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 Government will inject another $250 million into the Eldercare Fund, bringing it up to $750 million. We are progressively building up the Eldercare Fund and this will provide subventions to the various step-down care facilities. Second, we implemented means testing and the 3-tier funding for the nursing home residents since July last year. I am happy to say that this 3-tier subsidy scheme has given more support to the nursing homes. The funding of nursing homes receiving Government funding under this new 3-tier system has increased by over 20%, as more residents now qualify for funding and at higher funding rates than before. The Government's recurrent subsidy to step-down facilities is $31 million last year and we estimate that this will increase to $100 million by the year 2010 and that is why we are building up our Eldercare Fund quite aggressively. In the third area, I am pleased to announce that we will extend Medifund to the residential step-down facilities with effect from this year. This measure will supplement the fund-raising efforts of VWOs. For this fiscal year, we will set aside $1.7 million from the Medifund interest income for this scheme. Let me clarify that the extension of Medifund to VWOs is not meant to displace the role of the community in raising funds for the VWOs, but it should be seen as complementing their efforts. This is part of our "Many Helping Hands" approach. The final component to make sure that healthcare is affordable to our elderly will be to establish a Severe Disability Insurance Scheme to help defray out-of-pocket expenses in the event of severe disability. This payout is not only for those in institutional care, but also for disabled elderly who are cared for at home, using community-based services or home care services.”
“Last year, we worked with the various VWOs to integrate the services provided by the VWOs. In July, we announced the framework for integrated health services for the elderly. This is a long-term plan to guide the developments of the various VWOs in providing step-down care. I am not sure about my relentless efficiency, but I would like to assure Dr Jennifer Lee that since we are at the initial stages of the development of the plan, we will review this each year. So far, the feedback has been very good and the VWOs are confident that they can step up their provision of home medical and home nursing services. Basically, the whole idea is to divide Singapore into three regions, each supported by the geriatric and other departments of each regional general hospital. Then, the VWOs will run the community hospitals and the nursing homes and the other forms of step-down care - home medical and home nursing services. The Government will provide the funds, the training and the other resources for them to do so. We are working towards this. We will proceed at a pace that the VWOs can deliver the services. Sir, I am confident that in the next 10 years, with this framework, we will be able to build up all the necessary facilities to look after the elderly. The other element of this is, of course, the financing framework. Having built up all the facilities and services, we must also make sure that the elderly can afford to pay for it. Again, in addition to what I said earlier about the financing framework that applies to the elderly, there are four things which we have done to make sure that the elderly can afford all these services. One, we established the Eldercare Fund last year. This is an endowment fund built up by the Government's budget surpluses.”
“Making sure that our elderly is covered by MediShield will ensure that they will be in a position to pay for their hospitalisation bills. As I said earlier, the safety net provided by Medifund is also working. The elderly takes up between 25% - 30% of our restructured hospitals' Medifund disbursement. I think the elderly is well looked after in the primary care sector, as well as in the acute care sector. Let me now turn to the step-down care sector. Today, the VWOs provide about 60% of the market share in the nursing homes. The Government funds 90% of the development cost and last year, we introduced a new 3-tier subsidy level for the nursing homes. We recognise that there is a shortage of nursing home places and, therefore, we have taken steps to build more nursing homes. My Ministry is currently working with VWOs to build another seven nursing homes. They will be ready in the next one to two years. The Government funds 90% of the development of these seven nursing homes, which is about $75 million. At the same time, we have put up plots of land for private nursing home development. Our long-term intention is to allow the private sector to take up 40% of the market share by the year 2010. Today it is 70:30, and by the year 2010, we hope to achieve 60:40 the share between VWOs and the private sector. We believe that this 60:40 share will better serve the different socio-economic segments of our population. Both Dr Jennifer Lee and Mr Low Thia Khiang asked about the other provisions for nursing care and step-down care. Let me just say that for the other forms of step-down care, essentially home medical and home nursing, we have several VWOs providing this service. Today, there are six VWOs providing home nursing to more than 4,000 patients.”
“I agree with all Members here who made the point that prevention is better than cure that if the elderly were to manage their conditions properly, this would prevent severe complications and disabilities down the road, which would be even more expensive to treat and lower the quality of life of the elderly. Our polyclinics run the Comprehensive Chronic Care Programme (CCCP) to improve the management of diabetes, high blood pressure and high blood cholesterol. The polyclinics will remind those who are on this programme when the follow-up dates are due. Dr Lily Neo asked for a one-stop diagnosis and care planning centre. In fact, our polyclinics already serve this function. As I said earlier, most of the kind of problems that the elderly face can be managed quite well at the polyclinics. We have also experimented by co-opting private sector GPs in a pilot scheme to make healthcare more accessible to the elderly. This is working well in the four areas that we have started the pilot scheme, and we will extend this to other areas. The elderly can look forward to seeing their regular private GPs and continue to enjoy the same subsidy as they do in the polyclinics, if they meet the means test. Let me also assure Members that referrals of these elderly by the participating GPs to specialist outpatient clinics will also be at the subsidised rate. In time to come, the elderly will continue to enjoy subsidised rates at the specialist outpatient clinics, regardless of whether they go through the polyclinic or their private sector GPs, as long as they meet the means test. The third area is acute care. We all know that hospitalisation bills can be expensive and, therefore, last year, we offered to pay the MediShield premiums for the elderly for two years.”
“Sir, let me again assure Members here that the healthcare for the elderly is a very key item in my Ministry's agenda. I would just like to say that whatever I said just now about the whole financing structure for the country applies equally well, if not more so, to the elderly, because the elderly consumes a large portion of the healthcare services. In addition, we have also been making special provisions for the elderly but I must stress that the elderly must play their part and come forward and make full use of the healthcare facilities and services that have been set up for them. What can the elderly do? First of all, they should try and maintain a healthy lifestyle, eat sensibly and exercise regularly. Second, they should take part in the Community Health Screening Programme that we started in July last year. The cost is minimal. The elderly pays only $5 for the screening, which costs us about $20. In many constituencies, in fact, the elderly is only required to pay $3 or $2 and, even in some constituencies, just $1. But only 18% of the eligible residents turned up to be screened. Mr Ang Mong Seng said that one reason for this low turnout is the fear of detecting medical problems which are costly to treat. Let me assure the Members here and our elderly citizens that most of the problems that the elderly face can be managed at the polyclinic level. And at the polyclinics, the elderly enjoys a subsidy of 75%. So it is very affordable. For those who cannot co-pay the 25% portion, they can apply to the polyclinic for their fees to be waived.”
“The difference is that any surplus they make will be channelled back for medical research, training and patient care, ultimately, for the benefit of the patients they serve. This would therefore differentiate our restructured hospitals from the other private hospitals and Singaporeans will continue to enjoy a good affordable healthcare. Sir, in summary, I would say that the 3M structure has given Singaporeans a good affordable healthcare. We need to continue to make improvements primarily to extend the Medisave withdrawal limits so that Singaporeans do not have to pay out-of-pocket expenses. We need to extend MediShield and medical insurance so that the risk is better pooled among the population. And we need to implement casemix sensibly so that we can achieve better allocation of our resources. And by repositioning our two clusters as not-for-profit organisations, we want to reaffirm the importance of public service in the organisational structure of our restructured hospitals.”
