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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“So for subsidised patients, whether they see the consultant for the first time or for repeat visits, they pay $21 for the consultation fee. This increase is reasonable given that the last time SGH revised its subsidised SOC consultation fees was way back in 1993. As for the total bill size for subsidised SOC patients, the increase was kept to about 8%. SGH's fee revision is unavoidable, given the economic recovery and the need for SGH to keep up with the increase in its operating cost, contributed largely by manpower, medical supplies and medical equipment. Nonetheless, our restructured hospitals will always be mindful of the need to moderate the increase in healthcare cost. As such, they have undertaken various productivity and cost saving measures, including bulk purchasing and e-procurement of supplies, implementation of electronic medical records system and skills redevelopment programmes to deliver more cost effective and efficient healthcare services to Singaporeans. For Singaporeans who still cannot afford to pay even the highly subsidised rates due to financial hardship, they can always apply for Medifund help. I would like to give the House my assurance that no Singaporeans will be denied essential medical care because of their inability to pay.”
“Let me put the recent SGH specialist outpatient fee increases in perspective. The 70% increase in consultation fee applies only to private patients on repeat visits to the senior consultants, the most senior grade specialist in the hospital. In absolute terms, the increase is from $32 to $55. The rate of $32 before SGH's recent fee revision was close to the charges of GPs and therefore not reflective of the actual cost of specialist care rendered by a senior consultant. Therefore, the relatively larger increase is to better reflect the actual cost of specialist care as well as to close the fee differential for initial and repeat visits. The 70% increase in consultation fee does not apply across-the-board. For private patients on initial visits, the SOC consultation fees were raised by $13 to $18 and now range from $60 to $80, depending on the seniority of the doctor. This is an average increase of 30%. If we look at the total bill size, which includes prescription and other investigations which patients are more concerned with, the increase for private SOC patients is about 12%. As the last time SGH revised its SOC fees was in June 1997, the recent fee revision should therefore not be deemed excessive. While fees for healthcare services would have to be revised regularly, my Ministry will ensure that the cost of subsidised healthcare remains affordable. We will provide heavy subsidies to moderate fee increases so that healthcare continues to remain accessible and affordable to the middle and low income Singaporeans. In this recent fee increase by SGH, the consultation fees for subsidised patients, for both initial and repeat visits, were raised by $4 to $21.”
“Mr Speaker, Sir, can I be permitted to take Question Nos. 5 and 6 together?”
“My Ministry reviews the regulations and procedures in the Termination of Pregnancy Act regularly. We welcome feedback and suggestions on how to improve them. Many of the points raised in the recent debate on parental consent in teenage abortions are not new. If there are specific suggestions on how to improve the monitoring of teenage abortions, we are prepared to incorporate them.”
“We all know that the business world is very varied and a single Act like the Companies Act will have to cover a wide range of circumstances and therefore this requires quite a lot of deliberations and work. So I hope Members will bear with us while we let these three committees do their work and we will come back to the House some time next year with more comprehensive amendments to the Companies Act after we have done a review of the accounting and disclosure standards and after we have gone through the corporate governance standards. 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. OATHS AND DECLARATIONS BILL Order for Second Reading read.”
“Mr Speaker, Sir, first, let me thank Members for their comments and various suggestions. Let me first explain the context by which this Amendment Bill is put up. As Members are aware, we have three committees led by the private sector to look at the whole range of issues. There is the Committee on Company Legislation and Regulatory Framework which will review the Companies Act. The second committee is on Disclosure and Accounting Standards which Mr Gerard Ee referred to. And there is a third Committee on Corporate Governance on what constitutes corporate governance and how we should bring our standards closer to the best practices in the world. While these three committees are doing and reviewing their work and they project that they will be able to come out with their recommendations some time next year, we felt it necessary to make these amendments to the Companies Act following the recommendations of the Corporate Finance Committee. So this Amendment Bill is very much a work in progress while many of the other issues which Members raised are still being resolved by the three committees. So I would like to assure Members who raised these suggestions that these issues are indeed taken care of by the three committees, as I am sure you are all aware, and in the course of their deliberations, they will take the Members' views into consideration. So I would like to thank Members for their comments. But for the purpose of putting in place some of the recommendations put up by the Corporate Finance Committee, we felt it necessary to introduce this first so that it does not impede the workings in the companies.”
“Mr Goh Choon Kang asked the Minister for Law if his Ministry will consider charging a Town Council nominal fee only for using small vacant state land as precinct park for Housing and Development Board residents.”
“Rehabilitation services in Singapore are provided at both acute hospitals and community levels to help patients recover from conditions such as stroke and fractured hips. All the 5 public hospitals, namely, SGH, CGH, NUH, TTSH and AH provide rehabilitation services. The 4 private hospitals, Mt Elizabeth, Gleneagles, East Shore and Mt Alvernia, also provide rehabilitation services to their patients. At the community level, four community hospitals and 23 day rehabilitation centres provide among others 970 places for rehabilitation. Most nursing homes also provide rehabilitation to their patients. Half of the 50 nursing homes are run by private organisations. The standalone rehabilitation centres are all run by voluntary welfare organisations. Based on our provision norms of 3.5 places per 1,000 elderly, we estimate that there is currently a slight overprovision of day rehabilitation places by about 150 places. This is borne out by the utilisation rate of day rehabilitation centres, which at 60% is a little underutilised. We will have sufficient day rehabilitation places over the next 10 years, based on projected requirements and known development plans over the next few years. However, my Ministry reviews the provision of such step-down facilities regularly so as to ensure an adequate supply to meet the needs of our patients. VACANT STAE LAND (Fee structure) 16. Dr Wang Kai Yuen asked the Minister for Law whether his Ministry will consider using a different fee structure for vacant state lands when the proposed use has no commercial value such as a soccer field maintained by the Town Council. 17.”
