Loh Meng See
Singapore
“Sir, on Infocomm 21 plan, this has been implemented for some years now. I would like to ask the Minister to give us an update on the expenditure and the benefits that have been derived from those investments. Recently, the CEO of IDA announced the Government's plan to widen the scope of the network and introduce better technologies.”
“Sir, I am happy that the Government is allocating new funds for the Library 2010 project. I just want to ask what can the public expect from this additional $118 million that has been provided for.”
“Sir, on the HDB shops, my request is for the Ministry to consider granting the exit package to the rental shops, if their business is not viable and there is an over-capacity.”
“We have heard what Dr Lily Neo and Dr Chong mention about the geriatrics and the need for home nursing care. Many do not have CPF accounts to enjoy the Medisave top-ups.”
“We have been down this road before. Let us not falter, but let us persevere and build up ourselves with the right values, virtues and beliefs to galvanise our people forward. We need to remind ourselves that there is no free lunch.”
“Sir, media competition among local newspapers and TV stations is bearing fruits as consumers are getting better quality products and services. I am pleased to also note the progress of Singapore Press Holdings and Lianhe Zaobao in making inroads into China and also Channel NewsAsia gaining greater viewership in regional countries.”
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“We need to plan ahead to meet the increasing need for homes for the aged to provide adequate residential care facilities for the frail aged. Sir, the question as to whether we should go as far as legislating the obligations of children to maintain their parents is a subject that should be openly discussed and debated. Prof. Walter Woon has spoken on this topic last year. If there is a growing trend of children neglecting and rejecting their parents and failing to look after them, it may be necessary to turn to the experience of Israel and Taiwan where there are laws in place to ensure the maintenance of parents by the children. Sir, I believe a better and more constructive approach would be through family life education, counselling and persuasion. We have to exercise extreme care in dealing with this delicate and sensitive subject. Perhaps we can wait for the Advisory Council on the Family and the Aged to come up with their report some time this year. It is really up to Singaporeans to show that they do not need laws to prod them into looking after their aged parents. Sir, I beg to move. Question proposed. Mr Peh Chin Hua (Jalan Besar GRC)( In Mandarin): Mr Speaker, Sir, I support the motion in the name of the Member for Kampong Glam GRC. In particular, I wish to deal with the problem of the greying population in Singapore. With smaller families and the increase in the life expectancy of Singapore, the problem of a greying population is becoming serious. According to the Report of the Advisory Council on the Aged published in 1988, it was revealed that in the year 2030, Singapore will have 248,000 of elderly persons aged 75 and above, eight times more than the figure in 1988.”
“If a person has a property of a market value equivalent to the Minimum Sum, no cash need to be set aside, the assumption being that the person has the property to fall back on. Sir, I think there is a flaw in the assumption to expect people to sell their property to turn into cash for their living expenses. Old people generally prefer to continue living in their homes that they are familiar with and would unlikely sell their house to fetch the cash needed. I think they would only do so out of real necessity and as a last resort. I think it is important to review this premise of not requiring those with property to set aside a Minimum Sum needed for living expenses in their old age. It is important that they set aside cash as well even if they have properties. An alternative would be for HDB to consider allowing the flat owners to purchase annuity through the reversionary interest in the HDB flat. In this way, those with property but without cash for living expenses can receive monthly dues against the property and remain living in the property until they die. Family support in looking after the aged parents and close relatives is essential. With strong family and kinship ties, family members can help look after one another and our aged will be taken care of by their children. The Government can show understanding by increasing the aged dependants relief and recognising the cost involved in taking care of the needs of the elderly. The elderly needs more and regular medical attention to defer the onset of frailty. We need to provide easy access for health screening and medical counselling for the elderly. Medical centres at constituency level, and working with the help of grassroots organisations, will ensure that the expenses incurred will be affordable.”
“It is right that the Government concentrate its expenditure on basic health care, education, public housing, infrastructure and security. Singapore's population is greying fast. The aging problem is a cause for concern. This issue has been discussed and documented first in the Report of the Committee on the Problems of the Aged, Ministry of Health, in February 1984, and then the Report of the Advisory Council on the Aged in January 1989. The Government has already taken several measures to deal with the concerns of the aged ? by raising the retirement age to 60, by encouraging people to save more for old age and in promoting exercise and healthy living. Singaporeans have to make the necessary adjustment to cope with this demographic change and adopt a positive attitude towards old age. We have to be careful before raising retirement age beyond 60 too quickly. It has to be done gradually to allow the labour market to adjust. With the extension of retirement age, the older staff should be happy with the extra years of working even if it means going into new careers. The younger colleagues should not feel aggrieved that their career advancement and promotion opportunities have been delayed in the process. Employers will have to find a way to accommodate the retention of the older staff and meeting the aspirations of the younger ones. CPF savings is Singapore's way to provide the nest-egg for old age security. When the CPF Minimum Sum Scheme was first announced by the then Minister for Labour in Parliament on 25th August 1986, the Minimum Sum Scheme effected from 1st January 1987 was $30,000. The sum has since been increased to $34,600 for individual members.”
