentiles is not available.”
“The Second Review of the Comprehensive Economic Cooperation Agreement (Second CECA Review) is ongoing. The review is taking some time as both countries have our respective interests to work through, such as in the area of labour mobility. Our agencies regularly engage Indian counterparts to work through issues collaboratively.”
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“The per capita approach is really the most equitable and it makes sure that there is a minimum income level per head. If we use family income as a measure, then it will disadvantage the larger families. So the per capita income approach, to me, seems the most sensible approach. On how we go about adducing the income, how we go about assessing the means-test, we require the family to produce income statements. I think this is a pragmatic approach rather than asking them to self-declare. And, we are prepared to accept a number of different documents as evidence of family income - whether it is their pay-slip, income tax statement, CPF statement, or bank book showing their monthly salary. We are prepared also to review this and accept self-declaration provided they also authorise us to check with IRAS on their income. So if the person says, "I declare this is my income and I authorise the Government to check with IRAS that that is the income", I think we can examine that as a possibility. But basically we need to have the means to determine income and I do not think the various measures that we have adopted are overly onerous. Dr Lily Neo asked whether we will raise the cut-off point. As I have explained earlier, previously the step-down care had a single level of subsidy of 50%. We raised it to 75% for the more deserving, and then we have a three-tier system. Obviously, in due course, we will look at the income cut-off, but I just want to make the point that when we changed over, we were already doing it in a more generous way. She also asked whether we would have a centrally-run means-testing mechanism. There are pros and cons.”
“We attract foreign nurses from all over, and over time we would like to reduce our dependence on them but, quite realistically, I do not see the day when we can be totally localised. We have to have both local nurses, as well as foreign nurses, for the simple reason that we need to top up our talent. We need to attract these nurses to come here to work with us, and those who are better, we would like them to sink roots in Singapore. So, I assure Members that this is an area that we are definitely very concerned about and we will work continuously to improve the career path for nurses, both for the local as well as foreign nurses. Let me turn to the several questions raised on the step-down care sector. First, Dr Jennifer Lee asked whether I am happy with the progress so far since we started seriously to develop this framework two or three years ago. There has been some progress, but obviously we need to make more improvements. We still have a long way to go. I think we have done quite well in developing and becoming adequate in terms of facilities. We have put more funding into the step-down care, but we need to do more now on standards and making sure that the care is properly integrated across the board. We have also put in place means-testing for all the step-down facilities - a three-tier subsidy level. So, I think we have set in place the key things that we want to do. But, as I said, there are many improvements, and the questions raised by Members point to the improvements. So let me take these questions one at a time. First, on means-testing. The most equitable way of means-testing is per capita income. This means dividing the household income by the number of family members. So it does not discriminate against bigger or smaller households.”
“We have to do all that we can to train more nurses and to retain them, whether Singaporean or foreign nurses. So we have done several things. First of all, to set the backdrop, the public healthcare sector is short by about 364 nurses, which means a vacancy position of about 4%. We are aware of the current shortage of nurses around the world and we know that we have to compete for these nurses. Therefore, the onus is on us to make sure that we can attract more local nurses to join the profession, and the foreign nurses that we attract to come to Singapore, stay with us as long as possible. We have worked with the Nanyang Polytechnic and the Institute of Technical Education to raise the total nursing student intake. The target now has been raised from 728 to 820. Because of the extensive publicity that we have done, both with the clusters and with the educational institutions, we managed to attract almost 900 nursing students last year. So we hope to do just as well this year. More importantly, as Dr Chong Weng Chiew raised, is really to make sure there is a proper career path for nurses. I believe he understands what we have been trying to do the last few years. It is not just adjusting the pay to be more competitive. It is also giving the nurses a wider range of career prospects so that they can develop in the management arena, if they want to, administration management or they can be educators and trainers, or they can be specialist nurses. We have also widened the scope of training possibilities. Many of our nurses now go overseas for a stint of training and attachment under the HMDP programme, and they are very, very happy with this arrangement. Similarly, for foreign nurses.”
“The clusters are actively recruiting more foreign-trained doctors to address the shortage of junior doctors in the public sector hospitals. I believe these recruitment efforts would be greatly facilitated by the recent expansion of the Schedule under the Medical Registration Act. On her second point about the different training, whether you are a foreign-trained or local-trained doctor, let me assure the Member that there is no policy of discrimination in our public sector hospitals, either for or against overseas-trained Singaporean doctors. All doctors are appraised and assessed based on their performance and ability, and not which medical school they come from. Similarly, all opportunities for higher training and career advancements are awarded on the basis of the doctor's individual merit and whether he or she has satisfied the necessary professional criteria. On the need to make sure that our junior doctors are adequately trained, I totally agree with her. We need to make sure that the training of our junior doctors continues to be a major priority area for us. We are working with our partners, like the Singapore Medical Council and the Joint Committee on Specialists Training, to set the training objectives, the standards and the programmes for both the housemen and the medical officers, as well as specialist trainees. We have a system in place to look at and monitor the training that is conducted. To audit this training programme we have a system of collecting trainee feedback so that we can be assured that these training programmes are effectively carried out on the ground. Let me next turn to the comments raised by several Members on nursing. The nurses are a very critical component of our healthcare system.”
“First, let me address the issues of junior doctors raised by Dr Lily Neo. I agree with her that we want to set in place sensible requirements for our doctors, especially the junior doctors, to make sure that when they serve the people, their hours of service are reasonable. And, at the same time, when they undertake training, they have time to develop their career further. The situation in the past had not been entirely satisfactory and that is the reason why we have been progressively setting tougher and tougher standards for the clusters to meet. Right now, my Ministry closely monitors the number of night calls performed by our junior doctors, and the latest figures we have is that, in the two clusters, 74% of our junior doctors do an average of six night calls, or less, per month. So we are setting higher standards for the clusters to meet, and the clusters are working hard to increase the percentage of junior doctors who do six night calls, or less, per month. So, I want to assure the Member that the clusters will progressively set better and better standards. We have also asked the clusters to ensure, as far as possible, that the junior doctors are able to go off work by lunch time, the day after their night call, so that the total duration of the call is not more than 28 hours. The clusters are, again, trying to achieve this. We obviously monitor the working hours guidelines in other countries, and we are benchmarking against them. But I hope Members will understand that based on the current manpower situation, we cannot adopt these benchmarks overnight and, therefore, we are working closely with the clusters to try and improve this situation.”
“SGH was built 20 years ago and, if it leaves the impression that it is a 5-star hotel, then I think it is doing a good job in maintaining the hospital.”