“We encourage more babies within a family context. PUBLIC AND PRIVATE REHABILITATIVE CENTRES 15. Mr Goh Choon Kang asked the Minister for Health (a) how many public and private rehabilitative centres are there in Singapore; (b) whether the current number is sufficient to meet needs; and (c) what is the projection for such service over the next five to ten years in view of our rapid greying population.”
“Our position is, if you bring a baby into this world, you should be responsible for the baby. But in the case of a single mother, we understand that she is probably in more financial difficulties and so we will refer her to all the various agencies. There are no special benefits for single mothers.”
“If the single mother requires financial assistance, there are various agencies to provide this financial assistance. So she will be referred to all these agencies, as I have explained in my answer.”
“Mr Speaker, Sir, all women, married or single, undergo compulsory pre-abortion counselling conducted by trained counsellors when they attend any registered medical clinic to request for an abortion. At least 48 hours must elapse after the pre-abortion counselling before a woman can go for the abortion. During the pre-abortion counselling the risks involved in the abortion procedure and the possible consequences of abortion are explained. Depending on the circumstances and the reason for seeking an abortion, the counsellor will discourage women from going through with the abortion by explaining the benefits of keeping the baby, which include the joys of parenting, the bonding of the family, and that a baby is not a burden and will not jeopardise a woman's career. If the woman is single and decides to keep the baby, assistance appropriate to her needs will be rendered. She is referred to shelters for pregnant single women for accommodation if she finds it difficult to stay in her own home. She is also provided with information on adoption procedures and alternative child care arrangements. She can be referred to agencies such as the Family Service Centres and the Pregnancy Crisis Service for social support and services like mediation between the single mother and her parents, arrangements to retain her in school and referral to agencies for financial assistance and free antenatal care.”
“Mdm Claire Chiang See Ngoh asked the Minister for Health, between 1995 and 1999, what were the trends on abortion in youths in the age cohorts of 13-14 years, 15-16 years and 18-21 years. Mr Lim Hng Kiang: The number of abortions in the age groups 13-14 years and 15-16 years is very small, less than 2% of total abortions annually for the period 1995 to 1999 (Table below). There is a decreasing number of abortions for the age groups 13-14 years and 15-16 years from 1995 to 1999. The number of abortions for age group 17-21 years has remained relatively stable over the same period. Legalised Abortions by Selected Age Groups, 1995 - 1999 Selected Age Groups Year (years) 1995 1996 1997 1998 1999 Overall Total 14504 14365 13827 13838 13753 Total (aged 13 - 21 2661 2729 2764 2475 2610 yrs) 13 - 14 17 19 29 9 7 15 - 16 223 228 256 155 168 17 -18 679 698 793 682 689 19 - 21 1742 1784 1686 1629 1746 ADOPTION OF BABIES 6. Mdm Claire Chiang See Ngoh asked the Minister for Community Development and Sports if he will indicate (i) the guidelines for the adoption of a baby from Singapore and from overseas; (ii) the number of adoptions between 1985 and 1999; and (iii) whether there is a need to relax adoption regulations to fulfil the dreams of infertile couples.”
“Chronic sick patients refer to patients suffering from chronic degenerative diseases such as heart disease, stroke, cancer, hypertension, diabetes, arthritis and osteoporosis. These patients will require long term care. As income is not a criterion for seeking medical care at Government Polyclinics, data on the income profile of chronic sick patients is not captured on a routine basis. Currently, 68% of the nursing beds are provided by Voluntary Welfare Organisations (VWOs) which cater to the poor and the lower income groups. In July, the Government implemented a 3-tier subsidy scheme of 75%, 50% and 25% for care in VWO nursing homes. Previously, there were only 2 subsidy rates, 75% for those on public assistance and 50% for households with monthly income less than $2,000. As at December 1999, 51% of the patients seeking long-term care in MOH funded VWO nursing homes were on public assistance, 39% were from households with monthly income of less than $2,000, and 10% from households earning more than $2,000 per month. The new 3-tier subsidy scheme considers the household size and a higher quantum is given to larger households with lower income. Household with per capita income of less than $300 per month will receive 75% subsidy. Those with per capita income of between $301 and $500 per month will receive 50% and those with per capita income of $501 and $700 per month will receive 25% subsidy. The new 3-tier subsidy framework will result in higher subsidy for care in VWO nursing homes. Data on patients by per capita income is not available as yet as the 3-tier subsidy scheme was implemented in July 2000. ABORTIONS 5.”
“Under the Termination of Pregnancy (TOP) Act, a pregnant woman who: (a) is a citizen of Singapore or is the wife of a citizen of Singapore; (b) is the holder, or is the wife of a holder, of an employment pass or a work permit pass issued under the Immigration Act; or (c) has been resident in Singapore for a period of at least 4 months immediately preceding the date on which such treatment is to be carried out. can have an abortion performed by an authorised medical practitioner after consenting in writing. Regulation 5(2) and (3) of the TOP Act makes it mandatory for an unmarried girl below 16 years of age who seeks an abortion to undergo pre-abortion counselling. Such counselling is provided by trained nurses and medical social workers at the School Health Counselling Clinic. If the patient dies while undergoing an abortion procedure, an autopsy will be conducted. Under the law, all deaths resulting from complications arising from operative procedures are reportable to the Coroner. The Coroner will conduct an inquiry to determine the cause of death and the persons responsible. This is the procedure regardless of age of the patient. CHRONIC SICK 4. Mr Low Thia Khiang asked the Minister for Health what is the income profile of chronic sick patients who need long-term health care services and who attended Government and Government restructured hospital clinics and polyclinics, as at end December 1999.”