“To underscore this "not-for-profit status", the Minister for Finance has agreed to exempt the two clusters from paying corporate tax. Instead, the tax savings and any surpluses generated as a result of their efficiency gains will be ploughed back for medical research, training and patient care. While the concept of not-for-profit is relatively new in Singapore, it is well established in the US. In the US, some of the very well-known medical centres, such as the Mayo Clinic Foundation in Minnesota and Johns Hopkins Medicine in Maryland are operated as not-for-profit organisations. By modelling themselves as not-for-profit organisations, our restructured hospitals will have a different organisational culture from the private hospitals. Our restructured hospitals will continue to preserve their sense of public service. Let me clarify that not-for-profit does not mean that our restructured hospitals do not have to worry about costs. The not-for-profit organisation must still exercise financial prudence, cost their services accurately, control their costs and improve productivity. So what is the difference, you may ask? For the private patients in Class A wards, they will continue to pay for the full costs for the healthcare services they receive. The difference is that the profit is not taxed and the profit is not meant for disbursement to the shareholders. For subsidised patients, they will continue to enjoy a high quality of medical care that is heavily subsidised by the Government. The difference is that the hospitals will be more efficient and more service-oriented than if it is run as a Government department. For the staff, they will continue to be part of a dynamic medical institution with high standards and a strong reputation.”
“Mrs Lim Hwee Hua raised some very fundamental questions about the role and philosophy of our restructured hospitals. Let me just say that we cannot just deal with the increasing healthcare costs by simply increasing the Government subventions every year. If we have to, I am confident the Minister for Finance would provide the additional budget, as he has done this year with his 30% increase. But, at the same time, for all of us in the healthcare sector, we have to continue to be more efficient, more productive and more responsive to the patient's needs. One key strategy in containing healthcare costs and yet providing quality healthcare has been the restructuring of the private healthcare delivery system. Since the late 1980s, we have been restructuring our public hospitals one at a time, starting with the Singapore General Hospital. By October last year, we have successfully completed the restructuring exercise, with the restructuring of Alexandra Hospital, Woodbridge Hospital and the polyclinics. I am aware that some Singaporeans are concerned that restructuring of public sector hospitals and polyclinics could lead to higher charges because they are private companies out to make a profit. I would like to reaffirm that making profits has never been the main objective of our restructuring exercise. We restructure so that we can be more efficient, more productive and more responsive. In this way, we bring the costs down and offer a better service to Singaporeans. I want to make our position on this explicit. SingHealth and NHG would therefore be repositioned as not-for-profit entities. As not-for-profit entities, their main objective is not to maximise profits, neither are they under pressure to pay dividends to their shareholders.”
“All I want to say is that we would take his comments and review them. I want to assure the House that casemix is intended to be a more effective and efficient way to allocate resources. It is not intended to cause doctors to discharge patients earlier. The casemix provides for outlier cases, as Dr Michael Lim raised, that means people who need to stay longer than what is provided for in casemix subvention. We allow the outliers to continue to stay in the hospitals if the doctors deem it necessary and we will then subsidise those outlier patients on a per day basis. So there is no change in the way we continue to subvent these patients. 1.45 pm I want to assure Members that casemix will not result in doctors coming under pressure to discharge their patients prematurely. Casemix is still in its initial phase. We need to build up confidence and I am sure people would have more confidence in the system as we implement it. As we get the costing data sorted out, people will feel that the costing is more reflective of the real cost, and the system is more equitable. So we are not rushing the system. We are making sure that the system is well implemented, the cost data is well researched. So far, of course, we have seen that our local cost data, when we compare it with the Australian cost data, is very close. So there is no reason to believe that we are costing our system wrongly. We also have an ongoing process where we review the costing methodology with the hospitals. We will look at the subvention rates every year to take into account the changing pattern of resource utilisation. So I just want to assure Members here that, before casemix is fully enforced, we have the safeguards in place and we will make sure that it will be implemented properly.”
“But if you enter the hospital through the private GP, at the point of entry into the hospital, whether or not you are in the A&E ward, you can choose the ward that you want to go to, whether it is B2 or C. If you choose B2 or C, then obviously you will enjoy the 65% subsidy and 80% subsidy accordingly. The choice is available at the point when you are admitted. If you are referred to the Specialists' Outpatient Clinic by the private sector GP, then as a starting point, we will treat you as a private patient. If you are referred to the Specialists' Outpatient Clinic by the polyclinic, we will treat you as a subsidised patient. But if you cannot afford to pay the fees in the Specialists' Outpatient Clinic, you can ask to be reclassified and we will require you to be means tested. So it is a win-win situation for Singaporeans. Anybody who wants to enjoy subsidised healthcare can go to a polyclinic and then go to the SOC, and no questions are asked, we would not require you to be means tested, and you can enjoy subsidised fees. But if you enter the public healthcare system through the private GP and you think that you deserve subsidised healthcare because you are from a low-income family, then you ask to be means tested. And if you do qualify, then you will enjoy the subsidy. So that is a fair system. It may not be completely effective, because as Mr Low Thia Khiang suggested, you will allow rich people to enjoy subsidies by going through the polyclinic system. So I hope Mr Low Thia Khiang will continue to plug the line and when the population is ready to accept means testing, we will use means testing in a wider way. Dr Michael Lim raised some concerns about casemix. I do not want to go through the details because this is a very specific issue.”
“Sir, on this whole issue of Government subsidies, again, let me stress that the Government basically assures all Singaporeans that they will have access to affordable basic healthcare. The same package of basic medical service is available to all classes of wards. The key differences are that in the unsubsidised wards, you enjoy the ambience of fewer patients to a room and you can name your own consultants. But other than that, between a B2 and a A ward, the Government will extend the same basic level of service. Several Members also remarked about the high level of subventions to the hospitals. As you well know, the highest share of medical expenses occurs in our hospitals and therefore this results in a higher proportion of subvention. Government subvention to the restructured polyclinics and hospitals has therefore increased significantly every year. In FY1999, it was $580 million. In FY2000, it was revised to $700 million and this year, we will increase it to just about $1 billion. While the Government is prepared to increase the subventions, we must make sure that we target the subventions appropriately. I agree with both Mr Low Thia Khiang and Mrs Lim Hwee Hua that subsidies should be directed at those who are most deserving. The most direct way to channel the subsidies to the lower-income group, which may eventually be necessary, would be through some form of means testing. However, as pointed out in the 1993 White Paper on Affordable Healthcare, means testing is an administratively clumsy procedure which the public will take some time to get used to. The current rules allow you to enjoy subsidies if you go through the polyclinic system and then you go to the public hospitals. We keep these rules.”
“I think it is worth reiteration, and these remarks would have to be more widely transmitted to the professional community. Let me at this juncture try and respond to some of the other points raised by Dr Tan Cheng Bock. We have some rules in the way the subsidies are given. If a patient opts for a B1 or A class ward, he or she can ask for a downgrade, and most times this would be acceded. The only exception is if you go to a private hospital and then later you want to transfer to a public hospital, we will insist that you transfer to a B1, that means, a non-subsidised ward. But if you are within the public hospital system, if you ask for a downgrade, this would be considered with one condition - we will ask that you go for means testing. So if you enter the health system and at the point of entry you choose B2 or C, no questions are asked, we would let you have the subsidies. But if you opt to be non-subsidised and later on you ask to be subsidised, then we insist that you go for a means test so that we know that the subsidy is correctly targeted at the low income families. So that is the only rule. If you cannot afford to pay the fees, you can ask the medical social workers in the hospitals and they will undertake to review your case. And the hospitals have some means to waive the fees, if the case is genuine, or to seek Medifund assistance. Dr Tan also asked that we prescribe shorter duration for drugs rather than giving out one to two months' supply. I think we would have to depend on the doctors to exercise the judgement. In some cases, it is more sensible to give one to two months' supply so as to make it more convenient, and the patients do not have to come back so often. At other times, it may be sensible, as he suggests, to just give one or two weeks' supply.”