“I hope the HDB will understand the financial situation of these low-income families and allow for an easy payment scheme for them to buy the flats. The sale of hawker stalls and HDB shophouses at a discount will give rise to an even larger number of small businessmen who could put their enterprise and hard work to full advantage. Sir, there are two aspects that need to be considered and be mindful of when carrying out the asset enhancement programme. We need to ensure that the future generation would not be deprived of the same opportunity to enhance their assets when their turn comes. We have to retain some room for our children and our children's children. Singaporeans cannot expect such asset enhancement programme to come naturally and as a matter of course. There will have to be budget surpluses and accumulation of our country's reserves. The benefit given is intended to be a long-term investment. If the people were to decide to take immediate profit from the share allocation or the sale of HDB properties, they will have to live with their choice and not regret later and pass the blame to others. It is the cyclical nature of property and stock markets and Singaporeans must appreciate that the values of assets do fluctuate from time to time. It is the long-term value of HDB properties and Government privatised company stocks that matters. The long-term investors who hold on to their assets long enough are usually the winners. The Government's fiscal policy of a balanced budget is a sound and fundamental one. Not only the Government but every one of us must live within our means. We have to be judicious as to where and how our limited resources are to be allocated and spent. There will be competing demands on the resources of the country.”
“We will pay the high prices, if we must, but we better get value for money. With the Goods and Services Tax due to start on 1st April, I would urge the Government to watch the situation closely and take swift action, if necessary, so that the livelihood of Singaporeans will not be seriously affected. The Government should encourage the further growth of the cooperative movement. Cooperatives play a meaningful role in sectors like consumer, credit, insurance and health care, contributing to the well-being of the working population. The spirit of self-help in the cooperatives to obtain goods and services at competitive prices and to be able to borrow money at attractive rates of interest is a boon to the large majority of the working population who would not normally get credit for short periods for cash needed to tide them over due to unforeseen expenditure. Perhaps the Government can consider the setting up of a statutory body to replace the Registry of Cooperatives and the Central Cooperative Fund to better supervise and coordinate the cooperative activities in Singapore. With regard to the asset enhancement programme, I welcome the effort taken by the Government to spread the nation's wealth and to share the benefit with as many Singaporeans as possible. The HDB 'heartland' where already 90% of HDB dwellers own their flats is the right target group for the Government to concentrate on. I am particularly happy, looking after a constituency in the city area, with the decision of the Government to sell the 2- and 3-room HDB rental flats to sitting tenants. These residents can now feel even more secure after owning their own homes.”
“Many of our students are now able to proceed to higher studies in the polytechnics and universities. Our emphasis in science, engineering and technical courses helps in the employability of our students. This happy employment situation in Singapore is indeed rare in many countries. Countries which have enjoyed strong economic growth in the past, like Germany and Japan, are facing serious economic recessions today. This adverse situation may well come to Singapore if we do not prepare early and adopt sound long-term economic policies. There is consensus among Singaporeans that the next stage of Singapore's economic development will be to actively promote the development of an external wing to reinforce our domestic economy. We should apply the same diligence in growing the external economy as we have done in building our strong domestic economy. Our future will be more secure and stable, and we can fly higher and further with two wings, which is definitely better than one. Singaporeans who venture and invest abroad can work towards building a distinctive Singaporean character and identity in the manner in which they conduct themselves overseas. They should be good ambassadors of Singapore. By earning an excellent reputation, Singaporeans will be warmly received by the host countries, and the goodwill and ties established between countries arising from our overseas investments will pay handsome dividends in the future. Sir, there is always the likelihood that the hard work and good incomes received by our people for the effort put in could be undone by the scourge of inflation. Our standard of living is the real purchasing power of our income and savings. We do not wish to have our incomes eaten away by unnecessarily high prices and inflated cost of living.”
“Mr Speaker, Sir, I beg to move, That the following Address in reply to the Speech of the President be agreed to:- "We, the Parliament of the Republic of Singapore, express our thanks to the President for the Speech which he delivered on behalf of the Government at the Opening of the Second Session of this Parliament." Sir, Singapore experienced the last economic recession in 1985. Since then, our economy has not only recovered but enjoyed strong rate of growth. There was uncertainty in the world economic situation in the last two years, in 1992 and 1993. We were expecting an economic slowdown but, as it turned out, we came out even stronger in the midst of high economic 8growth in the region. We have learnt the lessons of the 1985 recession well. Our economy was restructured. We understand fully the need to continually upgrade ourselves, invest in training and retraining, and increase our productivity. The competition has become keener and more intense. We have to compete vigorously to stay ahead. We concentrate on attracting new investments in high-technology and knowledge-based industries to bring better paying jobs to our people. If we look back to the economic growth achieved in the last six years from 1988 to 1993, at a remarkable average rate of growth of 8.5%, we are well on our way to acquiring the developed economy status and standard of living. If we ponder to consider the present situation in Japan where many university graduates and school leavers are finding difficulties getting employment, we can count our blessings for our young Singaporeans. Some of our young university graduates even go overseas for a good holiday before starting work. Many are confident of securing good paying first jobs with plenty of job offers to choose from.”