“Parental consent is not required for TOP for the underaged. We debated this issue when the Act was considered in Parliament. We acknowledge that parental awareness could enable parents to play a part in preventing the young girls from repeating the same mistake. However, it has been observed that the pregnant girls are often in a very desperate situation and likely to resort to extreme measures. If parental consent is made compulsory, some may even resort to suicide. There is also the possibility of going to unlicensed practitioners for abortion locally or in neighbouring countries with its inherent dangers of botched up operations, severe infection and death. Besides surgical procedures there is also a possibility of them taking "medicines" purported to cause abortions which may be harmful to health or be dangerous. On balance, we decided not to make parental consent compulsory. ABORTIONS 3. Mdm Claire Chiang See Ngoh asked the Minister for Health, since the law does not provide for parental consent for an abortion decision, who will be held responsible when a 14-year-old dies during an abortion procedure.”
“My Ministry is studying this recommendation and will consider ways to encourage and help the self-employed to further save for their retirement. CENTRAL PROVIDENT FUND SAVINGS 22. Mr Hawazi Daipi asked the Minister for Manpower if the Central Provident Fund Board has thought of ways of giving better return on CPF savings.”
“Mr Thomas Thomas asked the Minister for Manpower (a) what proportion of the Singapore workforce make no or make irregular contributions to the Central Provident Fund; (b) whether this proportion is on the rise; and (c) what steps are being taken to ensure that these workers can still enjoy basic social security benefits provided by the Fund. Dr Lee Boon Yang: Currently, about 1.22 million people in the Singapore workforce make regular contributions to the CPF. This is an increase of 16% compared to 1991. The proportion of the workforce that makes no or irregular contributions has remained stable over the last 10 years at about 17%. These could be self-employed persons. Since July 1992, self-employed persons with a net trade income of more than $2,400 per year are required to contribute to the Medisave Account. They contribute between 6% and 8% of their yearly net trade income, depending on their age. Such contributions are granted tax relief. The number of self-employed persons who contribute to the Medisave accounts has increased by 24% from 126,000 in 1995 to 157,000 in June 2000. To encourage self-employed persons to contribute beyond their Medisave Account, tax relief is also given for additional voluntary CPF contributions. Voluntary contributions by the self-employed have increased significantly by 35% from 58,000 in 1995 to 78,000 in June 2000. The Inter-Ministerial Committee for the Ageing Population had suggested that the CPF system should be extended to provide coverage for as many Singaporeans as possible. One of the recommendations is to make contributions to the CPF Special Account compulsory for the self-employed.”
“My Ministry is aware of the impact of rising health care cost to the public. Therefore, fees and charges are reviewed regularly to ensure that fee increases, if need be, are minimised. The last fee revision was more than 21/2 years ago. As a result of the economic crisis, Government hospitals and polyclinics refrained from revising their fees last year. However, with the recovery of our economy this year, there is a need to revise the fees to recover part of the cost increases. Hospitals and polyclinics need to revise their fees regularly to keep up with the increase in their running cost. The increase in running cost is in part due to the rise in manpower cost, which is the single largest cost component at 60% of total running cost. To keep pace with advances in medical technology, the cost of medical supplies such as drugs, which account for another 15% of the total running cost, will also rise. The cost of replacing medical equipment, utilities, etc. will also add to the increase in hospitals' running cost. It is therefore unrealistic to expect our hospitals and polyclinics not to increase their fees and charges. Singaporeans should therefore expect such regular fee revisions. The Government will, however, continue to bear the major responsibility in absorbing the increase in health care costs for subsidised patients. Basic medical care in the class B2 and C wards of the public sector hospitals and outpatient clinics will continue to be heavily subsidised, and remain affordable to the lower income group. Those who are unable to pay even the heavily subsidised rate can apply for Medifund help at hospitals or waiver of charges at the polyclinics. CENTRAL PROVIDENT FUND CONTRIBUTIONS 21.”
“Medisave is primarily intended for inpatient hospitalisation expenses. For maternity purposes, Medisave may be used for the delivery of a woman's first three children. This is in line with the national population policy of encouraging couples to have three or more children only if they can afford it. Couples who decide to have a fourth child or more must rely on their own finances rather than on Medisave to pay for the delivery expenses. GOVERNMENT HOSPITAL AND OUTPATIENT CHARGES 19. Mr Low Thia Khiang asked the Minister for Health what is the rationale for the recent increases in Government hospital and outpatient charges and its impact on those who need long-term medical treatment and medication.”
“We are in the process of reviewing the coverage. But I must stress that the reason why MediShield works is that it is a very well defined catastrophic insurance scheme. We have contributions of co-insurance and also a high deductible so as to make it affordable. There is no free lunch. If you want a more extensive medical insurance coverage, then the premiums will have to go up. So we always have to strike a balance between adequate coverage as well as affordable premiums. CENTRAL PROVIDENT FUND ACCOUNTS (Payment of mortgages) 10. Mr Yeo Guat Kwang asked the Minister for Manpower, with the proposed adjustments to the contribution rates to the Central Provident Fund's Special and Medisave Accounts, whether there is any plan to help those who have not enough savings in their Ordinary Account to pay for their mortgages.”
“When MediShield was introduced in 1992, I do not think the life expectancy was only 70 then. So there was no implicit or explicit linkage or peg between the MediShield coverage age and the life expectancy. We want to make sure that the MediShield coverage is sensible compared to the life span of Singaporeans. So there was a general move that as the life expectancy of Singaporeans increases, we should look at the coverage and extend the coverage age of the MediShield scheme.”