“As I have said many times here in this House, if any Member comes across genuine deserving cases that require Medifund assistance, feel free to write to either my Parliamentary Secretary or myself, and we will take up the cases. But from my experience in the last years, the Ministry has shown that the Medifund safety net is a very effective safety net. By and large, the 3M framework has served us well. I think what we need are refinements and adjustments. What is our target? Our target is that all Singaporeans who make regular contributions to their Medisave and who are covered by MediShield would not need to pay out of pocket, if they stay in a B2 or C ward. If their Medisave accounts run out, they can apply to Medifund to help pay for their bills. So that is our target, and by and large we have achieved that. But I must caution that Singaporeans who choose to go for higher ward classes or who wish to go to private hospitals would have to pay out of their pocket. It is therefore important that Singaporeans who require hospitalisation choose their ward class prudently. This is why financial counselling is a mandatory requirement in all hospitals, both in the public and private hospitals. This is a requirement before they are allowed to use Medisave for their patients. I agree with Mrs Lim Hwee Hua when she spoke about the importance of financial counselling which would enable patients to have a better estimate of the expected hospitalisation charges so that they can choose the type of ward class according to their means. I think Dr Tan Cheng Bock also made several very timely and wise remarks about the role that doctors play in helping to keep health cost down.”
“My Ministry is currently reviewing MediShield with a view towards enhancing its features, in particular the claimable amounts. We are also looking at the deductibles. This is to ensure that MediShield is able to provide adequate protection to the elderly and other Singaporeans who incur high medical bill sizes. Again, we need to strike a balance between enhancing the features of MediShield whilst at the same time keeping MediShield premiums affordable to all Singaporeans, especially the elderly. The third "M" in our 3M structure is Medifund. Dr Wang Kai Yuen asked about the utilisation of Medifund interest income. The average utilisation is about 77%, and this is despite the approval rate for Medifund which is consistently being above 97%. 97% of applications that come to us are routinely approved, and even then we only use 77% of the funds available. So I want to assure Members here that Medifund is more than adequate to meet the needs of the low-income Singaporeans. In fact, it is a very effective safety net. As we all know, Dr Richard Hu announced that the Government will inject a further $100 million into the capital sum of Medifund, bringing it to a total of $800 million. I agree that we should publicise the use of Medifund more deliberately so that people who face financial difficulties will seek recourse to Medifund. Let me assure Members that we have medical social workers in all our hospitals. Whenever they come across cases of patients facing financial problems, they will take up the cases and apply for Medifund on behalf of the patients. I do not think we will find very many people falling through the Medifund safety net.”
“Let me now turn to the whole framework of financing - we call this the 3M framework (Medisave, MediShield and Medifund) - and how the 3M framework has allowed Singaporeans to be able to pay for their medical bills. First, Medisave. I agree with Members that there is a general perception that the use of Medisave is rather restrictive. There are many suggestions to extend Medisave to outpatient treatments. While the original intent of Medisave is to help Singaporeans cope with hospitalisation expenses, we all agree that the trend is towards ambulatory care. Medisave is already allowed for day surgery and over time, we will extend Medisave to more outpatient treatments where appropriate. However, I must say that we must proceed cautiously because an overly liberal use of Medisave would necessitate higher monthly contribution rates. So we need to strike a balance. My Ministry will be making adjustments to the Medisave withdrawal limits so that most Class B2 and C patients would be able to pay their hospitalisation bills through Medisave. We will also increase the Medisave withdrawal limits for certain expensive outpatient treatment, such as chemotherapy and renal dialysis, to help alleviate the financial burden on Singaporeans. Details of these adjustments will be announced soon. But I would just want to dampen expectations. We know we need to make the change, but we will have to move cautiously. Second, MediShield. My Ministry is also looking at relying more on medical insurance to complement medical savings to improve the efficiency of the entire patient finance structure. Mr Yeo Guat Kwang has pointed out the problem of low payouts of MediShield.”
“It is more important to look at the output. Notwithstanding what I said about our low national healthcare expenditure, I do not think we are complacent. We know that the pressure on healthcare cost is relentless, and many Members have spoken about this. The increase in healthcare cost is a world-wide phenomenon. Singapore cannot be insulated from the trends and developments around the world. Medical technology continues to advance and we expect new developments in diagnostics, biomedical devices and drug development. In the US, for example, drug prices have risen by as much as 15% a year. Also, as our standard of living improves, Singaporeans will have higher expectations. Demand for healthcare services will correspondingly increase. In particular, we are undergoing a major structural change in our demography. So we are under tremendous pressure on healthcare cost. The challenge for us is how do we keep abreast of this challenge so that to the average Singaporean, healthcare continues to remain affordable. Mr Bernard Chen's comments on health cost is spot-on, 60% of our cost is in manpower, 15% of our cost is in medical supplies, the majority of which is imported and therefore out of our control. So the cost pressure is there. 1.30 pm But so far, we have done reasonably well. We have been able to contain the increase in healthcare cost to within the range of 6% to 8% per year. Looking forward, we cannot keep still. We have to adjust and refine our financing framework so that we can continue to enjoy sensible improvements in our healthcare service, while still keeping it affordable to all Singaporeans.”
“They looked at all these factors and looked at our inputs, and they ranked us 6th. So I think we have done well. The other key macro parameter which Dr Lily Neo and Dr Wang pointed out is the public share of the national healthcare expenditure. They observed that the public share is about a third, compared to other countries which will range from probably half for the average to maybe 70-80% for countries which adopt a national health system kind of approach. Sir, if we look at the healthcare systems around the world, we probably can put them in a spectrum. On the one hand, we have a very equitable, open to all, everybody enjoying the same type of service, epitomised by the National Health Service of the UK. On the other end of the spectrum, you probably look at the voluntary health insurance system, as practised in the US, and somewhere in between, most of the other systems will fall in. Most of the developed European countries will be closer to the British end of the spectrum. Because of that approach, the share of the public sector will be higher. In Singapore, the public sector share is one third. This is because of the way we organise the healthcare financing. We ask every Singaporean to pay into their Medisave and then they pay the bills from their Medisave. If you can imagine that instead of contributing 6% into the Medisave account we ask them to pay 3% of their salaries into a national insurance system, as a medical payroll tax, and that is then used to fund the system, you will see the share of the public sector going up. So I do not think we should read too much into this sharing of the national healthcare expenditure between the public sector and the private sector. It is how you organise the medical financing framework.”
“This has played a significant role in containing healthcare cost increases. If we lose this discipline, we can expect healthcare cost to soar. Sir, all in all, I can say that our national healthcare cost is low and indeed we should be happy that our national healthcare cost is low, because this correspondingly means that the average Singaporean household needs to pay only about 3% of their household expenditure, or about $93 per month, on healthcare services. Based on an average household size of 4.2, each household member therefore spends about $22 per month on healthcare. To put this in perspective, this amount is less than the average amount that the average Singaporean spends on recreation and entertainment. So, because our national healthcare cost is low, the burden on individual household is also low. Of course, this is looking at the macro level. When we look at the individual level, we have to make sure that our medical financing framework caters for the family who has to pay a high bill because of a particular episode. I think Members agree that we should not look at how much we spend to evaluate our healthcare system. When we evaluate whether a national healthcare system serves its citizens well, we should not look at the inputs but we should look at what we achieve. I think there are many parameters, which I will not go through in detail. I would just say that these parameters are adopted by the World Health Organisation. They did an assessment of all the countries in the world. Among 191 countries, they came to a conclusion that our healthcare system is ranked 6th in overall cost effectiveness. That means they looked at our output, the clinical outcomes of service, our waiting times, sense of equity, sense of accessibility.”