“Sir, I am afraid that the $7,000 is based on the gross salary and many civil servants may be affected by the salary revision and cross over the $7,000 mark, and you actually have more people not receiving the compensation.”
“Sir, the civil servant who is going to retire after 1st January, I would presume, will enjoy the notional or, at least, the increased salary revision he is going to get, and that the retirement pay will be based on the new revised salary.”
“May I seek some clarifications from the Minister? Does it mean that a civil servant can now opt to go to private sector GPs or get OPD-equivalent kind of treatment now that you have provided the co-payment system? With regard to the pensionable staff, the Minister said that the cut-off point is 1st January 1994. Pensioners who retire on the eve of 1st January 1994 will enjoy whatever benefits that they already have. What about people who retire on 2nd or 3rd January 1994? How do you phase them out so that the forfeiture of some of the benefits will not be too painful? The Minister mentioned about the cap of $350 for outpatient expenses. What happens if the full sum is not used? Is it possible to provide incentives for non-use to the officer concerned, because you have saved that amount of money? One last question, Sir. There is a cap of $7,000 of salary for CPF contribution. It would appear to me that the higher salaried staff may lose out because of the limit. Is it fair that because of the salary limit imposed that these people will not enjoy the 1% compensation in medical benefits?”
“Even if he is unfortunate enough to fall sick, if he can afford it, should he not be made to pay for it?”
“If Mr Low disagrees, can he state his position on it? Either the person is responsible or not responsible. Is he saying that a person is not responsible for his own medical condition?”
“Once the decisions have been made and accepted, it is a matter of public education and information dissemination to rally the public behind in support of the exercise to contain medical cost increases. We all have a part to play to continue with this happy state of affairs in making health care affordable and accessible to all Singaporeans. I would like to thank the Ministerial Committee for making the contribution for all Singaporeans. Sir, I support the motion.”
“I must say that from time to time I am quite disappointed to hear medical practitioners mentioning about cutting corners in service because of the lower fees that they are able to charge. I think that is certainly not the hallmark of the medical professionals. As specialists, with the personal reputation to uphold, I am confident that they will maintain the high standard of medical service even if the rate of fees has fallen. We want our doctors and specialists in subvented hospitals to concentrate on the work of treating and healing the patients. Once there is stability in the medical professional manpower, excellent medical service delivery will be maintained. Sir, the last item is Medical Fee Council. For too long, there has been the overly high dependence and over-reliance on medical experts to influence and decide on health care delivery policies and issues in Singapore. As has been evident from public discussion and comments on the White Paper, the consuming public, though the most affected, are not as vocal as those from the medical community. It is not surprising as the private sector hospitals and medical professionals have vested interest. It is about time that opportunities were given for greater involvement and participation of consumer representatives. They should be given positions in the Medical Fee Council to represent the interest of the large consuming public. The consuming public has been at the receiving end of decisions made on health standards affecting them. If the consumer representatives are part of the decision-making process, there would be greater confidence in the objectivity and rationality of the decisions made.”
“Here, I think the key word is "adequate" supply, never mind the number, but they should be adequate, and 40% among the doctors being specialists. With the changing population profile and disease pattern, the type and number of specialists in demand will also change over time. For example, geriatric medicine will grow in importance to care for the increasing number of elderly Singaporeans. On balance billing, I agree to the limit imposed through balance billing in the charging of patients using Medisave accounts by private sector doctors and hospitals. It is right to use the cost of effective treatment as the basis for balance billing as a way to protect the interest of the patients. I think the yardstick must be what is the cost for effective treatment of the patient as the basis. We should not allow it to be over-lucrative for private sector specialists to affect the specialist in the subvented hospitals who would then want to leave Government service. We would want to retain and continue to attract very good doctors and specialists working in subvented hospitals. It is not how much that one earns that matters. But if the differential in earnings becomes too wide between the private and public sector specialists, it gives rise to the feeling of their worth not being recognised working in public sector hospitals. It is therefore right for the Government to recognise this problem and to use balance billing to correct the anomalies in earnings of medical professionals in the two sectors. We have heard that because of balance billing the private specialists' income will likely drop. This should be welcomed by all of us, because it means that the patient will be charged less for treatment.”
“For those few unfortunate cases where the staff have been receiving medical treatment, the employers should endeavour to help find a cure first before putting them into the revised medical benefits scheme, or to work out some scheme to accommodate these staff who are having a medical condition. Sir, I come to medical insurance and MediShield. Because of the unpredictability of a major illness befalling any one of us, Medisave savings may not be sufficient to pay for the sudden, unexpected catastrophic illness. The financial burden would be made worse when companies no longer pay in full or in part the medical bills incurred. I would urge the Government to get the CPF Board to quickly extend medical insurance coverage under MediShield. Such extended MediShield coverage will come in handy in instances of sudden and unexpected major illnesses. However, as MediShield is not likely to cover those living to the ripe old age beyond 70 years old, Medisave and other savings will still be needed to pay the sizable medical bill usually incurred in the last 1-2 years of a person's life. With regard to the supply of doctors and hospitals, I support the Government's move to regulate the supply of doctors and hospitals. I welcome the fixing of a minimum 65% of the number of B2 and C class beds in subvented hospitals and 9-11%, depending on how you look at it, allowed for the A class beds. This demonstrates to whom the subvented hospitals are mainly to serve. I agree with the Minister's explanation on the need to retain a fair number of A class beds in subvented hospitals to ensure that service quality is maintained. As for the number of doctors, we have been assured that there will be an adequate supply.”