“I would not use the word "pegging". I think we will review and increase the coverage age accordingly as the life expectancy of Singaporeans has also increased. But I would not use the word "pegging". It would not have a direct linkage as a peg.”
“Mr Speaker, Sir, my Ministry is aware that with longer life expectancy, there would be a need to raise the maximum coverage age for MediShield. As such, there have been regular upward revisions in the maximum coverage age. When MediShield was first introduced in 1990, the maximum coverage age was 65. This was subsequently raised to 70 in 1992, and 75 in 1996. Although the maximum coverage age for MediShield is 75, there are other Medisave-approved insurance schemes that offer insurance coverage up till age 80. Such schemes ensure that Singaporeans have a choice of being insured beyond age 75, if they wish to do so. Nonetheless, my Ministry would like to assure the Member that we are reviewing MediShield's maximum coverage age limit, and will raise it if necessary, to keep pace with the longer life expectancy.”
“We are looking at the overall tax regime in Singapore. We know we have to be competitive. But at the same time, we have to distinguish the two trends that we are facing. One is the cyclical trend. Because the economy is doing well, one would expect the tax collection to increase during this cycle. The second is the structural trend. We know that because of globalisation, competition, and changes in the economy, certain tax collections would change over time. Therefore, we must be prepared for it. Similarly, Singapore's society is also undergoing restructuring. We will need to spend more not just on education but on life-long learning. We need to spend more on health and many other competing demands. So we need to balance our tax collections with our tax expenditure. But as I said, this is still early days before the next budget. 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. BUILDING CONTROL (AMENDMENT) BILL Order for Second Reading read.”
“Mr Speaker, Sir, I would like to thank the two Members for their views. First, in response to Mr Leong's query, Dr Richard Hu explained this previously when we discussed the Entrepreneurial Employee Stock Option Scheme. Basically, we are putting this scheme in place not just to benefit the individual but also to anchor the activities in Singapore. Therefore, to qualify for the scheme, the company must demonstrate that substantial activities are done in Singapore. Dr Richard Hu explained then that we want to start off by having both companies and the holding companies incorporated in Singapore and then they automatically qualify for the ESOP. However, if they can demonstrate that even though they are not incorporated in Singapore and that they have substantial activities in Singapore, Dr Richard Hu said that he was prepared to consider this on a case-by-case basis. I would also like to thank Mr Tay Beng Chuan for his views. This is an early start to next year's budget. I will convey his views to the Ministry of Finance for their evaluation for the next budget, but let me just respond in general terms. First, the tax burden in Singapore is not onerous. The tax incidence is actually quite light. Second, we need to balance business cost versus a fair and competitive remuneration to our workers. Although we do appreciate the business community's concern about cost, we must also ensure that there is fair and competitive remuneration to our workers. Therefore, the whole idea is to strike this balance. Third, I would like to assure Mr Tay that the Government will not have to impose tax increases to pay for the wage rise for the civil service. This is well within our budget. I can assure the Member that we are not complacent.”
“A less expensive therapy with 2-drug combination and without a protease inhibitor would cost about $600 per month. Patients are allowed to use $500 per month from their Medisave account for any of the anti-retroviral drugs that are registered in Singapore. The treatment of HIV/AIDS is very expensive. It delays but does not prevent the onset of AIDS. The effectiveness of such therapy over the long term is still not known. Treatment would have to be life-long as studies have shown that the virus rebounds soon after treatment is halted. Therefore, we should channel our available resources to more cost-effective treatments for the benefit of the majority of patients. HIV/AIDS patients who require further financial assistance could approach Action for AIDS (AfA) or other charitable organisations for help. SOCIAL WELFARE RECIPIENTS 4. Mr Low Thia Khiang asked the Minister for Community Development and Sports how many social welfare recipients receive their monthly financial assistance via GIRO and which bank his Ministry uses to disburse the Government assistance.”
“My Ministry is fully aware of AIDS as a disease of public health importance in Singapore. As early as 1985, we implemented the National AIDS Control Programme, even before the first case of HIV infection was detected. The multi-pronged control strategy comprises health education, protection of the national blood supply, counselling and management of the infected and their contacts, surveillance of the disease, and the training of personnel. With no cure or vaccine for the disease, the main focus in the control of AIDS in Singapore continues to be on health education. As at 31st March 2000, a cumulative total of 1,194 Singaporeans have been reported to be HIV infected since 1985. Among them, there were 508 asymptomatic carriers, 283 with full-blown AIDS and 403 have died. Over the last five years, the rise in the number of HIV infections in Singapore appears to be slowing down, with the rate of increase declining from 29% in 1994-1995 to 4% in 1998-1999. My Ministry will continue to monitor the situation and ensure that all necessary and timely measures to control the disease are taken where appropriate. HIV/AIDS patients have access to subsidised inpatient and outpatient care like any other patient. This covers hospital charges, radiological and laboratory charges, treatment of complications with standard drugs where appropriate and consultation charges. Currently, there is no subsidy for anti-retroviral drugs, which are considered non-standard drugs. This is no different from all other non-standard drugs used to treat cancers, hypertension, etc. which are also not subsidised. The estimated monthly cost of "Optimal" therapy, which involves the use of 3-drug combination and including a protease inhibitor, is between $1200 and $1600.”
“Mdm Claire Chiang See Ngoh asked the Minister for Community Development and Sports (a) what capacity-building resources are identified to curb increasing alcohol consumption among young women; (b) what intervention and treatment strategies can be developed to help families cope with alcoholic members; and (c) whether it is appropriate for his Ministry to facilitate the setting up of Alcoholics Anonymous for Women and to fund the setting up of half-way houses for women under the influence of multiple substance abuse.”
