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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“As I have explained, this is not a synthetic pharmaceutical. For the Chinese medicine, they claimed that these are the ingredients in it. HSA can test that indeed these ingredients are there, but it is not possible for HSA to test what else is not there. We will be testing for a lot of things. We can test for the poisons, we can test for a few toxic metals, but they could be putting in a lot of other things, eg, steroids, all kinds of adulterants in it. So it is not possible for HSA to put upon itself the responsibility of testing what is not declared by the importer, because you do not know what to look for. Let me give another analogy. When I was in charge of the Ministry of National Development and we imported vegetables from Malaysia and we had this problem of pesticide residue. We could impose a very strict regime because the number of known pesticides used is limited and we can test for the 10 or 15 pesticides and make sure that the residue does not exceed the level that we set. Therefore, we can have a very tough system in testing every consignment for those 10 or 15 pesticides and make sure that it does not exceed the residue level. But when we come to Chinese medicine, we do not have a similar list of things we can say that you cannot put these in the Chinese medicine. We can have a list of the poisons, but they will be put in steroids and all kinds of stuff, and they may put in things which are above the safe dosage. So it will be very difficult for us to do tests on every consignment and to test for what is not declared as ingredients in Chinese medicine. That is why in 1999, when we were looking at how to regulate Chinese medicine, we decided that it is not possible for the HSA to license every product and every consignment.”
“On every consignment, the importer will then have a declaration to say that the consignment of the product coming in does not have any of the items in the Poisons Act, does not have any heavy metals or any microbial contents above the legal limits. It is not possible for HSA itself to test the items because, as you can appreciate, the CPM is a very wide range and, therefore, we use the regulatory regime of making the importer declare that whatever they bring in is in accordance with what they indicate as ingredients, and that they do not have any of the poisons in the Poisons Act and any of the other toxic heavy metals.”
“Mr Speaker, Sir, let me go through the process of how Slim 10 came in. Slim 10 was imported from China, and for the ingredients declared by the company, they claimed that the product contained five common Chinese herbs, with dosages within those recommended in the official Chinese pharmacy literature. So this product was, therefore, classified as Chinese proprietary medicine. HSA had these products tested and found that they were indeed based on the tea leaves and the Chinese herbs. On that basis, they were allowed to come in. Each time a consignment comes in, the importer has to declare that the consignment does not include any of the items in the Poisons Act and that the product does not have any toxic metals or microbial contents exceeding the legal requirements. Based on those declarations, they were allowed to be sold. Then, as I have explained earlier, HSA runs the Adverse Drug Reaction Monitoring System and, based on that system, in early April, HSA received reports from doctors about patients with serious adverse drug reactions. So HSA went to test the product from the shelf and discovered that there were indeed these adulterants in these batches. So HSA took action to withdraw these samples. That is how the issue became public. What I want to say is that for Chinese proprietary medicine, the procedure is, first, anybody who wants to import a Chinese proprietary medicine submits the application to HSA and tells HSA what the product contains. HSA will test the product and make sure that the product is as declared. On that basis, HSA will allow it in.”
“HSA will look into how the labelling of complementary and alternative medicines can help the public to make better informed choices as to whether to use a health product or not. HSA will also review and refine regulations and guidelines governing slimming products to ensure safety for users. HSA is developing a regulatory framework for health supplements, targeted for implementation in phases from 2003.”
“Labels and packages must not stipulate any of the 19 diseases or conditions specified in the First Schedule of the Medicines Act, such as cancer, diabetes and hypertension. Where there is any doubt on the documents submitted by the applicants, product samples are tested by HSA's laboratories to exclude suspected adulterants, and analyse toxic heavy metals and microbial contents. There are currently no licensing requirements for the import, manufacture and sale of health supplements and other traditional remedies like Jamu and Ayurvedic preparations, but dealers are required to ensure that the products do not contain any prohibited substances and the toxic heavy metal content does not exceed legally permissible limits. HSA also carries out regular post-marketing surveillance and runs a quality-testing programme on products sold in the market to ensure compliance with legal requirements. HSA also has an Adverse Drug Reaction (ADR) Monitoring System to detect any adverse reactions of products used in Singapore, and this is tied to international ADR networks to pick up early signals and intelligence on any problems with health products. Health care professionals are requested to report suspected adverse drug reactions encountered to HSA so that unsafe products can be removed from the market as and when they surface. Mr Speaker, Sir, synthetic pharmaceuticals for weight loss can only be used under a doctor's supervision. Where consumers are considering self-medication with other products that claim to cause weight loss, they have to be cautious and discerning and exercise care in the selection and use of these products.”