“The Medifund Committee should be more sympathetic and accommodating to these Singaporeans in need. It is right that we focus on the large majority of our population who are gainfully employed. It is good to make a start now to encourage personal responsibility on one's own health, especially among the younger members of our working population. With a cap on companies claiming for tax deduction on medical expenditure at 2% of the payroll and the medical bills of most companies fall below the 2% level, it is timely for employers to revise their medical benefits scheme to incorporate incentives for medical cost containment and strengthen their business competitiveness. Sir, the issue and challenge is how to make the transition phase in the switch-over more palatable to the affected employees. Staff and workers need to be assured that there will be no cut-back in their existing medical benefits. The medical benefits can be frozen at the present level with no further enhancement without co-sharing between management and staff. If employers wish to introduce co-sharing now, it would be only fair that financial incentives be given in exchange for co-sharing. I would ask the employers to first make a careful and detailed study on their own companies' past experience on medical expenditure and the number of cases involved so that the revised medical benefits scheme worked out could be perceived to be fair and reasonable to all parties concerned - the employer, the union and the individual staff.”
“Mr Low Thia Khiang suggested earlier that when a person falls ill, it is total Government responsibility. I think the Government should only come in in cases where the individual cannot help himself rather than to make it that anyone who falls ill, it is the Government's full responsibility to take care of every one. I think we should go for the exception rather than the norm. There would be exceptional cases of those unfortunate few, because of their serious medical condition, that will impose severe financial burden on themselves and their family members. And it is right that the Government has started the Medifund scheme to be the source for such people needing help from the State and I think the Medifund scheme has been a boon to all these people. Sir, there is a group of retired senior citizens who have depended on their life-long savings to keep them going. Because of the small CPF savings in the earlier years and Medisave accounts being non-existent, these retirees, having exhausted their CPF savings, are very afraid to incur high medical bills that impose a heavy financial burden on their children. Here, the family support is crucial and important. But there are those whose children are not well-off and these people have tremendous difficulty in looking after and supporting their aged parents. I hope that this will be taken into account when the hospital administration assesses genuine cases requiring additional subsidy or waiver of hospital fees. This group of elderly Singaporeans has contributed much in the past by laying the foundation for Singapore's present-day growth and prosperity, yet they are put in the undeserved plight because of the unfortunate circumstances in the old days of colonial government and early independent Singapore.”
“The President of the Pharmaceutical Society of Singapore, who is a member of the GPC (Health) Resource Panel, told us that the standard drug list provided by subvented hospitals and polyclinics is in fact much longer than those recommended by WHO and are of higher quality. But, Sir, maybe because of certain medical conditions where first-line drugs are needed for cancers and heart ailments, they are expensive no doubt, but they are very much needed, the Ministry should consider including some of them as soon as possible. Therefore, Singaporeans should not worry about the quality of drugs being dispensed at Government pharmacies. The other interesting item in the White Paper is the need for Government intervention in the structure of the health care industry and the regulation of the health care system. Mr Low Thia Khiang just now made some comments about the contradiction between having free competition on the one hand and Government intervention on the other. I think it is only right that the Government intervenes, because the Government has chosen to intervene particularly where it wants to concentrate its resources on the subsidised patients in the B1, B2 and C class wards, focusing on the middle and lower income groups. I hope that the Government will constantly review the total number of beds in the different class wards so that the public will always have a choice according to their affordability. The changing demographic profile of our population and the disease pattern mean that adjustments will have to be made to the number of beds in the different class wards to meet the demand of the day. In the area of health financing, Sir, I subscribe fully to the principle that the individual patient pays his own medical bill.”
“What cheered me is the comment of Mr Lye Thim Fatt at the meeting the GPC (Health) had with the Resource Panel. Mr Lye is the Chairman of the People's Association Senior Citizens' Club Co-ordinating Council. According to him, senior citizens, especially the elderly in their 70s, do not favour the use of expensive life supporting equipment in ICU wards to prolong life and delay death. They take a philosophical view that when their time comes to leave this world, they wish to die with dignity, comfort and in peace. He thinks that it is the children who would be more inclined to ask for such life support equipment to save the parent when taken gravely ill. They normally take the decision on behalf of the parent out of filial piety. Perhaps the White Paper's mention of this delicate and sensitive matter may serve to bring the discussion out in the open among family members. I agree with Mr Lye' suggestion that the hospital doctors be properly trained and be ready to counsel the young next-of-kin on the possible outcome of any treatment, given the medical condition of the patient, before coming to the decision on the medical care to be given to the patient. The children can then be reassured that they have done their utmost for the parent in the most difficult circumstances when having to make the decision one way or another. Next, Sir, I come to the standard drug list. The basic medical package also provides for a standard drug list based on World Health Organisation's (WHO) recommendation. However, the perception seems to be that they are of inferior quality as WHO connotes drugs suitable for the less developed third world countries.”