“Dr Lily Neo and Dr Wang Kai Yuen have commented about our low level of national healthcare expenditure (NHE), which is about 3%-odd of our GDP compared to other major developed countries which can range from about 7% in UK to 14% in the US. Dr Wang asked specifically how we can spend so little and yet achieve so much. I must first say that we cannot claim full credit for this performance. There are several factors in our favour, some of which have been pointed out by Dr Wang. We are an urbanised society, compared to many big countries which have a rural sector, which will cost quite a lot more to service. We have, right from the onset, laid a very good foundation in very stringent and good environmental health, and that has, of course, given us a good starting point, and public healthcare is therefore lower. At the same time, another key factor is that we have a relatively young population, compared to many of these developed countries. Our aged population, those aged 65 and above, constitutes about 7%. In many of the developed countries, it is closer to 10-12%. We have a much younger population. So we can expect that when our population ages, the national health expenditure will increase correspondingly. Another reason is our strong economic growth in the last 20 years, which averaged about 8% per annum, compared to our population growth of less than 2% per annum. In this way, we could enjoy significant improvements in our healthcare every year without the percentage share of GDP going up by very much. But as we move forward, as our economy matures and growth slows down, we can therefore expect the NHE, as a percentage of GDP, to correspondingly increase. Another very important reason is our prudent policies in the provision and financing of healthcare.”
“Sir, I want to thank the Members for raising the issue of healthcare costs and the affordability for Singaporeans. This gives me the opportunity to reassure Members that the Government is indeed committed to providing good and affordable basic medical services to all Singaporeans. This commitment is clearly set out in the 1993 White Paper on Affordable Health Care and we intend to meet this commitment. First, I must say that I am very happy with my Ministry's budget this year. It has been increased by 30%. Mr Bernard Chen has asked how we intend to use the additional funds. We will put the additional money to good use. We will increase the budget of our two healthcare clusters. Specifically, we will increase the budget of the primary care sector by 28%, the acute medical sector by 14% and the psychiatric medical sector by 26%. The additional budget will be used to offset increases in manpower cost. I think several Members raised the importance of paying our medical staff appropriately according to market rates. The money will also be used to strengthen quality assurance programmes and to also implement new initiatives. My Ministry will also increase the budget for health promotion activities by a very significant 68%. The funds will be used to strengthen preventive healthcare, health promotion and public education, to prevent the onset of chronic diseases. This is what Dr Lily Neo said, "setting the foundation to keep future healthcare cost down." In addition, we will also set aside $75 million for specific national programmes, such as the health services development programme, setting up the various disease registries and so on. Funds will also be set aside specifically to train our medical undergraduates and specialists. Let me now turn to healthcare expenditure.”
“HSA will build a strong and credible world-class professional capability to regulate all health-care products and to provide specialised scientific expertise to support essential statutory functions. As the national regulatory agency, HSA will provide seamless service to the health-care industry, and effectively safeguard public confidence in the quality, safety and efficacy of all health-care and blood products in Singapore. HSA will forge strategic alliances and partnerships with other world-class regulatory and scientific agencies, such as those in the US, Europe and Australia, to achieve global recognition of its capability and expertise for Singapore. Sir, I beg to move. 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. ADJOURNMENT TO THE NEXT DAY (Motion) Resolved, "That at its rising today, Parliament will stand adjourned to tomorrow, 23rd February 2001, at 2.15 pm." - [Mr Wong Kan Seng]. ADJOURNMENT MOTION”
“MOH has already faced difficulty in attracting these professionals into the highly specialised fields of expertise in the five departments. As a statutory board, HSA will now have greater flexibility to be competitive so as to recruit and retain its fair share of professional talent. With more competitive recruitment policies, HSA will also be able to attract foreign talent to augment and enrich the local talent pool. Mr Speaker, Sir, I will now highlight the main features of the Bill: The composition of the Authority shall consist of a Chairman and six to ten other members as provided in clause 5(1). All members, including the Chairman, shall hold office for such terms not exceeding three years, as specified in the appointment by the Minister. The main functions of the Authority as provided in clause 11(1) are: (i) to regulate the consumption and use of medicines, cosmetics, medical devices, tobacco products, radioactive materials, irradiating equipment and other health-related products in Singapore in accordance with statutory requirements; (ii) to maintain a safe and adequate national blood supply; and (iii) to provide professional, investigative and analytical services in health sciences to the Government and to any other person or body. The other features are: All the staff in the five departments will be absorbed into the service of the Authority on terms no less favourable than those enjoyed by them immediately prior to their transfer as provided in clause 31. All other parts of the Bill are similar to the Acts of other statutory boards. Sir, in conclusion, the formation of the Health Sciences Authority as a new statutory board will establish a comprehensive and integrated regulatory and scientific agency to support the Health Sciences.”
“The evaluation of a biotechnology product derived from genetically-engineered human blood, tissue or cells, and delivered by special miniaturised devices will require close scientific interaction of a range of professionals skilled in the evaluation and testing of drugs, devices and blood products. New capabilities in molecular biology, genetics, toxicology and pre-clinical evaluation will have to be developed. Combining the professional strengths in HSA will ensure that Singapore continues to have a capable and credible regulatory agency that is able to rigorously evaluate and approve these new and innovative products. The formation of HSA will also result in a one-stop regulatory agency that will administer a seamless regulatory process for all therapeutic products. Convergence in the application of medical technology has increasingly blurred the boundaries between health-care products. There is already a trend towards products that combine multiple technologies, eg, medical devices that also release drugs. As a multi-disciplinary agency, HSA will be able to deliver a well-coordinated regulatory process efficiently and effectively. The medical and pharmaceutical industry will now only need to interact with a single agency which will have the full range of professional expertise necessary to evaluate and approve their therapeutic products. Mr Speaker, Sir, the key to HSA's success is knowledgeable and well-trained professionals who are able to discharge their regulatory and statutory responsibilities with competence, integrity and commitment. With the growth of the health-care and biomedical sectors in Singapore, there will be increasing competition for good doctors, pharmacists and scientists.”
“The Health Science Division of the Department of Scientific Services comprises a group of specialised analytical laboratories that provide scientific testing services to support pharmaceutical, food, cosmetics, occupational and environmental safety. The Division is accredited under the Singapore Laboratory Accreditation Scheme of the Singapore Accreditation Council and is internationally recognised as a WHO Collaborating Centre for Drug Quality Assurance and Food Contamination Monitoring. Mr Speaker, Sir, the formation of the Health Sciences Authority (HSA) will build on our existing strengths and achievements by enhancing the management autonomy and scientific synergy of the five departments. Government has recognised the need to ensure the continued presence of a strong and progressive regulatory and scientific agency to perform these essential functions. In an era of rapid change in medical practice and increasing complexity of regulatory issues, the formation of HSA as a new statutory board will allow more timely and effective development, harnessing and integration of professional capabilities necessary to meet the challenges of the future. This will allow Singapore to keep pace with the best international practices and to be world class in our regulatory and professional expertise in the Health Sciences. The formation of HSA will result in a larger and stronger critical core of medical, pharmaceutical and scientific expertise to provide the synergy for professional and regulatory excellence. Developments in the biomedical sciences, both internationally and locally, will lead to the discovery of novel health-care products that will require new expertise and systems to make good evaluations before they can be used by patients.”