“Compared to synthetic pharmaceuticals, traditional and complementary medicines are generally considered to be relatively less toxic, because they usually comprise herbs in low individual concentrations and, in the case of traditional medicines, because of long historical usage. However, the manufacturing processes may result in contamination of the products with toxic heavy metals and micro-organisms, or the products may be adulterated with Western medicines. In view of this, for CPM, the main group of complementary medicine remedies used in Singapore, HSA's system is more stringent than that of the US and UK which do not have pre-market assessment of CPM products. In Singapore, control measures to ensure that CPM meet appropriate quality and safety standards comprise the following: One, the licensing of CPM dealers - importers, wholesalers, manufacturers and re-packers - to ensure accountability for the safety and quality of their products. Two, pre-market product assessment to ensure that products are from licensed manufacturers, sold freely in country of origin, do not contain Western medicines or naturally occurring toxic substances, and that heavy toxic metals, such as mercury, arsenic, lead and copper, and microbial counts are within permissible limits. Three, submission of test reports and written declaration of the absence of any synthetic drugs or poisons as defined in the Poisons Act by the licensed importers for every consignment imported. Four, approved product labelling in English to clearly specify the ingredients, indications for use, dosages, batch number, expiry date and the identity of the importers and manufacturers.”
“Mr Speaker, Sir, synthetic pharmaceuticals for treatment of obesity, for which safety, quality and efficacy can be scientifically assessed, are regulated as Prescription-Only Medicines in Singapore. Currently, we have approved five Western synthetic drugs for treatment of obesity in Singapore. Due to the presence of generics, these five approved drugs come in eight brands. These medicines are effective but can only be prescribed by doctors as they may sometimes have serious side-effects. Such medicines are used in the short-term treatment of obese individuals in conjunction with an overall weight-loss programme under medical supervision. All synthetic medicines, commonly known as Western medicines, are stringently evaluated by HSA for their quality, safety and efficacy before marketing approval is granted. After marketing approval has been granted, these products are subjected to post-marketing surveillance that includes quality compliance testing and Adverse Drug Reaction monitoring. Besides these synthetic pharmaceuticals, there are a number of other products, ranging from Chinese proprietary medicines (CPM) and health supplements to other complementary or traditional medicines, which are promoted as being useful for weight reduction. These claims cannot be evaluated by HSA since rigorous scientific data to validate efficacy and benefits are generally not available. Instead, such products are regulated on the basis of safety and quality of the product. This is a risk-based approach that is in line with the systems adopted by regulatory agencies in developed countries like the US, UK and Australia.”
“Sir, incorporated bodies or persons are subject to the corporate rate but there is a schedule, and that schedule will remain but the maximum of the schedule will now be reduced to the new corporate tax rate. On maid levy for singles, I think Dr Richard Hu had explained last year that maid levy is meant for the married woman to go back to work and therefore the maid levy is for married women with children. Therefore, singles with no children will not qualify. But divorcees and widows with children would qualify. Third, on the double child relief, the effective relief is $2,000 because you still enjoy the normal child relief and that really translates, even at the maximum of the personal income tax, to about $500 in cash benefits. But, nevertheless, the Minister for Finance has decided that withdrawal of the double child relief should not be done suddenly and he has decided to phase this out over two years. Therefore, the double child relief would come down to $3,000 from the Year of Assessment 2003 from the current $4,000, and revert to the normal child relief of $2,000 from the Year of Assessment 2004. On the claims, I would like to tell Dr Ong Seh Hong that we have adjusted the amount of claim to $2,500 and based on the current claims, the average amount claimed per person is only $1,600. The ceiling is not causing a problem to people who want to claim and therefore we have decided that there is no urgency to increase the quantum.”
“They have considered other alternatives to this fair settlement price but they decided against these alternatives because it was less equitable. As to what investors can do, let me just say that the Commercial Affairs Department is currently investigating whether criminal offences were committed in relation to trading on Links shares and if the persons under investigations are convicted, then these investors in Links shares who traded with these persons will be able to obtain legal recourse.”