“I hope that the Government does not take his cue to reduce the subsidy for Singaporeans going into the B2 and C class wards. I think our concern is that the subsidy will be further reduced and, if possible, we will ask the Government to increase the subsidies for the B2 and C class ward patients. The Government has assured us that the basic medical package will be constantly reviewed and expanded from time to time to take into account medical progress and improvement in the socio-economic status of our people. It is advisable and wise for us to go for results and to spend only on essential medical treatment of proven value that enhances the patient's health and quality of life. There are innumerable health care needs but the resources available are limited. We therefore should opt for cost-effective treatment that yields the best outcome possible. Sir, one item in the White Paper that concerns many people is the exclusion of "unwarranted effort to prolong life and delay death" as part of the basic medical package. There are some who view this as a step towards the practice of euthanasia or mercy killing in Singapore. I am sure that this is not what the Government has in mind even though the Straits Times editorial of 25th October 1993 seems to indicate that "Singaporeans are being prepared for the day when conditions would be rendered acceptable for the plug to be pulled on those patients for whom, in the doctors' judgment, nothing more can be done." Here, I wish to state my position on this issue. I would not agree to euthanasia or mercy killing. We have no right to take away another person's life, not even the person himself. Sir, in the GPC, we also have the views of the senior citizens.”
“Mr Deputy Speaker, Sir, I rise to support the motion standing in the name of the Minister for Trade and Industry, Mr S. Dhanabalan. The many debates in Parliament in the last few years culminating in the White Paper on Affordable Health Care show clearly that the health of Singaporeans remains a high priority of the PAP Government. The White Paper sets out clearly the health care philosophy of the Government and its commitment that good health care will remain accessible and affordable to Singaporeans. Sir, the recent tragedy of AIDS-tainted blood in Germany is a useful lesson for us. In our drive to contain medical cost increases, the quality of medical care should never be open to jeopardy. In our effort to economise on medical cost, we should not risk a nightmare of disastrous consequences. The disaster in Germany shows that it may take years to uncover the grave and irresponsible error and system failure if no checks are in place. By the time it is found out, irreparable harm had been done to the innocent people. We cannot be complacent but to remain vigilant. I would like the Minister for Health to assure this House that in Singapore we handle all medical cases with care and that the exposure to accidents of the kind reported will not happen and that Singaporeans shall have no fear because their health and safety are in safe hands when undergoing medical treatment in Singapore. We in the GPC on Health are happy that the Government has taken pains to define what universal good basic health care is. Our people are already enjoying comprehensive and quality health care. In today's B2 and C class wards, Singaporeans are being treated by well-trained and qualified doctors. Sir, Dr Michael Lim just now asked the Government not to give over-subsidy.”
“The general practitioners should be encouraged to play the key role as a gatekeeper to the expensive specialist treatment in hospitals. We need the support and cooperation of every Singaporean to help bring the cost of health and medical care down. It affects everyone and we are all involved. If we succeed in containing cost at the national level, it would be much easier for us to focus our attention on the smaller number who has special needs and we can devote our care and concern on this small number. Notwithstanding what I said, I support the motion.”
“We may need to set aside a larger portion of the monthly CPF contribution into the Medisave account in the near future to provide for hospitalisation needs. The existing coverage under MediShield may not be sufficient. We have to expand the coverage of MediShield and we may have to also supplement with private medical insurance to provide for a wider range of illnesses and a larger sum to be insured for hospitalisation and outpatient treatment. The Ministry of Health and the CPF Board can look into ways to help provide such medical insurance protection for Singaporeans who are Medisave account holders. The Government has since this year introduced the Medifund scheme for those Singaporeans who are unable to pay the medical bills. Maybe the Minister for Health could give us an update of the number of subsidised patients who have applied for and received a partial or full waiver of hospital charges under the Medifund scheme. It is important for us to demonstrate that in practice no Singaporean has been denied the medical treatment that he needs. It will debunk the vicious talk that one cannot afford to be sick in Singapore. Sir, I am not sure if it is the right thing to do to extend the visiting hours of selected Government outpatient clinics, especially when the attendance at Government polyclinics has fallen from four million in 1980 to 2.9 million in 1992. Maybe the idea is to serve as a check against private doctors' charges. But at the macro-level, it may not be a cost effective way of using public resources. The private general practitioner clinics should be allowed to play their positive role in cultivating good family doctor/patient relationship.”
“The "budget" Government hospital will serve as an added choice but, more importantly, to allow the Government to compare operating cost and efficiency of the range of hospitals in deciding the appropriate subvention and whether the hospital charges are reasonably priced. The Cost Review Committee has asked Singaporeans to exercise prudence in the use of their Medisave. This is right. If the account holder does not use his Medisave sparingly and chooses the category of ward according to his means, he will exhaust his Medisave account very quickly and he will have very little left for his future hospitalisation needs. It is disturbing to learn that 18% of the patients in the class A wards are from households with incomes of less than $1,000 a month. Should these patients blame the Government for the hefty medical bills incurred? Nevertheless, the hospital management has the responsibility to counsel and educate their patients that they should not incur medical cost beyond their ability to pay for them. Sir, everyone is concerned with the very unpredictability of major illnesses befalling on them. We are uncertain as to when and how severe a medical condition that could afflict us some time in the future. The current rate of Medisave contribution can take care of most of the normal hospitalisation cases. However, it would be inadequate to cover the catastrophic and chronic conditions that require surgical and long term treatment. There are hundreds of thousands of Singaporeans who are working but do not have medical benefits from their employers. Many more self-employed and part-time workers do not have CPF accounts. Medisave contribution is the only source of financial support for hospitalisation needs of these people.”