“SBTS has consistently applied the latest state-of-the-art technology for the testing of blood for infectious diseases to ensure that the risk of transmission is as low as possible, and to the standards of the best blood banks around the world. SBTS has achieved international recognition as a WHO Collaborating Centre in Transfusion Medicine since January 1992. The Institute of Science and Forensic Medicine comprises the Department of Forensic Medicine (DFM) and Department of Scientific Services (DSS) which serve as national reference agencies for forensic medicine, forensic science, radiation science and statutory scientific services. The standard of forensic pathology expertise provided by our Department of Forensic Medicine to the police and the courts for the investigation of death is well respected by the international forensic fraternity. The Forensic Science Division of the Department of Scientific Services provides a wide range of scientific expertise to the police for the investigation of crimes, such as trace evidence analysis, DNA profiling, document examination and toxicology. The Narcotics Laboratory supports the Central Narcotics Bureau in the investigation of drug offences under the Misuse of Drug Acts. This Division has achieved international recognition by being one of the few non-US laboratories accredited by the American Society of Crime Laboratory Directors since June 1996 and was also awarded the Excellence for Singapore Award in August 1999. The Radiation Science Division of the Department of Scientific Services is the national authority on radiation safety and control, and administers the requirements of the Radiation Protection Act.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The Government intends to establish a new statutory board, the Health Sciences Authority, by integrating five departments of the Ministry of Health, ie, the Centre for Drug Evaluation, Institute of Science and Forensic Medicine, National Pharmaceutical Administration, Product Regulation Department and the Singapore Blood Transfusion Service. The proposed Health Sciences Authority Bill is to provide the legislative framework for the formation of the new statutory board. The five departments to be integrated provide a wide range of highly specialised health scientific expertise and services. Our departments have achieved professional excellence in many of these areas of expertise and have been accorded international recognition. Our objective now is to build on the technical synergies and keep abreast of the rapid developments in the healthcare and life sciences industries. The National Pharmaceutical Administration (NPA) is responsible for ensuring the quality, safety and efficacy of medicines and other health-related products in Singapore. In January this year, the NPA achieved international recognition for its Good Manufacturing Practice (GMP) when Singapore became the first Asian country to be accepted into the Pharmaceutical Inspection Cooperation Scheme, an international benchmark organisation for GMP based in Geneva. The Singapore Blood Transfusion Service (SBTS) is responsible for the safe and adequate supply of blood and blood products for patients in Singapore.”
“They do not realise that diabetes is a silent killer, even though it may not manifest itself in very obvious symptoms. If you do not manage the condition carefully, you will end up with quite serious consequences. So this requires a lot of education as well as active assistance to the people, to make sure they are able to manage their conditions well. So it is an uphill task and we will continue to plug at it. 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. EXEMPTED BUSINESS (Motion) Resolved, That the proceedings on the remaining items on the Order Paper for today be exempted at this day's sitting from the provisions of Standing Order No. 1. - [Mr Wong Kan Seng]. HEALTH SCIENCES AUTHORITY BILL Order for Second Reading read.”
“Mr Speaker, Sir, we do not think it is necessary for us to set out in specific terms the qualifications of the board members. It is suffice to know that we will select a Board with different members to look at different aspects and who will add value to the Board. We will include of course medical professionals, with interest in the things that we are doing. We will include educationists, as I said earlier, maybe media people, who will help us devise the promotion strategy. We may include representatives from the various Ministries, for example, someone from the Ministry of Education or maybe someone from the Sports Council would be also useful. So we will look at all the various possibilities and put together a Board that can lead the management. On mammography facilities, we have started with two polyclinics and our intention is to extend this to all polyclinics in due course. This will happen by the middle or third quarter of this year. The polyclinics are now actively undergoing renovations to be able to take on these new facilities. On chronic cases, we have started the chronic care management programme some time last year so that people who suffer from chronic diseases, such as diabetes, high cholesterol, or high blood pressure, can be managed at the polyclinic level. They will be given a package to help them monitor as well as to go for regular consultations. This requires the people suffering from such chronic conditions to take an active interest and to manage their conditions actively. We are still in the early stages of the programme. It is not as successful as we like it to be. Some Singaporeans still take a fairly laid back attitude towards this, for example, towards diabetes.”
“The powers given to the auditor is necessary to make sure that they conduct effective audit of the Board. The auditor would be appointed by the Ministry, in consultation with the Auditor-General. On appointment, the auditor or his representative would be required to sign an undertaking to safeguard official information. So confidentiality will be safeguarded. The next point is on the use of the Board's seal. This is a standard provision. The provision allows the Board to have a seal to affix on to important documents and, if the Board wishes, it could break the seal, amend and create a new seal. I would like to assure Dr Lily Neo that even though a new seal may be created, any document that is sealed with the old seal will continue to be valid as long as the seal is applied in the correct manner by the Board. Dr Lily Neo also made the point about composition of offences. The provision to compound offences is an administrative way in which we give the offender the option to compound it by paying a composition fine. If the offender does not want to accept the composition, then the full process of the law would take its course. Let me assure Dr Lily Neo that these are all the standard provisions in setting up a statutory board. I recognise her concerns and these concerns are duly catered for in the Bill.”
“So one of the priorities of the Health Promotion Board is to direct their efforts at the workplace. Sir, these are the key issues that the Health Promotion Board, when set up, will deal with. Let me next turn to some of the administrative provisions in the Bill which Dr Lily Neo pointed out. These are standard provisions. But, nonetheless, since she raised them, it is worth my while to clarify them. First, on the qualification of the board of directors. We do not believe that we should restrict the board of directors to just medical or professional people. The Board should encompass a wide range of Singaporeans - those who can add value to the Board, whether they are educationists, whether they are people from the media that can help us promote and deliver the messages - who can in fact contribute to the Board. Regarding the conduct of the Board, like most statutory boards, the conduct would be based on the majority vote, and not requiring 75% vote for serious issues. I would like to assure the Member that for serious issues involving larger sums of money, the Board would comply with proper financial procedures which would require approval by a certain committee of the Board as well as the approval of the Ministry headquarters. On disclosure of interests of members, this is a standard provision. Most board members meet together to discuss projects and papers, and that is a convenient time for them to indicate their disclosure. However, if there is a project or decision paper that is done through circulation, then the board members can indicate the disclosure of their interest through writing and circulation as well. On the powers of the auditor, again, this is a standard provision.”
“Therefore, we are monitoring very closely the dental health of our population. Anecdotally, many dentists would tell you that in fact the volume of business has gone down because they are seeing fewer and fewer Singaporeans with bad teeth. The dental health of our population, by and large, is definitely improving. We agree that we should do more in the campaign against smoking. But I must emphasise that smoking is addictive and the trick is to prevent the teenagers from taking up smoking. Once they smoke and if they do so regularly in their early years, then they will be addicted and they will be hooked. We are tracking the incidence of smoking. By and large, the incidence of smoking in Singapore, as a whole, is dropping. But I do agree that the incidence for young females is rising which is a cause for concern. Therefore, one of the tasks of the Health Promotion Board is to target the anti-smoking campaign at these vulnerable groups - the younger people, including the younger females. Mr Yeo Guat Kwang emphasised about the importance of health promotion among the workforce. This is one of the new strategies that we are embarking to promote workplace health promotion programme. We recognise that the younger people in schools and institutions of higher learning provide us with an institutional setting for which we can conduct health promotion, health education and prevention programmes. But once they go into the workforce, there is less of this directed effort at the workforce. Therefore, we have embarked on this workplace health promotion programme to bring what we are doing in the schools also to every workplace. We are more successful in the community than in the workplace.”