“Therefore, by cutting off further infection, we were able to control and contain the situation. In the SARS case, the infection is brought in by humans. So, unless we encourage Singaporeans not to travel and avoid being infected overseas, we have no effective means to stop the chain reaction. Again, let me emphasise, please avoid these places, unless absolutely necessary. We are monitoring the situation very carefully together with our regulatory counterparts in Hong Kong. We have got assistance from WHO and from the CDC in the US. So far, things are under control. It will require us another 10 to 14 days, ie, two more incubation cycles, before we can declare it all-clear, if all things go well. But if there are additional infections, then I am afraid we will have to continue with the current measures. [Mr Deputy Speaker (Mr Chew Heng Ching) in the Chair] 4.05 pm As for the healthcare workers, I must say I am very proud of them. They have discharged their responsibilities admirably, taken all the precautions, even though eight of them have been infected. I can assure Members that we will spare no efforts to make sure that they are well looked after. I missed out one point about cost management, ie, just to emphasise that the cost that we set for the hospitals is not on a cost-recovery basis. The Government provides the norm cost, and we expect the hospitals to manage their cost within that level. So, it is very similar to your price-minus proposal. The hospitals are not allowed to incur cost and then expect the Government to pay for all cost increases. This is part of the discipline of managing cost. To respond to Mr Chandra Mohan who described SGH as a 5-star hotel, I am very flattered. I am sure the SGH would be very flattered.”
“We will keep ourselves in line and we will not be more stringent than them. More importantly, HSA will have regular meetings, every six monthly, with the medical device industry to obtain industry feedback. So I am sure HSA will get in touch with Dr Michael Lim and encourage him to bring up the specific instances where we have over regulated, and we will evaluate the cases again. Dr Lily Neo asked about the precautions taken for SARS and how we are protecting our healthcare providers. As Members may have read in the newspapers this is a worldwide problem. We suspect the cases could have emanated from Guangdong, Hong Kong and Hanoi. That is why we have set out a travel advisory, advising Singaporeans not to travel to these places, unless it is absolutely necessary. Right now, we have 23 reported cases, 21 in the hospitals and two have been discharged. All these cases stemmed from three index cases, ie, three original source cases, and then they spread to the others. They have spread to eight healthcare workers and 12 family members and friends. So, if we are able to contain the situation by not allowing it to spread further, over time, we will find fewer and fewer cases, and the situation will be completely under control. But if Singaporeans travel, get infected overseas, come back and infect other Singaporeans, then I am afraid the cycle will continue. That is the reason why we made it a point to advise Singaporeans to avoid travelling to these three places, unless absolutely necessary. We have gone through these difficulties before. A few years ago, we had an outbreak of the Nipah virus. In that situation, fortunately for us, we were able to cut off further infection by not allowing pigs to be imported into Singapore.”
“If we create a third cluster, I think there will be a lot of unhappy comparison between what is available in the third cluster compared to the other two clusters. There is also a likely discussion about what we should do with the ERC's recommendation on the regional medical hub. Our position is that we will encourage the private sector health institutions, facilitated by the economic agencies, such as the EDB, IE Singapore and the Singapore Toursim Board, to spearhead this effort. The public sector healthcare institutions will play a very important role to support these efforts, especially in the area of training and research. But the main focus of the public healthcare institutions must be to provide good and affordable healthcare to Singaporeans, and we will do so. In the 1993 White Paper on Affordable Healthcare, we stipulated that no public sector hospital should have more than 13% Class A beds to serve private and foreign patients. In that White Paper, we also envisaged that the overall private sector market share would grow from 20% to 30%. I believe these guidelines are still relevant today and my Ministry would continue to support the private sector institutions in achieving these guidelines. And we will ensure that the public hospitals remain focused on their role to service the majority of Singaporeans. Let me turn to two other issues. Dr Michael Lim has spoken on HSA's role. We need to strike a balance between regulating medical devices so that they are safe. At the same time, we do not want to impose so much regulation that they incur cost. I assure Dr Michael Lim that HSA's regulatory requirements would be closely aligned with those set out like their counterpart regulatory agencies in the USA, EU, Canada and Australia.”
“If indeed he faces financial problems, please do talk to his doctor. He or she is there for him to talk to. Let me next turn to the whole issue about the way we organise the clusters, whether we should have two or three and how we should encourage competition. I think the jury is still out. Some can argue that if you have more competition, you bring healthcare cost down. Other Members have made out an equally cogent case to say that competition means the clusters try very hard and they induce demand. By and large, today, we have decided to have two clusters. Why? Because we want to make sure that we have a full, integrated service and that the services provided to Singaporeans are seamless between different levels of institutions, whether it is from the national centres to the tertiary hospitals, to the regional general hospitals or to the polyclinics. Because we believe that integrated care is the most cost effective setting. If you have an integrated care, the doctor can assign the right level of care commensurate with your medical condition. If your condition is not so serious, he can assign you to the polyclinic. If it is more serious, he can assign you to SOC. Or if it is even more serious, he can assign you to the tertiary centre. To minimise duplication, we make sure that the more specialised services are located in the tertiary hospitals and the national centres so that the regional general hospitals focus on the management of the common medical conditions. Dr Chong Weng Chiew suggested that we keep the two clusters to only doing the frills and we set up a third cluster to focus on the top-end medical treatment. Let us try out the two clusters system first.”
“So even though we may not have renovated the class C or class B2 wards to meet the demand, anybody who requests for such a subsidised ward, if it is already full, we will temporarily lodge him in a higher class ward but he pays the rates of the subsidised ward that he has requested for. When the bed is available, we transfer him back to B2 or C class ward. So he is not penalised in any way if there are temporary shortages in the B2 or C class wards. Several Members also raised about the difficulty of specialist outpatient clinic patients who, because of changes in their financial situation, may request for downgrading. I assure Members that, if indeed they are in genuine financial difficulties, please raise them with the medical social workers and they will take care of them, and if they do qualify, they will provide Medifund support for them. Dr Tan Cheng Bock wants to know whether the specialist outpatient patients can request to break down their prescriptions or medications into smaller allocations so that they do not have to pay three months' worth of medication at one go. In general, I would not want to interfere with the doctor's judgement of how much prescription is needed. But I would like to assure Dr Tan Cheng Bock that indeed if a patient tells his doctor that he cannot afford it and he prefers a shorter period, say, two weeks, as Dr Tan Cheng Bock suggested, I think the doctor will accede to his request. But as a rule, I do not think the Ministry wants to impose the rule that doctors should only prescribe two weeks first, and not three months. I think we have to leave it to the professional judgement of the doctor. If he prescribes too short a period, then we will be forcing the patient to make more return visits to SOC or to the pharmacy.”