“The Government should be sensitive to the affordability of a large segment of the population using hospital services. As a gesture, the Government may wish to quickly raise the subsidy rate of the class B1 wards at the Singapore General Hospital. The current subsidy rate at 11% for class B1 ward at SGH is well below the 20% long-term subsidy target. This will show to the people that the Government will give easily as much as it takes from the people. The objective of hospital restructuring was to induce hospital management to manage the scarce resources more efficiently and to provide maximum value for every dollar spent in its operations. However, as it was pointed out in the Committee's Report that hospital restructuring had contributed some 14% of the total increases in the operation cost, it has no doubt, in the process, upgraded the quality of service delivered to the patients. However, there are patients who do not require the frills and pampering that the restructured hospitals provide, nor the administrative cost in terms of better reception and personalised services. As all these "extras" come at a price, the patients may not wish to pay for them. I therefore support the recommendation of the Cost Review Committee to ask the Government to retain one "budget" Government hospital with no frills for those Singaporeans who find such medical facility adequate for their purpose. The challenge for such "budget" Government hospital, however, is the ability to attract and retain good doctors, nurses and other ancillary staff.”
“There was also the grievance that subsidised patients in class B2 and C wards have no access to specialist consultant treatment. The defect in the earlier consultancy fee scheme has since been corrected this year with the revised scheme of remuneration that pays consultants the same whether they treat subsidised or non-subsidised patients. This feeling that subsidised patients are not receiving treatment by specialists should be put to rest. Of course, the subsidised patient cannot choose a particular specialist to treat him. Sir, it is about time that the Government defined what is basic medical care. Singaporeans would want to know what constitutes basic medical care in the Government and restructured hospitals. I am afraid that I differ slightly with the Committee's Report here. This clarification is necessary as it would allay the fears of those in the lower-income group who are afraid that they would not receive medical care on financial grounds. We also need to moderate the rising expectation of those in the middle-income groups. Singaporeans will then be guided as to the level of medical care and the cost associated with it. They will be able to determine the level of medical care that they can afford and make the appropriate choice. With regard to the long-term subsidy targets for the different class wards in Government and restructured hospitals, the time-frame taken to achieve the targets should be carefully considered. It is not only the reduction of subsidy that causes medical cost to rise but also the passing on of a part of the increased hospital operational cost to the patients. The cost increases arising from these two items should be alternated and not done at the same time.”
“Sir, I wish to focus my attention mainly on the health issues raised in the Cost Review Committee Report. There are some Singaporeans who feel that our national expenditure on health and medical care is not enough. They ask for more money to be spent since our expenditure on health and medical care at 3.1% of GDP is relatively low compared to 6-9% spent by the developed countries. But the point is that it is really not the amount of money spent on health and medical care that matters. If the low expenditure could give us as good a result obtained by the developed countries, we should be happy with our favourable situation. We are indeed comparable today in terms of long life span and low infant mortality. We are, in fact, achieving very high productivity and value for every dollar that we spend on health and medical care. We should therefore be careful not to throw good money away with frivolous expenditure that does not yield incrementally better outcome. Sir, indeed the substantial adjustment in the ward charges in 1989/1990 after a lapse of five years since 1984 had the negative effect in the minds of Singaporeans that medical charges had gone out of hand and beyond the reach of ordinary citizens. But it is a thing of the past now. I am sure that the Government will not make the same mistake again by delaying the cost increases and lumping them together in one big dose. The lesson is that the public generally favours and finds it much easier to accept small and gradual fee increases. The Government has also since made its intention known that it wants to cap the hospital charges through the use of the CPI plus a X% formula in granting the subvention to restructured hospitals.”
“Sir, will the renovation cost of $27 million be reflected in the new prices to be charged to patients or can the Minister show us that the fees charged by the hospital will remain the same notwithstanding the renovation cost?”
“Then how does the Member suggest that the hospital management admits the patient? Should they ask him whether he would need the Medisave account of his relatives in deciding on the ward charges? Or the hospital need not have to ask that question of the particular patient and so decide on that basis?”
“Mr Speaker, I just want to seek a clarification from Mr Ling. Is he suggesting that the Government does not allow family members to tap the Medisave savings of their relatives in the hospital? I just want to confirm that point from him.”
“Sir, will there be any increase in the number of beds in the intensive care wards in the expanded hospital? Or will the number be the same?”
“Sir, may I ask the Minister whether any concession will be given to residents living in the CBD because it would appear that they would be penalised for living within the CBD. Mr Mah Bow Tan: Currently, Sir, the residents in the CBD do not enjoy any concession and indeed they also do not suffer any congestion during the peak hours. There is no reason for us to vary the situation when the whole-day ALS comes into being.”