“If they know that they have a diabetic condition, they will take active steps to manage this and mitigate the complications that may arise due to diabetes. Dr Lily Neo also mentioned pneumonia. We are studying this. Also, the problem of elderly falling. This is related to what I mentioned earlier about osteoporosis. It is not just building up the bone mass when we are young, but also taking part in exercises so that the bone structure continues to be strengthened. But, as Dr Lily Neo stressed, we need a more holistic approach to also make sure we have non-skid floors and less barriers in the design of our walkways. So HDB will undertake all these in conjunction with other agencies. Mr Chiam See Tong made the comment that he hopes that the Board would do a better job, implying that the current departments are not doing a sufficiently good job. The idea of creating the Board is of course to do a better job, but not to cast a judgement on the present departments. The present departments are doing a commendable job. What we want to do with the Health Promotion Board is to make sure these efforts are integrated and more focused on the children, adults and elderly in different settings, in schools, institutions, at the workplace and in the community. By putting the five departments together and by integrating the efforts and by focusing on each disease, we hope to be able to achieve better outcomes based on the strategies for each disease. On dental health, I hope when Mr Chiam said that he saw many Singaporeans with bad teeth, he is not doing so in a professional capacity. Indeed, the dental health of Singaporeans is improving. We have statistics on children's dental health status when they are seven, 13 and 19 years old. The number of cavities has reduced.”
“Mr Speaker, Sir, I would like to thank the three Members for their support of the Bill. I think we are all agreed that the intention of the Health Promotion Board Bill is to provide the framework to encourage Singaporeans to take better care of their health and this is the approach that the Board will undertake. They are systematically looking at the 10 most common causes of death in Singapore, analyse each disease, try to understand what causes the incidence of disease and then work out a strategy to try and bring down the incidence. Take, for example, cancer. The incidence of cancer is indeed rising, primarily due to two main reasons. First, because our population is getting older and therefore many cancers related to an ageing population are now on the rise. Second, there are also many types of cancer related to lifestyle that are more prevalent now than 10 or 20 years ago. So we are seeing a shift in the pattern of diseases. In particular, breast cancer is on the rise. Looking at each of the cancer types, the Board would devise strategies to deal with them. For breast cancer, we are going to set up mammography facility in every polyclinic. But the key is to get Singaporean women to go for breast screening. This requires both education, promotion and to get the women to act upon awareness, and not just know that breast cancer is a rising disease and mammography is important, but, more importantly, to get them to act and go for the screening. Second, coronary diseases and diabetes. These are related to lifestyle and therefore the messages we put out to the children, the adults and the elderly are very important. Diabetes is a condition that can be managed. What we need is to screen the people, particularly, the elderly.”
“The formation of the Health Promotion Board will also ensure more efficient use of financial and manpower resources, and strengthen the capacity and capability to develop, implement, monitor and evaluate these programmes. The Board will focus on outcomes and standards and will provide the impetus to ensure that results, especially in the problem areas, are achieved. Mr Speaker, Sir, I will not touch on the main features of the Bill. Part III, clause 11, sets out the functions, objects and duties of the Board which are: (a) to advise the Government on all matters connected with the promotion of good health and health lifestyles amongst the people of Singapore; (b) to organise and implement effective health education programmes and other activities to promote good health and healthy lifestyles and to prevent and detect diseases; (c) to determine, establish and recommend standards and guidelines on diet and nutrition to encourage healthy eating habits; and (d) to provide medical, dental, health screening and immunisation services to school children and other persons. Part VII, clause 42 of the Bill covers the consequential amendments made to the Infectious Diseases and Dentists Acts, portions of which will now be administered by the Board on behalf of the Ministry of Health. The rest of the provisions in the Bill are the standard provisions found in all statutory board Bills. Sir, we are facing new challenges in the pattern of diseases in Singapore. The formation of the Health Promotion Board will enable us to focus on and spearhead health education, health promotion and disease prevention programmes to meet these challenges. Sir, I beg to move. Question proposed.”
“The incidence of breast cancer has more than doubled over the last 30 years. A study among women showed that they are not well informed about breast cancer and its risks. They are also not aware that mammography is effective for the early detection of breast cancer and for improving the survival rate. Again, much more needs to be done in this area. Osteoporosis or brittle bones is a disease of old age. It is associated with higher risk of hip fractures and results in significant morbidity and mortality. The rate of hip fractures has risen by 38% from 42 cases per 100,000 in 1990 to 58 cases per 100,000 in 1999. With an aging population, the number of hip fractures is expected to increase, giving rise to much ill health, disability and suffering. As the build-up of bone mass reaches its peak by about 30 years of age, we need to ensure that measures to prevent osteoporosis start from the young and continue throughout life. Sir, we need to embark on a more focused integrated and concentrated approach to get the health outcomes we want. The setting up of the Health Promotion Board will provide the framework for a greater focus on these major health problems and spearhead health education, promotion and prevention programmes and create a supportive environment to tackle these and other health problems in children, adults and the elderly. The Health Promotion Board will work in collaboration with public, private and community organisations to develop and sustain national efforts to manage these problems. This building of close partnerships with other agencies and organisations will enable the Health Promotion Board to reach out to all Singaporeans in various settings and to reinforce the messages in many different ways.”
“Although the incidence of heart attacks has decreased from 94 per 100,000 in 1990 to 88 in 1998, our death rate of 76 per 100,000 population from coronary heart disease is higher than the rates of 58 and 60 per 100,000 in Canada and Australia respectively. Similarly, our death rate of 29 per 100,000 from stroke is higher than the rate of 14 per 100,000 in both Canada and Australia. These diseases often strike people in the prime of their life, resulting in premature mortality or severe disability. This results in both economic and social burden for their family and the nation. Fortunately, studies have shown that these conditions are preventable. The lifestyle related risk factors of these diseases, such as physical inactivity, unhealthy diet, smoking, obesity, high blood pressure and high blood cholesterol can be controlled. Reduction of these risk factors can improve the health of the individual and of the population. We must improve the health of our adult population by focusing our efforts on the areas that we are not doing so well, otherwise, although Singaporeans are living longer, their quality of life in their autumn years may actually be quite poor due to ill health. Singaporeans must take responsibility for their own health. They must adopt healthy lifestyles, go for health screening to detect chronic diseases early and if they have chronic diseases, they should go for treatment and regular follow-up. Unless Singaporeans take health education, health promotion and prevention seriously, many Singaporeans will live the last years of their life burdened with ill health and disability. There are other areas of concerns, such as breast cancer and osteoporosis. Breast cancer is the leading cancer among women in Singapore today.”