“My Ministry, together with the other community organisations, like CDCs and VWOs, has started a joint programme to promote subscription to PCPS and the IDAPE scheme. Voluntary organisations, like the Home Nursing Foundation, are doing a lot of promotion and I would also like to encourage Members, when they do block visits, to help us distribute these brochures to get more elderly to sign on the PCPS scheme. Dr Lily Neo suggested that we extend PCPS to chronic care. Mr Gan Kim Yong also wanted PCPS to be extended to the handicapped, the other low income group, as well as people with chronic diseases. These are worthy suggestions and we will consider possible extensions of PCPS later. Because right now, our priority must be to reach out to all the elderly who are eligible but who still have not signed on. Let me then turn to the hospital sector. Mr Nithiah Nandan wants to know if more class C beds would be created in the tertiary hospitals. The answer is yes. Dr Lily Neo wanted to know whether we are deploying more doctors and nurses to areas where there is an increase in demand. The answer is also yes. NUH will increase its number of class C beds from 56 to 160 beds, an increase of 104 beds by April this year. And SGH will increase its class C beds from 134 to 214 beds, an increase of 80 beds by September this year. Let me assure Members that any patient who requests for subsidised beds in a particular class ward and if the class ward is already full, he will be lodged in a higher class ward temporarily. But he will continue to pay only the subsidised rates of the class ward of his choice.”
“We have done this. If anything else, we err on the safe side. We counsel them and many of them then take up class B2 or C. And this is part of the reason why we have an over demand for these subsidised wards. In addition, over time, as the medical insurance component increases, I hope that the insurance companies will also build up the competence and interest to control healthcare cost. Sir, let me, over the next 10 minutes, cover the other specific issues which have not been covered in my reply so far. Let me take it systematically. First, in the primary care sector, Mr Yeo Guat Kwang asked about night clinics. We have night clinic services now in seven polyclinics. The reason why we introduced it is to make it much more convenient for Singaporeans to seek care at night, instead of having to wait till the next day. As these night clinics are popular among Singaporeans, my Ministry plans to extend night clinics to five more polyclinics this year. Mr Yeo also asked about our plans for development of new polyclinics. As we have announced earlier, we plan to develop new polyclinics in Sengkang, Jurong West and also to redevelop Queenstown Polyclinic. Several Members asked about the Primary Care Partnership Scheme (PCPS). I thank Members for their favourable comments on PCPS. We agree that the scheme is working well. But we really need to reach out to more elderly to make sure they sign on under PCPS. Dr Lily Neo said that, today, we have probably achieved less than 50% of those who are eligible. I agree with her. We should work harder so that we could reach out to more elderly. Today, some 6,200 elderly are participating in PCPS. Singaporeans, who are on public assistance, are automatically eligible regardless of their age.”
“45 pm Sir, as the purchaser, my Ministry will ensure that Singaporeans get the best value for money for their healthcare services. My Ministry is not obliged to buy only from the public sector restructured institutions. Dr Ong Seh Hong and Mrs Lim Hwee Hua have suggested, and I think several others as well, that the Government buy services from the private sector as well. I am open to this option. If the private sector can offer lower cost with the same or better quality in service, my Ministry will consider contracting the service from them once we put the proper framework in place. For example, under the PCPS, the Government engages private GPs and dentists to provide outpatient medical and dental services to the needy elderly. The patients pay polyclinic charges and the Government provides a subsidy to the participating GPs. My Ministry has also put in place a similar framework for the step-down care sector. This framework will include means test, accredited private sector facilities, properly audited norm cost and revenue caps. So the accredited private sector nursing homes will be able to take in subsidised patients as of 1st April this year. I know many Members have raised this whole issue about healthcare cost. Dr Lily Neo and Mdm Halimah suggested a watchdog body to monitor healthcare cost. Let me just say that controlling and managing healthcare cost is a job for all of us. It is not the job of MOH alone, although, as I have outlined earlier, we have a very comprehensive scheme in place. The individual and his family must also take the effort to understand the cost implications of their choices. Dr Chong Weng Chiew suggested that we do public education and counselling to make sure that people understand what is the cost implication of their choices.”
“Let me just use the example which Dr Chong Weng Chiew raised that the specialist may ask patients to make extra follow-up visits beyond what is necessary. We track this and our data over the last three years have shown that the ratio of re-attendance to first visit is very stable. It is between 3.6 and 3.8. So there is no escalation in repeat visits. Several Members like Dr Lily Neo and Mrs Lim Hwee Hua also asked whether the remuneration structure for the doctors in the public hospitals is properly set, so as not to create the wrong incentives. This is so. We make sure that the doctors pay equal attention to both private and subsidised patients. Their remuneration takes into account several factors, of which clinical service load of the doctor is only one of them. I also want to assure Members that the clinical service load includes both private and subsidised patients seen by the doctors. So the public sector doctors do not have a financial incentive to order more expensive tests, drugs, or stents, because they do not personally get a cut from these items. The revenue from these items goes to the hospital. And at the hospital level, my Ministry has put in place a revenue cap framework to discourage over-servicing. Under this framework, excess revenue that exceeds a pre-determined cap will not be allowed to be retained by the hospitals. So there is less incentive for over-servicing and over-pricing. What this means is that, every year, we do not allow the hospitals to increase costs beyond a certain limit. So if they charge more, they do not keep the money. The money goes back to the Government which will then reuse it for subsidies for the system. 3.”
“In addition, my Ministry provides the strategic oversight on overall public healthcare capabilities and facilities. We want to make sure that on capabilities, we have in place a medical capability framework to ensure that there is no unnecessary duplication of the more specialised and the most costly services and facilities. Such facilities and services are concentrated in the tertiary hospitals and national centres. On facilities, the Ministry determines the number of beds and its distribution by ward classes in every public hospital to minimise over supply at the national level. Public hospitals also need to seek the Ministry's approval before they can expand their facilities. As a purchaser, my Ministry will also ensure that the clusters provide quality care that is appropriate to needs and not drive up healthcare costs unnecessarily, eg, the example which Dr Lily Neo raised that they use more expensive stents when a cheaper one is adequate. In fact, we have several mechanisms in place to prevent such things from happening. The first mechanism is, of course, all healthcare professionals are bound to abide by their respective ethical codes. Breaching the code could lead to healthcare professionals being asked to defend their actions and, ultimately, to face disciplinary proceedings for professional misconduct. The second mechanism is that the Ministry regularly produces clinical practice guidelines, so as to assist healthcare practitioners to manage their patients based on the best available evidence to date. Third, the Ministry also monitors key clinical, financial and other operational indicators so as to detect trends and outliers that deserve further investigation or audit.”