“Sir, to Mr Arthur Fong's two points, I think both groups are catered for by our arrangements of the offsets and retraining. So I think the middle income group really will also benefit from the offsets and the various assistance packages. For the retrenched bank employees, I think the same arrangements that we have for industry-specific training also will work out for them. As regards Mr Steve Chia's query on the Links-Island, the reason why SGX took two years to investigate is because it is a very complicated issue. They have to examine the trades of more than 50 parties involved during the transactions. They have to investigate the significance of the commercial and personal relationship of all these 50 parties. They also have to investigate the cash flows and the trading patterns of these individuals and institutions which were trading in the Links-Island shares. As a result of their investigations, SGX has determined that Links shares were indeed cornered and I guess what Mr Steve Chia is referring to is the decision of SGX on how they should settle the market trades during this period before the suspension. So SGX has decided that the market trades during the period 14th to 16th August, as he mentioned the three days, will be settled by cash instead of delivery of shares. Now they have set the fair settlement price at $1.21. They have decided that this is the most equitable solution without distinguishing whether the trades were done by investors with long or short positions. So having considered the circumstances of this case, the Settlements Committee has concluded that the weighted average of the Links shares during these three days would be the most equitable and the most appropriate price.”
“Indeed, Singaporeans can help our security agencies by staying calm in an emergency and alerting the security agencies if they come across something suspicious in their neighbourhoods. The Home Team and various security agencies are ready to deal with a wide range of security threats. We will constantly anticipate changes in the security environment and prepare our uniformed officers to deal with these challenges. We will spare no effort in protecting Singapore's safety and security.”
“These exercises not only help to validate the operating principles and plans, but also provide valuable insights into the formulation of contingency plans and the development of capabilities to deal with various security threats. Even before September 11th, Police had been training its officers, including Operationally Ready National Servicemen, in identifying bombs and improvised explosive devices, as well as guarding of key installations. We have over the years built up a specialised Key Installation Protection (or KINS) Force comprising National Servicemen. We also have specialised units within SCDF which are trained to respond to incidents involving hazardous materials, and biological and chemical agents. In view of the current security environment, the Home Team has also stepped up training for all its regular officers, to maintain a high level of readiness. In addition, Police, together with ISD and the SAF, have briefed and trained security guards from private security firms and in-house security guards of selected establishments to identify explosives, firearms and other weapons, as well as how they should respond to any security incident. The Government has consciously been creating security awareness amongst Singaporeans since the introduction of the Total Defence concept in 1984. Singaporeans recognise that they too have a role to play in ensuring Singapore's security. One way residents can contribute to the security of our neighbourhoods is by participating in the Community Safety and Security Programme (CSSP). Singaporeans also participate in Emergency exercises, such as the National Emergency Blood Donation Exercises or the Civil Defence Public Shelter Exercises, which are held from time to time.”
“Mr Speaker, Sir, there are many products in the market. Some of them try to pass themselves off with all kinds of claims on health benefits. My Ministry continues to monitor this and make sure that such claims are correctly substantiated. The minimum requirement in Singapore, throughout the whole continuum, whether it is food, health supplements or drugs, is that the manufacturers must list the ingredients and show truthfully what goes into the product. That is the minimum they have to do. Beyond that, we will continue to take action to make sure that they are able to substantiate their claim. My only other comment to Singaporeans is - take all these claims with a pinch of salt! ENHANCED COMMUNITY SECURITY (Training of uniformed servicemen and population) 11. Mdm Ho Geok Choo asked the Minister for Home Affairs what measures are being taken to better prepare and train our uniformed servicemen and population on enhanced community security. The Senior Minister of State for Home Affairs (Assoc. Prof. Ho Peng Kee) (for the Minister for Home Affairs): Sir, let me assure the House that our uniformed officers are well trained and equipped to handle a wide range of security threats. We have, in place since 1982, a National Emergency System to ensure that Singapore survives any security threat. We conduct exercises regularly to ensure that the Home Team and various relevant agencies are operationally ready to respond to any emergency, including those arising from unconventional threats. Last year, and again in March this year, Police, SCDF and the SAF came together to exercise their plans to deal with various other unconventional threats, including chemical agent attack by terrorists.”
“Mr Speaker, Sir, all pre-packaged food products are required under the Food Regulations to bear a label to show the list of ingredients and additives. A diet that is not excessive in energy, fat and salt, and provides adequate nutrients and dietary fibre helps to reduce the risk of heart disease, stroke and certain cancers. Provision of nutrition information on food products allows consumers to compare the nutritional value of different products and make informed decisions when they purchase the products. The Health Promotion Board (HPB) is actively promoting nutrition labelling and is working with food manufacturers to encourage them to voluntarily label their products. Since the implementation of the nutritional labelling programme, there has been an increasing number of products carrying nutrition information. HPB will continue to promote and facilitate nutrition labelling by food manufacturers.”
“Mr Speaker, Sir, we have made quite a quantum leap from serving less than 10 constituencies to serving all constituencies now. So this is already putting quite a heavy burden on the administrative arrangements in the CDCs, getting the cards out to the elderly. We will consider extending to other areas when we gain more experience with the present scheme. But I must say that if we extend it, it means an increasing proportion of Singaporeans will come under means testing. So we have to be quite sure of the pros and cons of extending this scheme. LABELLING OF FOOD PRODUCTS 10. Mr Chiam See Tong asked the Minister for Health whether his Ministry will make it compulsory to label all food products sold in Singapore with the necessary dietary information.”