“The number of admissions to hospitals from 1990 to 1999 for conditions related to problem drinking, such as acute alcoholic intoxication, alcohol dependence syndrome, alcoholic liver damage and alcoholic psychosis, is about 1,100-1,200 annually. The annual number of such admissions over the years has remained fairly constant. The male to female ratio is approximately 8:1. We do not keep track of the social class of patients admitted. Woodbridge Hospital runs an Alcohol Treatment Centre for the treatment and rehabilitation of problem drinkers. The Centre accepts referrals from hospitals, polyclinics, general practitioners, community groups dealing with alcoholism, like Alcoholics Anonymous, social service organisations such as the Family Service Centres, community agencies and counselling centres. In 1999, the Centre had managed about 170 admissions, 100 new outpatient cases, and 3,600 attendances at its alcohol recovery support group sessions. The staff of the Alcohol Treatment Centre also conducts public seminars and training for general practitioners on early identification of persons with alcohol problems and the management of such persons. In the community, the Alcoholics Anonymous and two halfway houses offer counselling and group therapy for problem drinkers. The current size of the problem does not warrant a national campaign. Nevertheless, my Ministry will focus on public education to increase awareness of the dangers of excessive drinking, specify safe drinking limits, and manage problem drinkers. HALF-WAY HOUSES AND ALCOHOLICS ANONYMOUS FOR WOMEN ALCOHOLICS 7.”
“Foreign workers in Singapore have to undergo a medical examination to ensure that they meet minimum health standards. It is also to prevent the spread of infectious diseases in Singapore. The rationale for requiring the medical examination to be conducted in Singapore in accredited medical establishments is to maintain an acceptable standard of medical examination and tests. We have received feedback that this requirement could pose difficulties and inconvenience to some applicants. MOH and MOM have reviewed this. We recognise that health concerns should be balanced against economic needs. EP holders, unlike the WP group, represent the skilled and professional talent that we wish to encourage companies to employ. We therefore should facilitate companies wanting to employ these talents, by not insisting on medical examinations in Singapore for new entrants. Foreign talents who wish to apply for an employment pass to work in Singapore will therefore be allowed to opt to have the medical examination done in their home country or in Singapore. However medical examinations required for renewal of Employment Passes would still have to be done in Singapore. PROBLEM DRINKERS 6. Mdm Claire Chiang See Ngoh asked the Minister for Health (a) from 1990 to 1999, how many cases of problem drinking were reported to hospitals annually and what was the profile of these problem drinkers by gender and social class factors; (b) what measures are in place to address intervention and treatment issues at the institutional and community levels; and (c) whether it is time for a national campaign against problem drinking.”
“Mr Yeo Guat Kwang asked the Minister for Manpower whether existing office workplaces are generally safe and what steps his Ministry is taking to ensure that our work environment will be highly favourable and on par with OHS standards of developed countries.”
“MediShield is an insurance scheme. Just like other health insurance schemes, the premiums will be higher if the co-payment is low, or if more disease conditions are covered by the scheme. We are fortunate that since its introduction in 1990, we have been able to keep the premiums low and affordable and expand MediShield coverage to new treatments and drugs, without increasing the premiums or co-payment. To give just two examples, we have recently extended MediShield reimbursement to stereotactic radiotherapy for the treatment of brain tumour, and Prograf, an immunosuppressant drug used in organ transplants. So, MediShield has delivered better and better value for money to patients over the years. However, we cannot take this for granted. The best way to keep MediShield premiums as well as patient co-payment affordable to Singaporeans, without compromising its coverage of a wide range of disease conditions, is by ensuring that Singaporeans remain healthy and when they do require medical care, the cost increases are moderated. The Government is already heavily subsidising health care in Singapore. Acute hospital care is subsidised at 80%, 65%, 50%, and 20% for Class C, B2, B2+ and B1 respectively. Polyclinics are subsidised at 50%. The measures to contain health care costs must be complemented by individual responsibility. Our best insurance for the future is to continue to encourage all Singaporeans to lead healthy lifestyles. If they fall ill and have to be warded, they must choose their wards prudently based on their financial means. For those who cannot afford to pay even the subsidised rates due to financial hardship, Medifund acts as a final safety net. SAFE AND HEALTHY WORK ENVIRONMENT 21.”