“And to us, the fairest and simplest criterion is per capita income. I also agree with both Mdm Halimah and Dr Ong Seh Hong that we need not run a single means test system. It is possible to vary the income cut-off, depending on the cost of service. So, even though we have implemented means testing in the step-down care sector, previously the subsidy in the step-down care sector was a standard 50%. When we introduced means testing, we provided three tiers - 75%, 50% and 25%. So, it went down very well on the ground. But it does not mean that we will necessarily use this same method for the hospitals, because in hospitals today, Singaporeans already enjoy 80% subsidy in C class wards, 65% subsidy in B2 wards; 50% subsidy in the B2-plus wards and 20% subsidy in the B1 wards. So it is possible for us to vary the income cut-off as well as the level of subsidy, depending on the cost of service. The third prong of our strategy is really getting down to the brass tacks and managing cost increases. How do we do so? My Ministry plays the role of purchaser of healthcare services on behalf of Singaporeans, especially the low and middle income. As a purchaser, I wish to reassure Mr Zainul Abidin, Mdm Halimah and Mr Chandra Mohan that my Ministry will ensure that clusters are accountable and that their interests are aligned with the Ministry's goal of providing good and affordable basic healthcare to all Singaporeans. I agree with Mrs Lim Hwee Hua that performance measurement is necessary to do so. And to this end, the Ministry has set out its requirements and expectations of the two clusters in a service agreement with them. We will review the service agreement with the clusters periodically to make sure that they abide by it and that it is relevant and effective.”
“Then the resources that we have, we can target these subsidies at Singaporeans who are most deserving. In line with this philosophy, we have selectively implemented means testing for the Primary Care Partnership Scheme (PCPS) and also the step-down care and home care services managed by the voluntary welfare organisations. Going forward, my Ministry will consider extending means testing gradually and selectively, to more healthcare services. If there are proxy methods to moderate demand and target the services to the more deserving, then there is less need for means testing. But if our proxy methods are not effective, then I think we have to consider means testing, so that the subsidies can be more equitably distributed to those who are more deserving. Some Members raised the situation in the specialist outpatient clinics. Dr Chong Weng Chiew and several others said that there are long queues and that it could be abused because the fees are only $21, which is sometimes cheaper than a visit to the GP. Singaporeans know that they can enjoy substantial Government subsidies simply by obtaining polyclinic referrals. So the polyclinic referrals, as a proxy, are not discerning enough to differentiate between those who are deserving and those who are not. Means testing at the SOCs will make the distribution of Government subsidies more equitable by delinking subsidies from the referral source. It will therefore enable us to redirect public healthcare resources and do more for the lower income. But we will have to study the implications of this and we will have to make sure that if we do implement means testing, that it achieves the purpose set. Mdm Halimah is right that if you want to do means testing, the criteria must be made clear.”
“So, I urge Members that when they come across a deserving case during their meet-the-people sessions, such as those mentioned by Mr Zainudin and other Members, whether they are the elderly, the handicapped or the retrenched, for chronic cases and other cases, do refer them to the medical social workers at the hospitals and clinics. Today, more than 99% of Medifund applications are approved. And with the additional funds that we have in the Medifund, I can assure you that Medifund, as a safety net, will continue to be there for all Singaporeans. The second prong of our strategy is to increasingly target subsidies to the most deserving. With increasing healthcare costs, the Government would do its part to increase its share of healthcare expenditure. We have done so. Government subsidies for Singaporeans' healthcare costs through the hospitals, the polyclinics and the VWOs have increased by more than 34% in the last four years. For example, in FY 2000, we spent $896 million in such subventions. And this year, we expect to spend $1.2 billion. Mr Andy Gan wonders whether it is wise for us to keep this 80% market share because this will result in high cost to the Government, as he observed the higher budget that the Ministry of Health is given year after year. His suggestion is to privatise the hospitals, but I notice the other Members are, in fact, asking for more C class wards and more B2 Class wards. So, we have to strike a balance somehow. I think all of us know that financial resources given to healthcare cannot be unlimited and, therefore, I hope Members will agree with me that Singaporeans who are able to pay for their medical bills should do so themselves, or with their families' help.”
“So, he gives a small pocket money to the student, and there is no way you can stop this abuse, because it is entirely within the right of a school boy to go to a clinic, complain of headache or tummy ache and be seen by the GP. So, you may run very elaborate audit systems, but if the national average has gone up to 11 times, the school boy is entitled to visit his GP 11-12 times and collect his pocket money. Although we do want to make sure that we have good coverage, we also want to make sure that it does not lead to abuse. Let me next turn to the third M, which is Medifund. Medifund kicks in for the small minority of Singaporeans who are not able to pay for their share of healthcare cost, even after Government subsidy, Medisave and MediShield. Over the years, the Government has steadily built up the Medifund capital sum. It grew from $200 million in 1993 to $900 million this year, with the latest $100 million injection, as announced by the Minister for Finance. I remember one Member mentioned why is the Ministry of Finance injecting an extra $100 million when, in fact, the Ministry of Health is quite comfortable with $800 million and using the interest income from the $800 million. The answer is that we believe that Medifund is a very important safety net and, with the additional funds given by Ministry of Finance, MOH is now in a position to gradually extend the coverage of Medifund. For example, when the Ministry of Finance raised the capital sum last year, MOH is able to extend the use of Medifund to step-down care organisations. Similarly, we will continue to make full use of MediFund to provide assistance to needy Singaporeans.”
“So we will have to evaluate whether or not we want to make MediShield compulsory. But as I said, this is a very big step. What we can do right now is to encourage Singaporeans not to opt out of MediShield. Because if they opt out and when they retire or become jobless, they will not be covered by their employers. There is also no guarantee that when they are no longer covered by their employers that they will be insurable at that stage, because they may then have pre-existing illnesses. Therefore, I think our first step is to encourage Singaporeans to opt back into MediShield while they are still young and healthy. 3.30 pm Mr Yeo Guat Kwang also suggested other changes to MediShield, so as to make it a national scheme, eg, covering only the basic tier and to have appropriate levels of co-payments. I think these are very important principles, because we want to minimise the buffet syndrome. If you introduce a national medical insurance scheme and you have a buffet syndrome, it will lead to escalating premiums. I was just describing to some Members during the break just now the experience of Taiwan. Taiwan introduced a national medical insurance about five years ago and they extended the medical insurance to cover visits to the GP. In Singapore, Singaporeans visit the GP, on the average, six times a year. In Taiwan, it is around 11-12 times. Why is that so? The Taiwanese Health Minister told me that in some clinics in the suburbs, it is very common for school children to visit the clinic and pick up pocket money from the GP, because every time the GP sees a patient he can claim, say, $20 from the state.”