“Mr Speaker, Sir, we have tried to make the administrative arrangements as convenient as possible, but it incurs extra administrative work by the GP clinics. I am happy to note that more than one-third of the total GP clinics in Singapore and nearly half of the dental clinics have signed up for this scheme. I think for many of the GPs and the dentists, they see this not as just a commercial service. They see this as extending community service to the elderly. So we are very happy to welcome them on board.”
“Mr Speaker, Sir, can I be permitted to take Questions 8 and 9 together?”
“And this is one of the indirect consequences that Singapore would have to face. MAS is also paying close attention to the claim situation and solvency position of local insurance companies. While there has been no immediate concern about their liability risk, we are closely monitoring the asset position of insurance companies, including life insurance, given the decline of the equities markets and the other assets markets. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Lim Hng Kiang]. Bill considered in Committee; reported without amendment; read a Third time and passed.”
“I think the changes that we put into this Bill are to regularise this, so that when somebody pays a premium for a policy, that premium should go to the insurer and the interest that comes from the premium should go to the insurer as well. Mr Leong also raised the point about the register of prohibited persons. I would like to assure the House that although we allow access to this register, this would be restricted. It would not be open to public scrutiny. The way we would operate it is that anybody who intends to employ somebody, whether as a director, an employee or as a broker, can come to MAS and query whether such a person is a prohibited person. Therefore, the register is not intended for public scrutiny, but it is for somebody to check whether that person has been under prohibition. Mr Leong also asked about the impact on the insurance industry arising from the terrorist attacks on the World Trade Centre. MAS is monitoring the impact. Our initial assessment is that Singapore-based insurers do not have any known direct exposure to the losses arising from the terrorist attacks. Singapore-based reinsurers have minimal exposure to US risks as their major markets are in the Asia Pacific region. So, our direct impact is minimal. The main impact would be indirect. First of all, weaknesses experienced by parent offices and foreign reinsurers may give rise to negative spill-over effects on local operations. Secondly, as Singapore insurers rely heavily on reinsurance support, they may be affected by a reduction or even cancellation of reinsurance cover, restricted coverages and higher premium charges. Mr Leong pointed out that because of the risk from such terrorist attacks, the premium for reinsurance is likely to go up.”
“Mr Speaker, Sir, I would like to thank Mr Leong Horn Kee for supporting the Bill. I would like to respond to his questions. First, on the cost impact on the insurance industry, let me assure the House that one of the objectives of putting this amendment in place is to make the insurance industry more competitive and cost implication is one of the considerations high in our minds. At the same time, we do need to enhance prudential regulations. So the example that Mr Leong posed, ie, the requirement to have actuarial certification of the liabilities, we consider this to be a very important prudential requirement. It should not add to the cost significantly. Secondly, on the operation of the Financial Advisers Act and the Insurance Act, the whole idea is to align the two Acts together so that the requirements for the different intermediaries operating under these two Acts would be the same, and the requirements would not be onerous. A life insurance broker, who has a permit under the Financial Advisers Act, would not face the additional requirements because both Acts have been aligned. Thirdly, the question on interest income from premium accounts. If you look at it logically, when somebody buys an insurance policy and pays a premium, that premium is actually due to the insurer and should not be kept by the broker. But the current rules allow the broker to hold the premium during the transition period, and in fact, keep the interest income from the premium during this transition period. This is not desirable because then it incentivises the broker to hold on to the premium for a much longer time and enjoy the interest.”
“The Ministry of Health plans to build a polyclinic to serve Sengkang and Punggol residents. The polyclinic should be ready by 2004. In the meantime, we have extended the Primary Care Partnership Scheme to Sengkang so that needy elderly residents have the added convenience of receiving subsidised care at private General Practitioner (GP) clinics near their homes instead of travelling to a polyclinic. BICYCLE LANES 23. Mr Noris Ong Chin Guan asked the Minister for Communications and Information Technology if his Ministry intends to improve the roads in Singapore, especially in newer housing estates, to cater for bicycle lanes, so that more residents can adopt the healthy lifestyle of cycling when they need to travel short distances within their estates, instead of relying on cars or feeder buses.”