“Sir, I beg to move, "That the Bill be now read a Third time." Question put, and agreed to. Bill accordingly read a Third time and passed. EXEMPTED BUSINESS (Motion) Resolved, That the proceedings on the remaining item 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]. AGRI-FOOD AND VETERINARY AUTHORITY BILL Order for Second Reading read. 3.44 pm”
“Sir, I beg to move, "That the Bill be now read a Third time." Question put, and agreed to. Bill accordingly read a Third time and passed. SUPPLEMENTARY SUPPLY BILL Order for Second and Third Readings read. The Second Minister for Finance (Mr Lim Hng Kiang): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The purpose of this Bill is to make final provision in accordance with Articles 148(2) and 148C(2) of the Constitution for additional expenditure in excess of the provisions authorised by the Supply Act, 1999. The additional sum has been presented as Supplementary Estimates which have been considered and approved by the House as Command Papers Nos. 1 and 3 of 2000. Sir, I beg to move. Question put, and agreed to. Bill accordingly read a Second time. Third Reading”
“Mr Speaker, Sir, I beg to move, "That Parliament doth agree with the Committee on the said resolutions." Question put, and agreed to. Resolutions accordingly agreed to. SUPPLY BILL Order for Second and Third Readings read. 3.40 pm The Second Minister for Finance (Mr Lim Hng Kiang): Sir, I beg to move, "That the Bill be now read a Second time." In accordance with Article 148(1) of the Constitution, heads of expenditure to be met from the Consolidated Fund and Development Fund, other than statutory expenditure, have to be included in a Bill to be known as the Supply Bill. The purpose of the Supply Bill before Members is therefore to give legislative approval for the appropriations from the Consolidated Fund and Development Fund to meet expenditures in the financial year 1st April, 2000 to 31st March, 2001. The heads of expenditure and the sums that may be incurred in respect of each head are shown in the schedule to the Bill. These have been approved by the House in the Main and Development Estimates of Expenditure for the financial year 1st April, 2000 to 31st March, 2001, and appear on pages 37 and 38 of Command Paper No. 2 of 2000. The Supply Bill, when approved, will empower me to issue warrants, authorising expenditure up to the amount for each head as shown in the Bill to be paid out from the Consolidated Fund and the Development Fund. Sir, I beg to move. Question put, and agreed to. Bill accordingly read a Second time. Third Reading”
“Sir, let us get the facts right. First, as my Parliamentary Secretary said, for emergency cases, the hospitals, under the law, have to treat the patient first and deal with the payment administration later. And we will deal with the investigation of this particular case. For the hospitalisation that Mr Chiam talked about, nobody is turned away in Singapore hospitals if he is a Singapore citizen for inability to pay. If a person tells the hospital that he wants to be admitted to a C or B2 ward, he does not even need to put a deposit. Lawyers collect deposit from their clients. Hospitals do not collect deposits from their patients when patients turn up for B2 and C wards.”
“Let me just say that the bottomline is that we are subventing the hospital at the same level as we did before. It is just how we manage it. For example, if you discharge your patient earlier, if his medical condition is so good that he is discharged in 3.7 days, we still pay you 4 days because it is the standard rate. If you discharge him in 7 days, we will pay you 4 days plus 3 days per diem, on a per day basis. That is the formula. 3.00 pm”
“The Government will bear its fair share of these cost increases through higher subventions to the hospitals. But the public must also pay for their share of the increases. Healthcare is an expensive business because 60% of healthcare is in manpower cost. It is not possible for us to ask the doctors and nurses to give us good quality healthcare and expect them not to receive their fair salary. We have to continue to give them a fair remuneration and that means we expect 60% of our cost to be increased every year. Drugs are also very expensive. They constitute 10% of our cost and we must expect to deal with better drugs, new medical technology and Singaporeans' expectations that they get the new drugs which are available in the market. So there is an increasing pressure on cost. We will manage it well. But at the same time, as I mentioned, the healthcare burden on Singaporeans is manageable because of the medical financing that we have put in place. Sir, I would like now to ask my Parliamentary Secretary to take over and answer the specific questions. 2.45 pm”
“I can assure him that we are able to achieve very good quality healthcare in Singapore at affordable prices, both to the individual as well as to the country as a whole, and this is not at the expense of quality. When we audit the hospitals, we look at four key parameters. First, accessibility, to make sure that everybody has full access to the services and facilities in the hospitals, and nobody is turned away because he cannot afford to pay. Second, the charges are affordable. We track the total bill size. We track the cost to the patient for the different ward classes. Third, we track the clinical outcomes of all the major operations in the hospital. So it is not good enough that you can go into a hospital, the cost is affordable, we also track the clinical outcomes that when you go in for a particular ailment, you come out properly cured. The clinical outcomes are rated with other reputable hospitals around the world. Fourth, we check the service quality - how the staff deals with the public, whether it is the waiting time, courtesy, the whole range of PS 21 parameters that we also set for our hospitals. We do monitor the performance of our hospitals in a very rigorous way. We are mindful that we want to ensure good quality affordable healthcare to Singaporeans, and not just look at the bottom line. So even though the patient load has gone up, the hospital manpower may not have gone up as much because of productivity and efficiency. But as I said earlier, we must keep our fair share of doctors, nurses and the whole array of people to run the hospitals, and we must continue to keep pace with the market remuneration. This means the cost to the hospitals will go up.”
“In general standard, typical cases, it will take about four days and the person will be well enough to be discharged. If the case is more complex and requires seven days for him to stay in the hospital, the doctors will continue to keep the patient for seven days in the hospital. At the end, when he has recovered, he will be discharged based on the decision of the doctors. In the subvention for the subsidies, the Government will pay to the hospitals the four-day standard rate for appendicitis, in this example. And for the three days extra, the Government will continue to pay the hospital a per day rate. So it is not true that the hospital is under pressure to discharge the patient because he wants to stay under the four-day standard rate. If it is an outlier case, the Government will continue to pay both the standard rate plus the extra days on a per day basis. So I want to assure the House that the casemix system will not result in premature discharge of the patients. Dr Tan Cheng Bock is absolutely right about this shift in the management of patients because we recognise that hospitals are very expensive institutions and they should concentrate on acute care. As can be seen in many developed countries and also, in Singapore, there is a trend towards day surgery, and there is a trend towards step down care and there is a trend towards recovery in other institutions, other than the acute hospitals. As I mentioned earlier, we have to set up this full range of supporting facilities so as to accommodate this shift in looking after the patient. Let me also address Mr Low Thia Khiang's point about the quality of care in our hospitals.”