“For example, many of our secondary school students who were born before we introduced Hepatitis B immunisation for babies, have not been immunised against Hepatitis B and are at risk of Hepatitis B infection and liver cancer. We have therefore taken action to address this. Earlier this month, we implemented the Hepatitis B immunisation programme for students. This four-year programme will cover over 300,000 students in secondary schools, junior colleges, centralised institutes, ITEs, polytechnics, universities and our full-time national servicemen. Currently, we have a comprehensive dental health programme for primary schools. Every primary school has a dental clinic where dental health screening and basic dental treatment is done. However, the programme for secondary school is less comprehensive. As a result, the dental health status of our secondary school students is not as good as that of the primary school students. We are therefore working with the Ministry of Education to build dental clinics in secondary schools so that our students can benefit from having dental care on site in their schools. Defective vision or myopia among school children has continued to increase from an overall rate of 43% in 1990 to 51% in 1999. The rate among Primary 1 children has increased from 19% to 30% over the same period. We therefore need to implement measures to arrest and reverse this trend as high myopia is associated with potentially blinding conditions in later life. Sir, although we have done well in our school programmes, much still needs to be done. Among the adults and the elderly, however, there are some areas where we are not doing so well, such as heart disease, stroke and cancer.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The Government intends to set up a new statutory board, the Health Promotion Board, by integrating five departments in the Ministry of Health, namely, the National Health Education Department, Department of Nutrition, School Health Service, School Dental Service and Health Promotion Division (Administration). The objective of the Bill is to provide the legislative framework for the formation of the new statutory board. Sir, let me explain the rationale for the formation of the statutory board. The health of Singaporeans today is good. We have done quite well by any parameter. Our infant mortality rate of four deaths per thousand live births, maternal mortality rate of 0.1 per thousand live births and still births and life expectancy at birth of 78 years are comparable to those in developed countries. We have made significant progress in improving the health of Singaporeans in many areas through our health promotion and disease prevention programmes. Let me start with the children. Our children represent the future of Singapore. We need to ensure the health and well-being of our young. We have done well in this area. The National Childhood Immunisation Programme has resulted in the elimination of severe infectious diseases, such as diphtheria and poliomyelitis. We have also reduced childhood tuberculosis, whooping cough, measles, mumps, rubella to a very low level. Our comprehensive School Health Programme of health screening, immunisation, dental care and health education has contributed to the good health of our young. However, there are one or two gaps that we need to plug.”
“Consumers will also gain from the convenience and choice of accessing cash-withdrawal services at these new cash-points, especially in locations further away from any bank branches or ATMs. MAS has decided that it has no regulatory objections to "cash-back" schemes. Banks and retailers are free to implement "cash-back" schemes using their Electronic Funds Transfer at Point of Sales (EFTPOS) and Cash-card systems. It is up to the banks and retailers to institute operational procedures, security measures, and appropriate cash withdrawal limits. I hope that retailers like NTUC Fairprice, petrol stations and convenience stores will take this opportunity to provide better service to their customers, and make cash withdrawal facilities more widely available. This will be especially helpful to lower-income Singaporeans whose monthly salaries are credited to their bank accounts by employers, and whose main need is to make regular cash withdrawals in small amounts for their daily expenses. BUDGET DEFICIT FOR FINANCIAL YEAR 2001 26. Mr Tay Beng Chuan asked the Minister for Finance if his Ministry can provide for a budget deficit for FY 2001 in order to stimulate domestic demand, given the many indications of a slowdown in the US economy and political uncertainty in the region which will adversely affect the Singapore economy.”
“Table 1: Number of Chinese Language Teachers Who Resigned, 1995-2000 1995 1996 1997 1998 1999 2000* Primary 29 27 31 43 57 51 (1.4%) (1.3%) (1.5%) (2.1%) (2.6%) (2.5%) Secondary 22 18 20 21 24 21 (2.6%) (2.0%) (2.1%) (2.1%) (2.4%) (1.8%) JC/CI 2 2 1 2 9 7 (1.0%) (0.9%) (0.5%) (0.9%) (3.8%) (3.1%) Total 53 47 52 66 90 79 (1.7%) (1.5%) (1.5%) (2.5%) (2.6%) (2.2%) * As at 31st October 2000. Table 2: Number of Chinese Language Teachers Who Retired, 1995-2000 1995 1996 1997 1998 1999 2000* Primary 117 139 177 173 140 116 (5.5%) (6.6%) (8.4%) (8.3%) (6.3%) (5.6%) Secondary 41 46 49 61 41 44 (4.9%) (5.0%) (5.2%) (6.1%) (4.1%) (3.7%) JC/CI 0 5 8 1 1 3 (0.0%) (2.3%) (3.6%) (0.5%) (0.4%) (1.3%) Total 158 190 234 235 182 163 (5.0%) (5.9%) (7.1%) (7.1%) (5.2%) (4.7%) * As at 31st October 2000. Table 3: Number of Foreign Teachers Recruited To Teach Chinese Language, 1995-2000 1995 1996 1997 1998 1999 2000* Primary 0 0 0 14 0 2 Secondary 0 0 0 19 50 74 JC/CI 0 0 0 0 12 5 Total 0 0 0 33 62 81 * As at 31st October 2000. "CASH-BACK" SYSTEM 25. Mr Seng Han Thong asked the Deputy Prime Minister whether he is prepared to allow a "cash-back" system to operate in Singapore whereby customers in supermarkets can withdraw cash from the check-out counters, as like that in the UK. BG Lee Hsien Loong: Cash withdrawals at point of sale, or "cash-back" schemes, are readily available in supermarkets and other retail stores in the UK, US and Australia. These are commercial arrangements between banks and retailers. Retailers who receive large amounts of cash benefit, as "cash-back" allows them to reduce their cash handling. Banks benefit as this means fewer cash withdrawal transactions at ATMs, a service which is costly to provide.”
“My Ministry will be monitoring them in various ways, including time set aside by these doctors for subsidised care and teaching, clinical performance measures and non-clinical indicators such as waiting times to ensure that care for subsidised patients is not compromised. CHINESE LANGUAGE TEACHERS 24. Mr Goh Choon Kang asked the Minister for Education, from 1995 to the first ten months of 2000 (a) how many primary, secondary school and junior college Chinese Language teachers have resigned; (b) how many of such teachers have retired; and (c) how many foreign teachers have been recruited to fill the vacancies, giving breakdown figures for each year. RAdm Teo Chee Hean: Resignations The resignation rate of Chinese Language teachers ranged from 1.5% to 2.6% over the last 5 years. This is comparable to the overall resignation rate of between 2% and 3% in the Education Service. Please refer to Table 1. Retirements Please refer to Table 2. Annual retirement figures for Chinese Language teachers ranged from 158 to 235 over the last 5 years. In the first 10 months of this year, 163 Chinese teachers retired. Due to the age profile of Chinese Language teachers in primary schools, the percentage of retirement among Chinese Language teachers in primary schools is higher than the corresponding percentage for secondary schools and Junior Colleges/Centralised Institutes. Foreign Recruitment Please refer to Table 3. We are tapping on overseas recruitment to supplement to a certain extent our pool of local Chinese Language teachers. The number of Chinese Language teachers recruited overseas ranged from 33 in 1998 to 81 for the first 10 months of 2000. Education Statistics Percentages quoted are based on the stock of Chinese Language teachers in that category for the particular year.”
“By and large, our current health care system maintains a clear demarcation between public and private sector medical practices. There is scope for greater public-private sector collaboration to improve the quality and accessibility of care for both subsidised and private patients. My Ministry has given public sector hospitals the flexibility to allow their doctors to practise in the private sector for part of their time. This is aimed at retaining doctors who would otherwise opt to leave completely for the private sector. They will then continue to contribute to the care of subsidised patients as well as to teaching. Subsidised patients benefit from the retention of their skills and expertise. Public sector hospitals already have a Visiting Consultants Scheme where private sector specialists appointed as visiting consultants can see patients in public sector hospitals. There is scope for the public sector hospitals to interest more private sector doctors to take up part-time work in the public sector. These doctors could be given remuneration and terms tailored to the amount of time and effort they commit to patient care, teaching and research in the public sector hospitals. In this way, we can foster greater public-private sector collaboration in administering patient care and this will benefit Singaporeans. My Ministry has left it to the two clusters to decide whether they wish to implement the private practice scheme, and they are considering it. If implemented, they can set the terms to best suit their requirements, including the number of doctors to be allowed on the scheme. They will have to assure my Ministry that the needs of subsidised patients are met.”