“I will get the report and ask my officers to study it. SINGAPORE OPEN UNIVERSITY (Use of CPF balances for degree courses) 18. Mr Thomas Thomas asked the Minister for Manpower if he will, in line with the national objective of promoting lifelong learning, allow Central Provident Fund account holders to use their balances to pay for degree courses at the Singapore Open University and for distance learning courses from reputable overseas universities.”
“The position is not different from WHO. We are saying that based on current studies, we follow WHO's standards. And WHO's standards say that while they are still studying the long-term effects, it is safe to use the handphone.”
“Mr Speaker, Sir, the Health Sciences Authority (HSA) had issued comprehensive Health and Safety Guidelines on Electromagnetic Fields (EMF) on 16th August 2001. These guidelines are based on the latest status of the World Health Organisation (WHO) EMF Project which is the international benchmark for research in this area. While noting that research is in progress, international scientific committees that have evaluated the current body of evidence, have reached the same conclusion: that there are no established health effects from EMF exposures below these internationally set guideline limits. In answer to question (b), the Infocomm Development Authority of Singapore (IDA) gives type approval of mobile phones. Part of this type approval includes radiation safety standards and the requirement for manufacturers to provide their Specific Absorption Rate (SAR) value for mobile phones. So these radiation safety standards are based on international safety standards. In answer to question (c), mobile cellular base stations are commonly installed in both indoor and outdoor locations. They function to provide mobile cellular subscribers with the required mobile service coverage. When the mobile operators install more base stations to improve mobile cellular services coverage for their subscribers, this actually reduces the transmitting power by which the mobile phones and base stations operate at. So the bottomline is the more base stations we have, the lower the power, and therefore the safer it is.”
“The BAC will finalise its views after consultations with the community, including the general public and interest groups, through dialogue sessions and forums as well as further international consultation. The BAC will submit its recommendations to the Life Sciences Ministerial Committee by the end of the year. ; THREAT POSED BY RELIGIOUS OR EXTREMIST GROUPS TO NATIONAL SECURITY (Assessment) 13. Mr Noris Ong Chin Guan asked the Minister for Home Affairs if he will (i) give an assessment of the extent of the threat, if any, posed by religious or other extremist groups to our national security; and (ii) highlight the approach adopted by his Ministry to monitor the activities and influences of such groups.”
“Mr Speaker, in Singapore, the practice of human embryology and in-vitro fertilization (IVF) is regulated under the "Guidelines on Human Embryology and the Practice of Reproductive Technologies in Singapore" issued by the Ministry of Health. All current embryonic stem cell research has been done in accordance with these guidelines and with internationally accepted guidelines. Ethical approval is required from the respective institutional ethics committees operating within the broad Ethical Policies and Guidelines set out by the Ministry of Health with the advice of the National Medical Ethics Committee. Researchers at the National University of Singapore, in collaboration with researchers in Australia and Israel, were able to develop 6 stem-cell lines which were derived from excess frozen embryos donated to medical research by couples who underwent IVF treatment. These excess embryos were donated voluntarily with the patients' signed informed consent. We are in the process of reviewing our embryonic stem cell research regulations. In November last year, the Bioethics Advisory Committee (BAC) was appointed by the Government to address the ethical, legal and social issues arising from research on human biology and behaviour and its applications. The BAC has been actively addressing and deliberating on the issue of human embryonic stem cell research. Among other things, it has received a report from an Inter-Ministry Committee set up to explore the ethical issues involved in cloning and stem cell research. The BAC also regularly consults with an International Panel of Experts.”
“My Ministry would definitely do so. We are in charge of healthcare. We want the best outcomes for Singaporeans. If we are assured that health screening is effective, you can have my assurance that we will do it quickly. BILL INTRODUCED CENTRAL PROVIDENT FUND (AMENDMENT) BILL "to amend the Central Provident Fund Act (Chapter 36 of the 1999 Revised Edition)", presented by the Minister for Manpower (Dr Lee Boon Yang); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. PATENTS (AMENDMENT) BILL Order for Second Reading read. 1.05 pm”
“For the bottom 50%, if they turn up first for the community health screening, it will go a long way to minimise the health problems faced by them. That is our priority. That is our main challenge - to get the older folks and lower-income people to do regular health screening. The $20 health screening will go a very long way in minimising all these chronic illnesses.”
“It is an effective screening and I think you should use your cash to pay for it. For the bulk of Singaporeans, if they all just turn up for the community health screening, I will be very happy as the Health Minister. Even if I allow Medisave to be used for executive health screening, it would not be the bottom 50% of Singaporeans who will go for this screening and this is the group that presents the greatest challenge for us, not the top 30%. And even if you go for executive health screening, you do not scope every year. The doctors would tell you if you are in the high-risk group, and you only scope if you are above 50 years old. If you can afford it and you want to do it every year, by all means, do so. But please do not use Medisave.”