“So our healthcare financing scheme is very robust and helps keep our healthcare costs down. Mr J.B. Jeyaretnam asked for a breakdown in the cost. Every patient who goes to the hospital gets this breakdown in cost, systematically setting out how much it costs to look after him, whether he is a C or B2 class patient and what he has to pay and what is the Government subvention. A typical hospital bill for a C class patient is less than $700. We track this all the time. And the Government subsidises 80% of the total cost. So the breakdown of the cost is given for every bill that every patient gets from the hospital. So I do not quite understand what Mr J.B. Jeyaretnam wants when he asked for a breakdown. It happens all the time in every case in hospital. Let me also touch on the implementation of the casemix and some of the issues raised by Dr Tan Cheng Bock. He is concerned that casemix may lead to premature discharge and a poorer quality of care. First, let me state that casemix does not dictate to the doctors in all the hospitals how they should manage their patients, nor does it help hospitals or clinicians decide when to discharge the patients. As always, the patient shall only be discharged when medically appropriate. Casemix is only classified after the patient is discharged. So the whole professional system will continue to look after the patient as before, based on their professional judgement. And the whole issue of subvention and classification only takes place after the discharge. Dr Tan Cheng Bock gave the example of outlier cases. Let me try to explain this to the House. Casemix assumes certain standard cases, say, for example, the case of appendicitis that Dr Tan mentioned.”
“In fact, that committee was set up in 1992 and the White Paper on affordable healthcare was a result of that committee. That committee deliberated and decided that Singapore would not have a national healthcare insurance system, but our system will cover the 3Ms - Medisave, MediShield and Medifund. Today, our healthcare expenditure constitutes approximately 3.1% of our GDP. So this is very affordable and it is a very good level of care at very reasonable cost. The national healthcare expenditure means the total expenditure by the country, people, employers and the Government. If you look at the household expenditure on healthcare alone, it is only 2.5% of household expenditure. Individual households spend on an average 2.5% on healthcare. This is again very affordable. And we have done so because of this very sound 3M financing framework - Medisave, MediShield and Medifund. For Medisave, 84% of our people have Medisave accounts. This is a very high percentage. But I think we can do more. We will want as many as possible to have Medisave accounts. 71% today are covered by MediShield, insurance or its equivalent. This is again a very high level of medical insurance. So instead of the national healthcare insurance that Mr J. B. Jeyaretnam talked about, first, we ask people to save through Medisave and then we put people on to MediShield and equivalent catastrophic insurance schemes. And 71% of our people are covered by MediShield. For those who cannot afford to pay their bills, they can apply through the Medifund for assistance. Last year, 97% of all applications for Medifund was approved. In the FY99 budget, the Government has topped up the Medifund by an additional $100 million, bringing the total now to $700 million.”
“The more generous you make the pay-out ratio, the higher the premiums will be. That has been our experience with MediShield. If you have a pay-out ratio of 1:10, then you can keep the premiums low and everybody can afford the premiums. If you make the coverage wider and the pay-out ratio higher, then the premiums will be much higher. So we need to strike the right balance. We have changed the name to "severe disability insurance" to better reflect the policy intention and not to reduce the coverage. I hope this sets out the framework of what we intend to do for the ageing population. We will continue to concentrate on preventive healthcare. We will undertake this very ambitious programme to screen all senior citizens aged 55 and above and, over time, to bring it down to also 50 years old, screening once every two years. Then those with medical problems, to manage them in the outpatient setting, and those with more severe disabilities, to allow them to be looked after both in the home setting as well as the nursing homes. We have put in place the financing for the low income group. They will be subsidised through the Eldercare Fund. For the average Singaporeans, in two years' time, we will set up the severe disability insurance so that they can save and pay for their long-term care. The third area that I would like to cover is the whole issue of affordable healthcare. This was raised by Mr Low Thia Khiang, Mr J. B. Jeyaretnam and also Dr Tan Cheng Bock. Mr J. B. Jeyaretnam is not around. Every time he is not around, he does not listen to our answers, the next time round, he will ask the same question. He asked for a committee to be set up to study national healthcare insurance.”
“This will encourage the operators to upgrade their facilities and their service. Secondly, we encourage the private sector to develop purpose-built nursing homes by tendering out sites for such homes. At least 10 sites, each sufficient for a 200-bedded nursing home, will be offered by the year 2010. We will, of course, monitor and review these plans over the next few years, taking into consideration the overall supply and demand of nursing homes. 2.30 pm Another key element in this framework is to be able to make sure that Singaporeans can afford such nursing home care. My predecessor has announced previously the consideration of a severe disability insurance to meet the high costs of such long-term care. We expect to launch this in about two years' time after we have completed the actuarial study to determine the appropriate levels of premium and benefits. Once we have this severe disability insurance scheme, then Singaporeans can save for their old age and be covered by insurance if they suffer severe disabilities. Dr Jennifer Lee was concerned that by changing the name of the scheme from "long-term care insurance" to "severe disability insurance", she reads the nuance as a diminution in the scope of the coverage. Let me explain that, when Mr Yeo Cheow Tong announced last year the thinking behind the long-term care insurance, he said that this insurance would not cover chronic conditions, such as diabetes and hypertension, which are not severe disabilities in themselves, but require outpatient treatment. So the intention all along is to restrict ourselves to those who have to incur a very heavy financial burden as a result of severe disabilities. Members will appreciate that if you are running an insurance scheme, you want the appropriate pay-out ratio.”