“Today, the MediShield claimable limits are set too low and we must raise it so as to allow patients with high hospitalisation bills to claim more from MediShield when they most need it. They then need to withdraw less Medisave and pay less out-of-pocket cash. And, we have to adjust the MediShield claimable limits in line with the DRG system. I hope Members understand the role of MediShield as a catastrophic insurance scheme. This means that as the medical bills go up, you cover the highest bill. For the average bill, Singaporeans are able to pay on their own using the subventions from the Government and using Medisave. But for very high bills, this is where you want the MediShield to kick in. And, therefore, we must raise the upper limits of the MediShield claimable limit so that it covers the top end of the bill. My Ministry will announce more details of how we will enhance MediShield subsequently. But, as I said, we need other changes, and we will definitely come back to the House over the next few years to discuss this. One big issue that we have to discuss and decide, for example, is the issue of whether we want to make medical insurance compulsory. Mr Yeo Guat Kwang asked whether the Ministry has any plans to make MediShield compulsory. Let me say that this is a very major step and we will need to consider this very carefully. Today, more than 90% of the working population is covered under either MediShield or one of the MediShield-approved private medical insurance schemes. This is quite a high participation rate. But, of course, as Mr Yeo pointed out, more than 200,000 are not covered, and many of these are the non-working spouses or people who are self-employed, and these are the most vulnerable people.”
“My Ministry has attempted to make, over the years, changes and enhancements to the MediShield, to try and keep up with the medical cost, but we have been constrained by not raising premiums. Premiums have remained unchanged since the scheme was introduced in1990. So, these enhancements are really not adequate to keep up with the medical needs of today. As a result, today, 4 in 10 B2 bills are higher than the existing MediShield claimable limits, which means that MediShield does not fully cover catastrophic bills, as it is meant to do. And this number of non-coverage would go up with medical inflation. So we need to make quite major adjustments to our MediShield if we want to meet the objectives that many Members have raised. Mr Yeo Guat Kwang gave many suggestions on how to enhance MediShield. I am happy to note that Mr Yeo is supportive of increases in the premiums for the enhanced MediShield scheme. I agree with Mr Yeo that we should also go for pre-funding of the policies, so that you pay more when you are younger and you are covered when you are older. This is in line with our move to make medical benefit more portable. So I assure the House that changes to the insurance element of our financing framework will be a major item in our agenda over the next two years. We need to make many changes, if we want to allow MediShield to play a bigger role in providing coverage for Singaporeans, not only during employment and in between jobs but, more importantly, also after retirement. These are very major changes and we need to prioritise the changes, otherwise Singaporeans may not understand and keep up with these changes. To me, the first priority is to raise the MediShield claimable limits.”
“This is a very blunt tool that is not customised to take into account the seriousness of the medical conditions and the resources required for treatment. In some instances, it is also restrictive as sub-limits are set on the amount patients can withdraw for each surgery performed. With improvements in medical technology, some patients may require very intensive treatment, but only require a very short hospital stay, eg, for certain types of heart surgery. In such instances, the amounts that the patients can withdraw from Medisave may not be commensurate with their medical condition. The DRG system is based on the resources required to treat the medical conditions, ie, the more resources required, the higher the severity level, the more the patient can withdraw from Medisave. This means that they will need to pay less out-of-pocket cash. These changes will apply to in-patient episodes and day surgeries at both the public and private hospitals. With these changes, more than 96% of B2 patients can have their entire bill paid for by Medisave, compared to 80% of B2 patients today. This means that more Singaporeans will not need out-of-pocket cash for their hospitalisation. Let me now ask the Parliament staff to distribute the brief on these changes, which contains some examples of how patients with serious medical conditions would benefit from these changes. [Copies of brief distributed to hon. Members.] Next, let me turn to the second M - MediShield. We discussed this last year and I mentioned that MediShield in fact plays a very limited role in our 3M framework currently. Today, MediShield payouts account for around 1.1% of our national healthcare expenditure. This, I think, limits the role of insurance in our overall healthcare financing framework.”
“I accept Dr Chong Weng Chiew's argument that if, indeed, home care is a substitute for in-patient care, that means, if there is medical evidence to say that instead of being hospitalised, home care is sufficient to meet the problem, and instead of eight episodes in hospital, you only need four episodes in the hospital, and the funds that we set aside for the four episodes can now be spent for home medical and home nursing, then I think there is a case to extend it. So we will examine this, and I will be very happy if he can give us proper scientific evidence to say that home medical, in fact, is a substitute for in-patient. Then I think Medisave can be extended for home medical and home nursing. Having said all these, we are not frozen in time. We have regularly adjusted the Medisave withdrawal limits. We have also progressively extended the use of Medisave to more outpatient treatments. Medisave withdrawals increased by 62%, from $250 million in 1991 to $400 million in 2001. If we had frozen the criteria for Medisave withdrawals, you will not see this major increase in the withdrawals. But I agree with many Members - Mr Yeo Guat Kwang, among others - who raised the point that Medisave withdrawals ought to be attuned to the medical condition, and that our present system of allowing Medisave withdrawals by days in hospitalisation and by the tables of operation, is outdated. So, today I would like to announce that from 1st July 2002, my Ministry will reset the Medisave withdrawal limits based on the DRG system. This new system will allow Singaporeans to withdraw more Medisave for the more severe medical conditions. Let me explain. Currently, Medisave withdrawal limits are set based on the number of days of hospitalisation and the type of surgeries performed.”
“We must, therefore, strike a balance between extending Medisave for more healthcare uses and preserving it for the time when it is most needed, ie, hospitalisation expenses in old age. The Medisave contribution and savings account is designed such that, for the average worker, he will save enough in his Medisave account to pay for around eleven episodes in the hospital. Our study shows that a normal person would probably have three episodes before he reaches 65 years old and, therefore, the remaining eight episodes are for the last 5, 10, 15 years of his life, depending on how long he lives. So when we look at the Medisave account, he must keep eight-eleventh of his Medisave total savings for his old age. If he were to deplete his Medisave account very early, then he would not have enough for his old age. So I am very sympathetic to Dr Chong Weng Chiew's request. He kept raising the point whether we can extend the use of Medisave for home medical and home nursing services. I have explained previously that by allowing Medisave to be used to pay for the premiums of ElderShield, we are, in fact, extending the use of Medisave to the more severely disabled, so that they can use the payouts to pay for home medical, home nursing and nursing home services. For those who are not so severely disabled, and if they meet our income means test, they will be highly subsidised by the Government. An average home medical visit, after subsidy from the Government, would therefore range between $30-$60, and an average home nursing visit, after subsidy by the Government, will be between $13-28. So, these levels of expenditure should be affordable, and seen as the same range as outpatient GP cost.”