“I have had this debate in my Ministry many times and my doctors tell me that right now, there is no evidence, on efficacy grounds, to do it in Singapore.”
“I have already said so in my reply that there is no strong evidence that mass screening through colonoscopy works. There are studies done in the United States and other countries and there is no evidence to say that mass screening works. We are looking at the evidence. We are looking at such clinical tests and when we are convinced that it is effective, we would do so.”
“Sir, if the Members here support an increase in the Medisave contribution rate, I would allow Medisave to be used for such screening. Dr Lily Neo: Mr Speaker, Sir, I would like to register my thanks to the Minister for Health for his consideration and may I also urge the Minister to expedite this reconsideration. But, Sir, would he also comment on the colonoscopy for colorectal cancer, please?”
“We have to use our Medisave carefully. I sympathise entirely with women who want to do their breast screening early. I would urge them to do so. My usual reply to them is: save on one hairdo and use the money for breast screening. I have been taken to task by many of my hairdressers in Telok Blangah but I think this is still my main message.”
“I do not dispute the number of people who died through cancer. People also die through heart disease, strokes and many other causes. The approach is, really, for effective mass screening, we do encourage. For mammography, we have it in our polyclinics, and we subsidise it up to 50%. I do not think cost is the main deterrent in people coming forward for screening. We have run free mammographies, and the take-up rate is still very low. So it is a whole process of education and getting people to come forward. Cost is not the key issue here. Other forms of health screening, where there is evidence that they are effective, we would do so. Colorectal cancer is one of the key cancer killers in Singapore. We are looking at other tests, not necessarily scoping, as a way of doing some kind of screening. We are still in the process of evaluating the efficacy of such tests. But I would urge against a trigger-happy use of our Medisave. Medisave should be largely utilised for hospitalisation episodes in the later stages of our life.”
“We stick to the old one, ie, do not smoke, eat healthily, exercise, manage our stress.”
“Vasoo (Tanjong Pagar): Mr Speaker, Sir, may I ask the Minister what other new healthy lifestyle programmes his Ministry will be promoting.”
“I do believe that prevention is better than cure and, therefore, I urge all Singaporeans to have a very healthy lifestyle. Screening is not a key mechanism for prevention. If we all undertake to have a healthy lifestyle, we will go a long way in making health care affordable and reducing healthcare costs. As I have said, I have not ruled out health screening as a useful device. But before we undertake a mass health screening and also allow Medisave to be used for health screening, we have to be very careful. First, we have to be convinced that the health screening based on trials and evidence is effective, otherwise we undertake a major health screening and we get people all worked up, too many false results and it is not money put to good use. Secondly, we must remember that Medisave is really intended as savings for medical treatment for old age. The amount of money that we put aside for Medisave is estimated, for the average Singaporean, to pay for about 10 or 11 hospitalisation episodes. So if we ask our constituents, those below 60 years old, as I do regularly in the dialogue sessions, to put up their hands if they had been hospitalised more than twice or thrice, very few had done so. In fact, most of the hospitalisation episodes are when we are old, when we are 65, 70 or 75. That is the whole purpose of the Medisave account - to save for the day when we are retired and we have to pay for our hospitalisation. When we are still active, earning and have our own savings, we should use these to pay for the other types of health screening which different people want to undergo, and reserve the Medisave accounts for hospitalisation in our old age. Dr S.”
“Mr Speaker, Sir, there is no evidence right now that a nation-wide scoping, as Mr Sin puts it, is going to be cost effective in preventing or detecting these cancers early enough. There are just too many false positives and false negatives involved. Dr Lily Neo: Mr Speaker, Sir, may I ask the Minister for Health whether he agrees that prevention is better than cure. If it is, would he not encourage more people to practise this concept using their own funds by allowing them to go for health screening for the common cancers, such as colorectal cancer as mentioned earlier by my parliamentary colleague, Mr Sin Boon Ann, and breast cancer using their Medisave?”
“Mr Speaker, Sir, this is indeed what we have done. We all believe in evidence-based medicine, and we regularly look at the tests which are done. If the clinical trials and the tests show that certain types of screening are indeed effective, then we introduce these and we make these mass-based. This we have done for pap smear and mammography, and we have also done, for the community health screening, for diabetes and high blood cholesterol and hypertension. But there is a wide range of medical screenings. So we look at the evidence and, if the evidence shows that a nation-wide mass screening is effective, we do indeed undertake this screening.”