“Second, we have put in place the whole package to help them manage their health condition. If they go to the polyclinics, they are subsidised 75% of the cost. They only pay 25% of the bill. This shows the very high level of support that the Government has put in place. We even allow them to go to the private sector GP, to make it more convenient for them, and they still enjoy the same subsidy. And every year the Government has a budget surplus, MPs in this House, including the Ministry of Health, will urge the Ministry of Finance to put in something for the elderly. As we all know, every time there is a budget surplus, the Minister for Finance will always put aside some top-ups in the Medisave for the elderly. This has happened on four occasions. And each time, we spent between $50 million and $250 million topping up the Medisave for the elderly. In the last National Day Rally, the Prime Minister put in place a scheme to pay the premiums for the elderly if they have not been covered under MediShield. All they have to do is to send a piece of paper saying, "I want to qualify for these two years' premiums." And only 65% made the application, ie, only 65% bothered to return the piece of paper to qualify them for the two years' premiums, despite all our efforts to encourage them and their children to send in the piece of paper. So I must say that we have put in place an entire framework to look after the elderly. I would like to urge all elderly Singaporeans not just to be concerned about their health but to take the first few steps to actually look after their health.”
“For the 1% which is not approved, please feel free to write to Mr Chan Soo Sen, or myself, and we will look into the case. So healthcare in Singapore is accessible to everybody in Singapore, and it is of the highest standard. As for the particular comment about healthcare for the elderly, despite his analogy of the three buckets, we have indeed set aside part of our old reserves in the form of Medifund for helping low income people to pay for their healthcare fees. And the main users of Medifund are, in fact, the elderly. We have set aside $700 million in Medifund and the interest from Medifund, which is equivalent to your NII, is used to fund Medifund applications, and 99% of the applications are approved. Last year, we set up the Eldercare Fund which is specifically targeted at the elderly, ie, those who have to go to nursing homes. Part of the past reserves would be put into the Eldercare Fund which would look after the elderly. The whole thrust of our healthcare system is largely aimed at the elderly because the younger population does not have healthcare problems. The bulk of the healthcare problems arise in the last five or ten years of your life. And in the last few years, we have put in the whole framework to look after the healthcare of our elderly. We started off with the community health screening. We subsidise it heavily and we encourage every elderly person to go for health screening. If the elderly are so concerned about their healthcare, I would urge them to go for healthcare screening. Instead, today, only 20% of those we have invited turned up for the health screening. Indeed, if they are so concerned, the first step that they should take, to be personally responsible for their health, is to turn up for their health screening.”
“Mr Speaker, Sir, although the main topic today is on the NII, Dr Wang has raised healthcare issues. I will be very happy to respond to it in full when we debate this during the Budget session. But I would like to make some points since it is fresh and current. First, total healthcare expenditure. I think Dr Wang, in the end, did clarify that the number he used for many of the developed countries of 6% to 7% of GDP on total healthcare expenditure and for the US, 12% to 14% of GDP, should be compared like with like to Singapore's case, which is 3.2% of GDP, and not 1%. 1% represents the Government's component. The second point is that healthcare should not be measured by the inputs. It does not really matter what you put in. The more important parameter should be the outcome of what you get for the money that you spend. Although we only spent 3.2% of our GDP on healthcare, the healthcare standard in Singapore is rated as good, if not better than many of the developed countries. And this is done not by us, but by the World Bank. The World Bank recently ranked the healthcare systems around the world and it will not surprise you to know that Singapore is ranked sixth, even though we have only spent 3% of our GDP on healthcare. The USA, despite spending 12% to 14% of GDP on healthcare, ranked quite far down, beyond 20. In the US, there are more than 45 million people who are insured. So even though they spent 12% to 14% of GDP on healthcare, not everybody has access to the same healthcare. In Singapore, I have given the assurance many times that if any MP comes across any low income Singaporean, who has difficulty paying his bill, he can write to the medical social worker in the hospital, and 99% of all Medifund applications are approved.”
“Anybody who wants to be treated as a subsidised patient can easily go to a polyclinic, be seen by the GP there and if his condition requires specialist care, the GP will refer him to the specialist outpatient clinic and he will be treated as a subsidised patient. So I do not know where he got the 40% from. Today, if you go to a polyclinic and you are suffering from a major ailment and you need to see a specialist, the GP will refer you to a SOC, and you will be treated as a subsidised patient. WATER SUPPLY IN SINGAPORE (Plans to achieve self-sufficiency) The following Question stood in the name of Mr Noris Ong Chin Guan - 7. To ask the Minister for Trade and Industry in relation to the supply of water to Singapore, whether his Ministry has any plans to achieve a breakthrough in gaining greater self-sufficiency. 8. Mr Tay Beng Chuan asked the Minister for Trade and Industry what is the Government's water strategy in the face of an imminent threat of water cut-off from the external supply sources and what is the progress of the proposed seawater desalination plant projects.”
“Under our system, if you have stayed in a B2 or C class ward in a hospital, and you later return to the SOC for follow-up treatment, you are treated as a subsidised patient. If you visit the polyclinic and the polyclinic's GP refers you to a specialist, you are treated as a subsidised patient. If you go to the SOC on your own or you are referred to by a private sector GP, then we treat you as a private patient.”
“It is related because we are under recovering. Because it is relatively inexpensive, people will come to see the specialists. When a specialist's cost is just slightly above a GP's, Singaporeans will all troop to see the specialist instead of going to the GP. I think we have to have a sensible structure so that there is a differentiation in the fee structure between a specialist and a GP. But, at the same time, we know that costs have increased and in running a healthcare system, 60% of the cost is manpower cost, and the public sector is losing doctors very rapidly. We have to adjust the pay and other remuneration structure for the public sector doctors and that goes into the cost. The Government subsidises this portion but part of that cost increase will have to be recovered from the fee increases.”
“But $21, I think Members will agree with me, is a very affordable cost to pay to see a senior consultant in the restructured hospitals.”
“Mr Speaker, Sir, the fee structure of our SOCs is a little out of sync and therefore we have taken this opportunity to try and re-align it correctly. As I explained earlier, the SOC fee is structured accordingly to whether you see a senior consultant, consultant or a Registrar. So it is structured based on the seniority of the people you see. It is also structured on whether you see the consultant for the first time or for repeat visits. Based on this structure, we have a set of fees. For the private patients, the higher end of this structure will be when you see the senior consultant for the first time and that would now cost $80. If you see the Registrar for a repeat visit, which is the other end of the structure, it will cost you $35. So that is the range of fees. And to see a consultant, as a private patient, paying this range of fees from $80 or $35, I think, is a reasonable reflection of the actual cost of the consultant rendering the service. As a subsidised patient, we also follow this structure. But because of the very heavy Government subsidy, we charge a single rate of $21 to see a consultant and we do not vary, whether by senior consultant, consultant or Registrar, and we do not vary whether it is an initial visit or a repeat visit. So for subsidised patients, every time they go to the SOC, the consultation fee is a flat $21. But for private patients, we adopt this structure to better reflect the costs. For the subsidised patients, as I have explained, the fees have not been revised since 1993 and even in this revision, we have raised it by only $4. $4 over $17 is a big percentage increase, $1 over $17 is a 6% increase. So raising it by only $4, is already an increase of 24%.”