“We expect healthcare cost to go up, and we expect healthcare cost as a share of the GDP to go up. So how do we address this? My Ministry has worked out three strategies to deal with it. First, we have to strengthen the 3M framework. Second, the money that the Government is prepared to spend, the subsidies that the Government is prepared to give, should be targeted at those who are most deserving. Third, we should take all steps to manage cost. Let me deal with the first strategy, which is to strengthen the 3M framework. Let me start with the first M - Medisave. Medisave, as we all know, is the foundation. We must build up sufficient savings, otherwise we would not have enough savings to pay for healthcare cost. That is the reason why we have decided to raise the Medisave contribution rate by an extra 1% in the near future. The Government is also pitching in by paying a higher interest rate of 4%, instead of 2.5%, for the Medisave account. We have done so since 2001. Last year, for example, the Government paid an additional $380 million into Singaporeans' Medisave accounts because of this change in paying a higher interest rate. This is to help Singaporeans build up their Medisave account. Let me stress that the Medisave contribution rate of between 6-8% is really not very high. In France, the equivalent contribution is 20% of the employee's salary. In Germany, it is 13.5% of the employee's income. So Medisave funds are not infinite. We know there are many competing demands for it. Members have raised it all the time. We use Medisave for hospitalisation expenses, for health insurance premiums and for certain outpatient treatments.”
“This is about the same amount that a household spends on telephone, pager and Internet charges. 3.15 pm So, overall, our healthcare expenditure is not high. Our problem is that healthcare expenditure is not a steady outlay across the population, nor is it a steady outlay throughout our lives. In fact, healthcare expenditure is very lumpy, and comes mainly when we grow old. That is why we have to deal with the lumpiness of healthcare and the incidence during the last 5-10 years of our lives. And that is the reason why we need a very, very sound healthcare financing system. In Singapore, we have developed our 3M framework - Medisave, MediShield and Medifund - over the last 20 years. This 3M framework has served us well, but we need to constantly adapt it so as to meet our future needs. There are two main reasons for this. First, our population is ageing. Today, 7% of our population is aged 65 years and above. This number will increase to 19% by the year 2030. We know that healthcare expenditure for an elderly person is between 3-4 times higher than that for a younger person. So, as the society ages, we can expect the national healthcare expenditure to increase. The second trend is that our economic growth is likely to slow down. We managed an economic growth of 7.3% per year in the last 15 years. We could therefore afford to spend more on healthcare without the share of the GDP going up by very much. The Economic Review Committee, however, estimates that GDP growth going forward will slow to 3-5% per year, in the medium term. With this slowing of our economic growth, and with healthcare cost still going up by between 4-6%, our national healthcare expenditure, as a percentage of our GDP, will therefore increase as a result. So, this is a very major challenge for us.”
“Sir, let me thank all the Members for raising issues and concerns on keeping healthcare cost affordable. This is a perennial issue and it must remain the main focus of our efforts. Let me first just give the overall picture and after that, I will go into the details of how the Ministry is proceeding to control healthcare cost. First, the overall picture. Healthcare cost went up by 4% last year. We must see this in comparison with the healthcare cost in other countries. It went up by 4.6% in the US and 6.6% in Australia. We cannot avoid healthcare cost going up, because we buy the same pharmaceuticals, we buy the same drugs, we use the same high quality medical devices, we use the most recent medical technology, unless Members are serious in saying that we do not progress as much as other countries. If we want to keep up, then I think this is the price that we have to pay. But what we do is to try and keep this cost down as much as possible, while still providing good quality care to Singaporeans. But despite healthcare cost going up by 4% last year, our overall national healthcare expenditure last year accounted for about 3.5% of GDP. Members will have noticed that this has gone up compared to previous years. In previous years, it was 3%. The main reason this has gone up is because our GDP did not increase very substantially in the last two years. The denominator has gone down and so our national healthcare cost has crept up to 3.5%. 3.5% is still quite low, compared to 7%-15% of GDP in other developed countries. The other parameter that we should be aware of is that the average Singaporean household spends only 3.3% of the household expenditure or $120 a month on medical services, meaning the out-of-pocket expense by Singaporeans is $120 per month.”
“Sir, as I said just now, the $5,000 deposit was put in place in 1967. So, just by adjustments for inflation alone, that deposit would have amounted to $13,000 by now. So, IRAS, in setting the new deposit at $10,000, is already under-pricing, based on inflation. But I would not say "no" today. I will take it back to IRAS and they can reply to you subsequently.”
“Together with the card issuers, we will try our best to make sure that standards are maintained in Singapore and that the security features incorporated are adequate and based on the best practices. I can assure the Member that we would take steps to ensure that this does not set back Singapore's goal as a financial centre. Both Dr Warren Lee and Mr Arthur Fong raised the issue about consumer credit, the need for counselling services and also mediation services. This must be a joint effort. On the part of MAS, under our guidelines, financial institutions may only run unsecured credit facilities to individuals who have a minimum income of $30,000 per year and the maximum credit limit is restricted to two months' salary of the borrower. So we do have some threshold or checks. But, at the same time, we do recognise that there are also other forms of avenues by which consumer credit can mount and which may cause problems for the consumer. In some countries, they do have consumer credit counselling schemes but we do not know of any jurisdiction that has mandated credit counselling or a cooling-off period before the consumer borrows, as Dr Warren Lee suggested. Our view is, if we make it mandatory or insist on a cooling-off period, this practice may appear to be intrusive and burdensome. Nevertheless, we do encourage consumers who face problems to seek credit counselling. The Association of Banks in Singapore and the Subordinate Courts, for example, are studying how best to encourage counselling and also how best to introduce mediation services. This is a problem that we do face and we are taking steps to address these problems.”
“Just as an aside, when we do financial counselling in the hospitals, we make sure that everybody signs to indicate that he has understood. But then it will come back to us. Later on, they say, "We signed, but we still did not understand." So, we will try, but I am not sure that is the final solution. On the third point whether lending and credit activities should be included in the Financial Advisers Act, I am afraid the scope of the FAA only covers investment products and, therefore, consumer loans are outside the ambit of the FAA. However, we do acknowledge the need to raise disclosure standards to meet international best practices, and it is important that borrowers themselves take responsibility in understanding what they are borrowing, and managing their finances to make sure that they can meet the obligations of the loans that they are entering into. 2.30 pm Mr Nithiah Nandan asked whether the recent report of credit card fraud may set back the growth of the financial industry. I would like to assure him only a minority of on-line merchant overseas would not accept Singapore issued credit cards. Credit card issuers and operators have clarified that Singapore issued cards are still accepted worldwide for the majority of on-line merchants. The few who do not accept Singapore issued cards have done so based on their internal business practices and these are not clearly subscribed by the major on-line merchants. Mr Nandan asked how many such frauds have taken place. There were 29 reported cases of on-line credit card fraud in 2001. So I think he would agree that this number is not very significant, compared to the large number of on-line transactions. Notwithstanding that, we do realise that credit card fraud is a growing problem and something of concern.”