“Sir, is it the intention of the Ministry to group all these elderly citizens together so that they can benefit from the scheme? How long will the total project of the pilot scheme last, and when will we see that every elderly citizen will benefit from the improvements?”
“Sir, I am particularly concerned about the first-timers, the young couples who are getting married. Will they be treated separately from those who are upgrading from their existing flats? And also those who are in the rental flats and who want to purchase their own flats for the first time, will priority be considered for such category of people?”
“Sir, may I know from the Minister where does he get the supply of available flats for rental? The other question is: How long do the applicants have to wait before they are allocated the rental flats?”
“Sir, can the Minister give some details as to the discrepancy between the target subsidy that the Government was prepared to give and the kind of subsidy requested by the private sector, so that we can have an idea of the kind of cost discrepancy that exists?”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn. The sum of $703,275,960 for Head P ordered to stand part of the Main Estimates. The sum of $226,421,200 for Head P ordered to stand part of the Development Estimates. Head E -”
“Sir, I beg to move, That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PE 1500. Sir, in less than 30 years' time, by the year 2020, we will have 750,000 elderly persons above 60 years old, three-quarter million people, and some will live to a very ripe old age. I want to know from the Minister what the Ministry is doing to expand the hospital geriatric services and whether more trained specialists, geriatricians and nurses are being made available to look after the elderly sick. And whether he is able to convince the HDB, particularly when they upgrade the old housing estates, to look into the needs of the elderly sick so that they will be able to make homes more elderly friendly and accident free. And for home care, whether the Government can expand the transport services to ferry these aged sick for treatment in hospitals and polyclinics. What are the facilities that could be made available to the care givers so that they can have periods of respite and relief? Maybe the Minister would like to address the special health care needs of the elderly.”
“I beg to withdraw the amendment. Amendment, by leave, withdrawn.”
“Sir, I beg to move, That the sum to be allocated for Head P of the Main Estimates be reduced by $10 in respect of Code PD 2400. Sir, I think the campaign against AIDS is an important campaign and that we should not lose its momentum. The statistics of the neighbouring countries suggest that they are reaching crisis proportions. The World Health Organisation has said that AIDS is spreading in Asia. More Singaporeans are travelling abroad for business and leisure. I would like to know from the Minister how his Ministry is proposing to control the AIDS problem. In Singapore, especially among the young adults, how do we give assurance to Singaporeans that the national blood supply is safe and we are well protected from it? And what is the Ministry doing to educate Singaporeans about AIDS to dispel the myths and misconceptions associated with AIDS?”
“Sir, I hope the Minister can give short replies so that we can finish off before the "guillotine" time.”
“I beg leave to withdraw the amendment, Sir. Amendment, by leave, withdrawn.”
“They need not duplicate in the purchase of such equipment. With economies of scale, this will help lower the cost of each test. I suggest this because our population base is small and the machines are highly specialised for specific tests only. As a country, we should maximise the use of whatever facilities and equipment purchased. Singaporeans, as a whole, spend a substantial amount on drugs and medicine each year. I wonder how much the registration procedures for drugs and the licencing fees charged add to the cost of medicine in Singapore. Because of the licencing fees, vendors are using this as an excuse to sell only expensive and high value brand drugs in the market. The fear is that the cheap alternative medicine may not be easily available because the vendors find these inexpensive items no longer advantageous to sell. May I ask the Minister to review the Registration of Drugs Act and the way it has been administered so that the unintended effects of profiteering do not take place? More generic medicines that are cheaper and equally effective should be made easily available to those who need them. Sir, recently, the hospitals and nursing homes have been affected by the stringent requirements on bio-hazardous waste disposal. The operating costs have gone up as a result. I support the high standard of infection control in Singapore. But we need not go overboard. It appears that for the sake of expediency, we classify all wastes from all such institutions as infectious and having to be treated as such. I wonder whether a more cost-effective method could be found so that we do not cause additional financial burden to the hospitals and nursing homes which would have to pass on the cost to the patients and residents of nursing homes.”
“As the major provider of hospital services in Singapore and because the middle and lower-income groups depend on the Government and restructured hospitals for their hospital needs, the Government has to ensure that the fees charged by the specialists are those that the public can afford to bear. The Government is in the strong position to decide on the remuneration package of the doctors. There is to be internal equity in determining the relative value of each specialty with a pay system that fosters team spirit among doctors working in the hospitals. 2.30 pm The Minister for Health has said that the remuneration system for specialists would be revised. May I know from the Minister what has been done to improve the hospital service to subsidised patients. How will the specialists be now paid? Medical malpractice compensation is a serious problem in the United States. The risks of malpractice litigation lead to high insurance cost and defensive medicine practised by doctors and specialists. This can bring medical costs up unnecessarily. I would like to know from the Minister what steps he proposes to take to avoid the problems faced in the United States from becoming a problem in Singapore. Can we give more teeth to the medical bodies to handle the issue themselves, or should consumer representatives and the legal profession work together with the medical practitioners to help address this matter which is an urgent one and could become a bone of contention in the future? A related issue is the high technology medicine, test and procedures. In this regard, I wonder if there could be greater cooperation and collaboration between public and private sector hospitals and medical centres to maximise the use of costly equipment.”