“Mr Speaker, Sir, the Medisave scheme is primarily designed to help individuals meet their personal or immediate family's hospitalisation expenses, especially during old age. However, over the years, we have extended Medisave to certain outpatient treatment, such as chemotherapy. My Ministry has considered extending the use of Medisave for health screening, including annual medical check-ups, and decided against it. First, there are many types of health screening, of which many are not cost effective. Second, for certain cost-effective health screenings, such as mammography and pap smear, my Ministry has already made them affordable by providing heavy subsidies at the polyclinics. Also, we have introduced the Community Health Screening Programme for the elderly to detect diabetes, hypertension and high blood cholesterol. Again, the cost is minimal, as the elderly pays up to $5 for the screening which costs around $20. Therefore, Singaporeans need not rely on Medisave to pay for cost-effective health screening. There is always the temptation to liberalise Medisave for various types of healthcare services. We have to guard against such a tendency, as an overly liberal extension of Medisave will result in even higher rates of contributions into the Medisave Account.”
“Public sector hospitals offer a range of wards to meet different needs. Ward classes A, B1 and B2+ are air-conditioned. Ward classes B2 and C are not air-conditioned but are well ventilated and have ceiling fans. Having fans instead of air-conditioning does not affect the quality of treatment or the pace of recovery. This is consistent with our approach to concentrate on effective, up-to-date medical treatment at the Class B2 and C wards, and not be distracted by frills and embellishments. 1 Serious crimes are classified as the 10 major offences of murder, rape, outraging modesty, robbery, snatch theft, housebreaking, motor vehicle-theft, cheating and related offences, rioting and serious assault. 2 Singapore citizens and Permanent Residents.”
“The Centre for Radiation Protection of the Health Sciences Authority undertook a survey of radiation that could possibly be emitted from computer monitors and the central processing units in computers in 1998. The survey indicated that the levels for both ionising radiation (such as x-rays) and non-ionising radiation (such as UV, electrostatic and magnetic fields) emitted were either non-detectable or well below international safety limits. This survey confirms findings from similar studies done on computers in other countries and reviewed by the World Health Organisation's International Commission on Non-Ionising Radiation Protection. There is no radiation hazard associated with the use of computers. AIR-CONDITIONING CLASS C WARDS IN PUBLIC HOSPITALS 6. Mdm Claire Chiang See Ngoh asked the Minister for Health, in our overall effort to enhance the comfort level of Singaporeans living in tropical conditions by providing air-conditioning in work places and public transportation at negligible costs, will the Minister consider air-conditioning Class C wards in public hospitals to offer comfort to sick patients.”
“Sir, I thought I have already made myself clear. Mr John Olds was brought here on a term contract. He was paid a compensation package which includes a significant part in performance bonuses. The one who received the commuted gratuity for 31 years of service is Mr Ng Kee Choe, not Mr John Olds. ACQUISITION AND MERGER OF COMMERCIAL BANKS 10. Dr Ker Sin Tze asked the Deputy Prime Minister whether the Government will encourage the banking industry to preserve one or two small banks to serve small and medium enterprises and small account holders in spite of the current acquisition and merger of commercial banks in Singapore. 11. Mr S. Iswaran asked the Deputy Prime Minister (a) whether consolidation within the domestic banking sector will have anti-competitive consequences; and (b) what measures are in place to ensure continued competition and quality in the provision of banking services, especially to small customers. 12. Mr Low Thia Khiang asked the Deputy Prime Minister what is the Government's vision for Singapore to become an international financial centre and whether the merger of commercial banks will help to move Singapore towards the vision.”
“Mr Deputy Speaker, Sir, I beg to report that the Committee of Supply has made further progress on the Estimates of Expenditure for the financial year 2001/2002, and ask leave to sit again on Monday, 12th March 2001.”
“But for a national screening exercise to be effective, we must look at the whole scale plus the payoff. And for these chronic illnesses, there is a good payoff, and therefore, based on the evidence and research, we are embarking on it. Of course, our community health screening process is barely started. We need to plug at it, and I am sure in five to 10 years' time, we will start to enjoy the fruits of that very massive national screening exercise. On the specific examples of cancer, there are some cancers which are amenable to national screening exercises and some which are not. Colorectal cancer, for example, is not amenable to a national screening exercise. But we will identify the high risk groups and alert these high risk groups to go for screening. Breast and cervical cancer is amenable to mass screening, and this is where we are concentrating our efforts for the time being.”