“The ABS has codified a set of best practice standards for member banks to abide by in the form of a code of consumer banking practices, which includes requirements for banks to disclose, in clear and plain language, all interest rates, fees, charges and penalties associated with their loan products. This code of consumer banking practices also requires the banks to highlight important terms and conditions in the loan contract, including charges for early or premature termination of a loan facility. In addition, ABS has prepared a booklet to advise consumers on the questions they should consider when choosing between various loan facilities. They have also prepared a template information sheet with details of the information that banks should disclose to their customers, and the manner in which this information should be presented. We encourage such initiatives by the ABS, and we will also encourage other providers of consumer loans to take such steps to enhance their disclosure standards. But I agree with Miss Penny Low that more can be done. ABS should not just encourage its member banks to abide by the standards in the code, but ensure that this code is regularly reviewed to keep in line with best international practices. Miss Low has also suggested that loan providers make clear the amortisation schedules of their loan facilities. This is an area that ABS should also look into. ABS should also consider an industry-wide method for computing annual effective interest rates, so that the long list of technical jargons which Miss Low pointed out just now can be made comprehensible to the layman. The second point which Miss Low made about signing on the compliance document is something which the ABS should also consider.”
“The higher rate of bankruptcies, I suppose, is also a function of the economic cycle. Whenever we have a downturn, one should expect a higher rate of bankruptcies. But, notwithstanding all that we have said, I think we agree that consumer financial literacy - or what Miss Penny Low described as FQ - is something that is very important. We want Singaporeans to save to build up wealth, and to manage this properly for their retirement needs. To this end, it should not be just the role of the Government. The Government will work with other agencies, both in the private sector as well as NGOs, to try and improve the basic financial know-how of Singaporeans. Investor education is a very important challenge, and Deputy Prime Minister Lee mentioned just now that, in the UK, the FSA is very deeply involved in making sure that consumer protection issues are adequately addressed. Similarly, we need to strike this balance in Singapore. But this is definitely something high on our agenda. Miss Penny Low also raised the issue about the technical jargon used in the loans and credit business, that we should have proper disclosures, so that people know what they are borrowing. This is also a very important issue. To some extent, we have made some progress. The Government, together with the Association of Banks in Singapore (ABS), has tried to bring in place better disclosure practices. The ABS, for example, has taken significant steps to raise the standards of disclosure within the banking industry.”
“MAS and the various agencies are closely monitoring the rules, as these are being discussed. The impact on our SMEs' lending will really depend on the details of these rules - as Mrs Lim said, how the Basle accord sets the weightage on the various risks. We will monitor this impact, and if these new capital adequacy rules should drastically affect the banks' ability to lend to the SMEs, then of course we will have to work with the banks to see how they can address this issue. We all realise that if we want to grow the SMEs, financing is a critical challenge, and I am sure that Mr Raymond Lim, working together with MTI and MOF, should be able to address this issue, and we will have a full range of avenues available to our SMEs to grow. Miss Penny Low raised the topic about consumer financial literacy. This is of course a very important issue, if we want to encourage Singaporeans to manage their financial resources, particularly for their retirement needs. But let me just address some of the points which she raised. First, the higher percentage of household debt compared to personal disposable income. This is partly because the percentage of home ownership in Singapore is much higher than in other OECD countries. Therefore, these properties being mortgaged will be flagged on the liabilities side and we get a higher household debt compared to personal disposable income. But we have looked at the household debt, and it is not something that causes us concern. Because of our high percentage of home ownership, we have a higher liability but, on the assets side, despite the downturn in the housing prices, the assets of households are still growing decently. So, on balance, we are still managing reasonably well.”
“The Corporate Finance Committee here in Singapore also suggested a similar arrangement, something along the lines of an Internet-based bulletin board, to bring together start-ups and venture-type companies and sophisticated investors who may be interested in investing in such companies. Today, there are no regulatory impediments to the OTC trading of any securities, including shares of SMEs. Indeed, SGX and others have reviewed the possibility of setting up an OTC market along the lines described by Mr Inderjit Singh. They think that such a set-up is not commercially viable at the moment. But I think they will still continue to review this. The MAS, in its recent amendments to the Securities and Futures Act two years ago, allows it to recognise different trading systems for the buying and selling of securities, including private equities. Basically, the legislation has been amended to allow us access to all these possibilities. We are depending on the market to see whether these are viable, and to throw up solutions. The Government, on its part, of course, as you all know, has a full range of assistance programmes for the SMEs, whether it is LEFS, LETAS, Micro Loans or the various programmes. Dr John Chen suggested that we should allow companies which wish to provide loan guarantees to be set up here. Again, there are no rules against this. MAS' approval is not required for such entities to be set up, and we will have to depend on the market to decide whether this is commercially viable. Mrs Lim Hwee Hua raised the issue of the New Basle Capital Accord, and whether the risk weighting vis-a-vis the smaller companies may act against the availability of financing for such companies. As Mrs Lim knows, the Basle accord is not likely to be implemented until at least 2006.”
“Sir, first, let me address the issue of financing for SMEs and other growing businesses. As Members realise, this is a multi-faceted challenge. We have many agencies involved in providing the financing for the different stages of growth of a company. On the one hand, we have the banks. Of course, banks do see SMEs as a good business to go in. They may not be prepared to take as much risk as other agencies, but banks do play a role. We also have finance companies, and they are subject to the prudential limit on unsecured lending of $5,000 to any single customer and 10% of capital funds in aggregate. These rules are necessary because finance companies do take deposits and we do need to protect the depositors. But, at the same time, in line with MAS' shift to a risk-based supervisory approach, we have allowed better-managed finance companies to be granted exemptions to this limit. Hong Leong Finance, for example, is allowed to extend unsecured loans up to 0.5% of its capital funds to a single customer, and 10% of the capital funds in aggregate. So, well-managed finance companies can play this role in providing financing to SMEs. Mr Inderjit Singh suggested attracting companies, such as Wells Fargo or SME Loan. Basically, the MAS is open to admitting banks or other entities with specialised expertise in SME financing, so long as they meet our prudential standards for licensing. So, there are no rules which bar entities like Wells Fargo or SME Loan to come to Singapore. Mr Inderjit Singh also suggested that we encourage an over-the-counter (OTC) market. He described the grey market in Taiwan and how it has facilitated the growth of companies.”