“Many GPs, nurses and private hospitals are also providing home medical and home nursing care services. My Ministry will encourage the private sector to reach out to more elderly sick in the homes and we will provide the necessary support to facilitate the development of such services. Beyond home care, we must also develop the nursing homes for the elderly with severe disabilities who cannot be cared at home and must be looked after in an institutional setting. Recently, we announced the development plan for nursing homes up to the year 2010. Mr Yeo Guat Kwang has asked whether the 40% private sector share for nursing homes is the right balance. Let me explain the rationale for this decision. Today, the VWOs are the main providers of nursing home services, providing around two-thirds of the total nursing home beds. As the population ages rapidly, I think it would be a tremendous challenge to find increasing numbers of volunteers who are able to raise increasing sums of money from the community each year to run the VWO nursing homes. We therefore need to establish the nursing homes on a more sustainable basis. The VWOs are charitable organisations and should focus their efforts on the indigent and the poor. They should also concentrate on upgrading their professional capabilities and level of care. If the VWOs can look after 60% of the nursing home requirement, I would see that as a tremendous achievement. To complement the VWOs, my Ministry will set up the private nursing home market share at 40% by the year 2010, so as to provide more options to Singaporeans. We will step up the development of private nursing homes with the following measures. Firstly, we will help the existing operators using these buildings to secure longer tenancies.”
“Just as in the US where the acute hospitals will only look after the more severe cases, there is now a general sharing of care through other step-down facilities. In Singapore, in fact, we are taking measures to develop this overall supporting structure. There will be a community hospital next to every regional general hospital. We are already starting to build the rehabilitation hospital in Tan Tock Seng Hospital and that is provided in the budget for this year. We have embarked on many, many nursing homes. So I can assure Dr Tan Cheng Bock that the full range of supporting facilities for step-down care is already in place, and the funds are available. But how to provide this full continuum to meet the various needs, both from the nursing homes to the chronic sick to home care? Dr Jennifer Lee has spoken eloquently several times on the need for more home care services so that the elderly can be cared for in their homes. I agree entirely with her that institutional care should be the last resort and where we can, we should encourage home care. But home care is a more complicated and a more complex delivery system. Although we are working on it concurrently, I think Members will have to bear with us if we take a little longer to develop this full range of home care facilities and services. Today, we have six VWOs who provide home care, home nursing and home help services for about 6,500 elderly. My Ministry is actively encouraging other VWOs to provide home care services and is also currently working with another seven VWOs who have expressed keen interest to do so. We are also currently reviewing the subsidy framework for home care services to ensure that the lower income group will have access to such services.”
“So it is important for people with chronic illnesses, like hypertension and diabetes, to be treated and managed properly so that they do not acquire complications, resulting in severe disabilities. If we do this well, and if we do this systematically, then those who suffer severe disabilities and require long-term institutional care will be minimised. Dr Lily Neo urged for more shared care programmes between the primary care doctors to jointly manage patients with chronic medical problems with the specialists. I agree with her. There are some programmes already in place. We can encourage both the private and public sectors to do more. Dr Lily Neo also commented that private GPs should remain the main providers for primary health. This is indeed the case, because at the primary care level, the private sector GPs cater for 80% of primary care needs. In a rapidly ageing population, if we can move the centre of gravity of managing the chronic illnesses to the outpatient setting, then I see the role of the primary care providers continuing. As I said earlier, there is pressure for the primary care providers to upgrade themselves and raise the confidence of the general public in their capabilities. We will do so by better training of the family doctors through various programmes, like the Masters in Family Medicine and the Diploma in Geriatric Medicine. If we can upgrade the doctors through continuing medical education, then the GPs would be equipped to provide better care. Beyond care in the outpatient setting, both Dr Jennifer Lee and Dr Tan Cheng Bock raised the issue of home care. We also anticipated this requirement.”
“We plan to extend the screening programme to those who are 50 years and above when the plan is well established after three years. We would also like to encourage each person to attend screening once every two years. The estimated cost to screen each person is about $20. The Government will subsidise $15 while the resident will co-pay $5. The participating charitable organisations will pay for those who cannot afford the co-payment. The pilot programme will involve 10 to 12 divisions in the first phase. I hope MPs will volunteer their divisions for this programme. Sir, I would like to stress that there is a tremendous long-term potential for this mass screening exercise. I would put this akin to the mass vaccination of our young. If we can organise this properly, we would be taking full advantage of Singapore as a small urban, compact society. I think no other country will be able to embark on a similar ambitious programme such as this. I hope over the years, such screening exercises in our constituencies will be as regular as our meet-the-people sessions that we conduct every week. I envisage that we will be doing this screening practically once every two or three weeks and systematically encourage all our senior citizens to go for the screening. And we can help manage the medical conditions for those who have these illnesses. Sir, let me go to the next stage of the framework. If, after the screening, we identify those with health problems, then we would like to encourage them to be managed by their family doctors in an outpatient setting. Most of the health care needs of the elderly can, in fact, be met in the outpatient setting.”
“As Advisers and MPs, we do this at the constituency level with the help of VWOs but often times, our best efforts are inadequate. In fact, those who need health screening most are the ones not likely to turn up for the screening. Instead, the more enlightened residents will turn up regularly. They are also likely to be the ones who are more healthy. Also, our efforts on the ground are often not comprehensive enough to cover all the elderly citizens in our constituencies. As Advisers and MPs, we also have limited resources to mount this effort year in and year out. After the screening, I think most of us feel that there is inadequate follow-up. Therefore, to redress all these shortcomings, my Ministry will reinforce what is being done now on the ground. We will embark on a systematic National Health Screening Programme in collaboration with the charitable organisations to detect diabetes, hypertension and high cholesterol level in people aged 55 years and above. The screening programme would start in the second half of this year. The plan is to complete screening all 374,000 of those aged 55 years and above within three years. To make it convenient for the elderly to participate in this programme, the health screening will be conducted at venues near to their homes, for example, in the void decks. Every senior citizen would be given a health booklet to track his screening results. I think Members will remember that this is one of the suggestions put up by Mr Ang Mong Seng, and we are pleased to adopt his suggestion. My Ministry will maintain the central database for all these screening exercises. All those screened and found to have abnormal results will be counselled on site and referred to their family doctor or the polyclinic for follow-up treatment.”