“Mr Ibrahim asked whether the Ministry will set up a central registry of medical records. Today, the records are already in a few key areas. When you are in school, the school health system has a record. When you enter national service, MINDEF has a record. When you enter any one of our two clusters in the public sector, we have your records. So I think we should improve the record-keeping in these key areas first. Whether we combine all of them into a central registry, we have to proceed a bit more carefully, because we have to be very careful about privacy of information, particularly of medical information. I know the technology allows us, but we would prefer to proceed a bit more carefully, to make sure that there are enough safeguards to preserve the confidentiality of all this information before we embark on this central registry. Mr Magad posed many good suggestions about preventive healthcare and health promotion. I think we will hoist them in. I just want to respond to his suggestion about special rebates for vitamins and supplements for the elderly. The doctors tell me that if the elderly eat sensibly, they have all the necessary vitamins and supplements they need to live a long and healthy life. So they tell me that a rebate is not necessary. The only case they tell me is probably calcium supplements to make sure their bone mass is good and they do not have early osteoporosis. I am told that calcium supplements are not very expensive. So, again, there is no need for special rebates. 3.00 pm Mr Sin Boon Ann suggested that we undertake screening in a more aggressive way. Let me assure him, that is our intention, provided it makes sense. We have done so for diabetes, high blood pressure and blood cholesterol.”
“So this requires a bit of a mindset change in the hospitals and I can assure you that we are working towards that. For the consultants, whether they stay with us or not, really we have to manage them just like any other employees that we manage. The hospitals have put in place several measures to make the restructured hospitals a more attractive place for these consultants to work in. This faculty practice scheme is one way to remove this very sharp divide between the private sector and the public sector. We will have to continue working at different measures to make sure that the public sector has a fair share of talent and provides the service that is required or expected by Singaporeans. Let me next turn to primary healthcare. On this point about setting up clinics in new towns, our preference is to let the private sector determine the setting up of clinics. I think it is very hard for the Ministry to dictate how many clinics should be set up by the private sector in each new town. So the private sector will obviously respond once they know that Sengkang is building up. If there are only two clinics and people there have to be served, you can expect more private sector GPs to set up clinics there. As far as polyclinic is concerned, our policy is to develop a polyclinic when the population in the new town builds up to a certain level. Therefore, I am happy to say that Sengkang is building up nicely and we are planning to build a polyclinic there, and we will build it in due course. Of course, it will not appear overnight. It takes three or four years for us to plan, locate the site and actually build the polyclinic. But I can assure you that a polyclinic in Sengkang will be built in due course.”
“Obviously, there is not very much time for me to deal with all of the many good suggestions. So I would seek Members' indulgence that we will follow this up in greater detail after this session. Let me just in the next six minutes respond to some of the key points which Members have raised. I think managing doctors is a very important task. It is not just a HR management issue. The medical profession is a demanding profession which requires very committed people working under very difficult conditions. So I take in all the suggestions raised by Mr Bernard Chen and Dr Michael Lim. Obviously, our approach towards this is not just salary adjustments. We know that we have to keep up with the pay, but it is also a whole host of other things - working conditions, training, sense of public service, and so on. I want to assure Members that we are working at this. We intend to keep our fair share of talent. But just to put all these reports in perspective, there are two groups of doctors that we are dealing with. One is the medical officers (MOs) whom we have to train and who have to serve five years of bond with us. The other group is the consultants, who after their training, can either stay with us or go to the private sector. Dealing with these two groups, of course, requires different considerations. For the MOs, we want to make sure we give them a good grounding in training, so that if they leave us and become GPs outside, they would have a good exposure to all the key departments in the hospitals so that they would be good family physicians. But while they are with us for the five years, we should not treat them as cheap labour. We should pay them competitive rates and we should treat them as we should treat all our employees.”
“All our nursing homes will be located close to our community, because that is an important consideration. By the year 2010, we expect to have about 70-80 nursing homes. So we can expect practically one nursing home in every constituency. That is the kind of facilities we need to have, because of the ageing population. Today, we have 50 nursing homes. We are building another seven more over the next two years, and we are going to tender land for a few more private nursing homes. Our plan calls for 70 to 80 nursing homes by the year 2010, which practically means one nursing home in every constituency. So Members will be able to serve their residents quite well with one nursing home per constituency.”
“Our intention is that Medisave can be used to pay the premiums of this insurance scheme. We are actively working out the key parameters of this policy and we hope to be able to introduce this scheme in the fourth quarter of this year. Sir, I hope I have assured Members here that my Ministry has put in place a comprehensive package for looking after our elderly. We have a framework to set up all the facilities. We can assure you that these facilities will be adequate in number and of an adequate standard, and that the services will be seamlessly integrated. At the same time, we have also put in place the financing framework for the elderly, and we can assure you that the services will be provided at a price that the elderly can afford and sustain, and also at a price that we, as a society, can afford and sustain.”