“The ElderShield scheme was launched very recently. The immediate priority of the Ministry and the ElderShield insurers is to ensure the smooth operation of the scheme. We need to let the scheme run for a while to get a better feel of the application and payout rates. Then, I think, we have a meaningful basis to make changes to the premiums and the payout. You need better data on payout ratios if you want to make changes. But we will leave it to the insurers. If they feel that there are any market gaps which they can modify the scheme to fill in, they are free to come to us and propose how they can fill in the market gaps. LICENCE FEE FOR TAXIS (Rationale) 17. Dr Amy Khor Lean Suan asked the Minister for Transport if he will (a) explain the rationale and basis for charging the licensing fee of $25 per month per taxi on taxi operators for monitoring the performance of taxis; (b) explain how the quantum of $25 is arrived at; (c) ensure that this additional cost will not be passed to commuters; and (d) state how the Land Transport Authority plans to monitor the performance of taxis.”
“Mr Speaker, Sir, the Ministry has asked the two ElderShield insurers to consider doing a survey to find out more about why people opt out of ElderShield. NTUC Income has since completed a telephone survey. There were 110 respondents. On the main reason for their opting out of ElderShield, 23% indicated that they could not afford the premiums, 22% indicated that they did not perceive the need for ElderShield, and 20% indicated that the benefits were not attractive. Great Eastern is conducting a similar survey, which will be completed in March. The Ministry will evaluate the results of the two surveys and ask the insurers to take these surveys into consideration when they subsequently review the ElderShield offer.”
“Healthy Start is a community-based early intervention programme provided by family service centres to identify families at risk and their vulnerable newborns. Such families are identified by family service centres after the babies are born at the hospitals. Regular home visits are made to assess the family situation, and to link them to relevant community resources for financial assistance, emotional support, childcare arrangements as well as parenting and family life enrichment programmes. Other support mechanisms include pregnancy crisis helplines, temporary shelters for teenagers during their pregnancy, and assistance on adoption for those who do not have the means to raise the child.”
“We went through this debate two years ago - whether it should be mandatory and whether parental consent should be necessary before teenagers are allowed to have abortions. I think Members will understand that there are pros and cons. Many of the teenagers who come forward for abortion may not have the necessary family support. And if you make it mandatory, you may force some of them to undertake illegal abortions in the side lanes or even out of Singapore. So, there is a downside risk if you make it mandatory. When this legislation was introduced, we decided it was wiser to keep it voluntary. We make every effort to encourage the young girls to bring in their families because family support is necessary. But, on balance, we feel that if we make it mandatory for parental consent, then we may drive some of these young girls underground. TEENAGE BIRTHS 15. Dr Mohamad Maliki Bin Osman asked the Acting Minister for Community Development and Sports (a) in each of the last 5 years what is (i) the number of births registered to teenage girls; (ii) the number of these births in proportion to all births; (b) what systems are in place to monitor what happens to these teenagers and their newborns; and (c) whether follow-up actions are in place to support these young mothers and their newborns. The Acting Minister for Community Development and Sports (Assoc. Prof. Dr Yaacob Ibrahim): Mr Speaker, Sir, between 1997 and 2002, an average of 843 births per year was registered to teenage females. This is about 2% of the total number of births. However, the number of teenage births has shown a slight increase, up from 704 in 1997 to about 849 in 2002. My Ministry works closely with our community partners to help teenage parents and their newborns who may need assistance.”
“My apologies. I do not have the data before these five years. We would take a look at those data.”
“As I mentioned in my reply, we do work with MCDS and MOE on the various programmes to educate our young women. MOE, for example, has a sexuality education programme in the schools. I hear that it has been quite successful. This was implemented about two years ago, and they monitor the progress of this programme.”
“There are such schemes in place and we have a committee to encourage procreation, marriage and birth. These are some of the measures which they are promoting. Assoc. Prof. Ngiam Tee Liang: I would like to ask the Minister if there is a study to review the various reasons and factors for teenage abortion and whether more efforts should be taken to look at human sexuality programmes in schools, to make it mandatory, in a sense, for teenagers to understand the various issues involved. Because it seems that for some cases, abortion was used as a means of family planning or birth control. They use it as a form of birth control instead of what it should be. So, is there any attempt to actually step up efforts? I think there is a danger of a growing trend in teenage abortions.”
“The counselling is done as a pre-abortion counselling, as I mentioned in my reply. The counselling is mandatory for the young teenagers. For the rest, we will encourage them to go for such counselling. The counselling involves the women directly affected. And we also encourage them to bring in their families so that counselling can be done holistically. So we try our best to explain the implications and consequences, and lead the affected persons through the process. And there is a mandatory period, after the counselling, for them to reflect on the counselling and before they make a decision to proceed with the abortion.”
“The decision for individuals to go for abortion is a personal decision and the reasons for doing so cover over a wide range. If the Member likes, we would put up a specific reply on the reasons. Offhand, I cannot provide the specific reasons with specific percentages. The number has not been increasing. As you can see, the total number of abortions had indeed come down from about 13,800 to 12,700. So, over the last five years, through our various efforts, we have kept the number declining, albeit in a very gradual way. Of course, we would like all babies to be wanted babies and we would also like to raise the birth rate. To this end, we work with all the various agencies to try and achieve this objective.”
“Mr Speaker, Sir, in 1998, there were 1,368 teenage abortions out of a total of 13,838 abortions. In 1999, 1,424 out of a total of 13,753 abortions. In 2000, 1,730 out of a total of 13,734 abortions. In 2001, 1,698 out of a total of 13,140 abortions. In 2002, 1,626 out of a total of 12,749 abortions. So, as Members can see, the number of teenage abortions averages about 1,500 annually, and represents about 12% of the total abortions. Pre-abortion counselling is provided to teenagers at the School Health Services, Health Promotion Board. My Ministry monitors the situation closely and works with other Ministries, like the Ministry of Education and Ministry of Community Development and Sports, on sexual education programmes that aim to reduce teenage abortions.”
“Intelligence report, sorry. Otherwise, that may create another big hooha. Let me rephrase it - intelligence report. Thank you. On the question of average returns, as I explained in my reply earlier, the funds are spread over different asset classes, and we have different benchmarks by which we evaluate the fund managers who are given these funds to manage. So far, we have done well compared to these benchmarks. So, our returns are better than the benchmark returns.”
“Again, I would not want to speculate on the basis of Dr Mahathir's intelligence. An hon. Member: Intelligence report.”
“The focus of our investments is to preserve the long-term value of our reserves. Our philosophy is to maintain a well-diversified portfolio, with investments in a variety of asset classes spread across different countries, currencies and sectors. The investments range from global equities and global fixed income to special investments and real estate. Hence, while we may not have made spectacular gains during the dot.com era, we were also spared the huge losses when the bubble burst. These are difficult times for investors. Equity markets around the world have come down sharply. But the impact of market movements on our portfolio is buffered by the diversified assets that we hold. Singapore's investments overseas have produced good returns over the years. Our investments have generally done well relative to market benchmarks, such as the MSCI, as well as against portfolios managed by the world's top financial institutions and fund management companies.”