“Sir, I beg to move, That the total sum to be allocated for Head P of the Main Estimates be reduced by $100. Sir, I am very pleased to note that Mr Chiam See Tong and his SDP colleagues have not submitted any cuts to this Committee of Supply debate on the Ministry of Health. It is not surprising, Sir, as the Government has done particularly well in taking care of the health care needs of the middle and lower-income Singaporeans. Those in the lower-income groups are especially reassured that they need not fear if they fall sick and have to be hospitalised. The newly established Medifund scheme should put this concern to rest. However, Sir, more could still be done by the Government. We need to continually seek ways to contain the cost increases without sacrificing the very high standard of medical care in Singapore. The mission of the Government and restructured hospitals is to provide affordable health care to all Singaporeans, particularly to the middle and lower income groups. The remuneration system allows specialists to earn professional fees only from private patients in the Class A and B1 wards. This has given rise to the perception that there is the discrepancy of treatment by the specialists favouring the private patients and are less inclined to treat subsidised patients from the Class B2 and C wards. The subsidised patients feel pressured to upgrade to A and B1 wards in order to receive specialist treatment when hospitalised. Sir, the doctors in the Government and restructured hospitals are employees of the hospitals. Though there is the constant need to reduce the income gap of specialists between the private and public sectors, we should not go over-board in the remuneration system.”
“In clause 6, there is mention about the possession of 10 copies of a publication. I would like the Minister to clarify whether a person would be committing an offence if he accumulates the monthly subscriptions of a journal up to a year, in other words, he is in possession of 12 issues of the journal for the year. There appears to be some discrepancy in the standards that we apply for those publications inside and outside Singapore. Is there not anything that we can do to close this gap? In other words, try not to make it too hard on those publications within Singapore and whether some influence can be made against those external publications. Sir, in clause 10 (1)(c), it saddens me that there is this provision about people who give or furnish cigarettes or tobacco to the young. It is a sad reflection that some adults do such things in offering cigarettes to the young and that it has to be reflected in this Bill. But I suppose that is a fact and it is happening, and we want to ensure that the adults do not give tobacco freely to the young. In clause 11(3), I wish the Minister to clarify whether public parks and recreational areas are included in the definition of "public place", because buildings and premises are mentioned and public parks and recreational areas are where the young gather often. Finally, Sir, under clause 17, the existing vendors are quite concerned about this question of licensing, though the Minister has said that he may not wish to have these regulations. But there is a concern whether he will control the number of licences, and how the existing vendors will be affected by this clause. Sir, I support the Bill.”
“How do you explain to the young that they cannot do what the adults can? But then, we should not emphasise on the ban but the ultimate objective and the spirit in which the stance is taken. We have the interests of the young at heart and for their long term good, we want to prevent them from taking up the smoking habit. As for the existing adult smokers, I am very sure that for many of them they have wished that they have never started smoking in the first place and kicking the habit now is so hard even when they have to do so out of necessity for their own health. When we look at the proportion of smokers in our population, there are actually more non-smokers. There is growing evidence of the harmful effects of breathing in other people's smoke. Non-smokers who are continuously exposed to tobacco smoke suffer the same danger to their health as smokers. Therefore, non-smokers can cry foul against smokers who smoke in their presence. It is time for non-smokers who are the majority to assert their right against the smokers. Private organisations have been slow in making their offices and workplaces smoke-free, and only about half of them have some form of smoking control measures. The Government offices have been declared smoke-free since 1986. I hope that both the employers and employees can act together to provide a smoke-free environment in their workplaces. At the national level, medical expenditure on tobacco-related illnesses places a heavy burden on the economy, not counting the unnecessary waste to human lives. It is better and more cost-effective for us to act early in our strive to be a nation of non-smokers. Sir, I would like to make some comments on some of the clauses of the Bill and to seek clarification from the Minister.”
“Mr Speaker, Sir, despite the many years of rigorous effort in anti-smoking measures, we have heard from the Minister that more people are actually smoking. The increase is most alarming among the young smokers. The number of regular smokers aged between 15 and 19 had more than doubled from 2.9% in 1987 to 6.7% in 1991. There is also an increasing number of young women who have taken up this smoking habit. What it meant to us is that if we ever have a winning chance in this battle against smoking, we have to concentrate on helping our young to resist ever starting this addictive habit. Notwithstanding that we have the legislation, Sir, parents and adults do have an active role to play in this drive against smoking. Personal counselling of the young individuals, reinforced by widespread publicity, can render our campaign more effective in convincing the young minds not to smoke. We have just now heard the Parliamentary Secretary to the Minister for Defence telling us that many of the smokers actually start very young, some as young as from the age of 12 to 13 years old, and they start their first puff out of curiosity and peer pressure. Unfortunately for many, once started on smoking, the nicotine addiction leads them to become regular smokers. In the long run, they will suffer higher health risks associated with smoking-related diseases of lung cancer, heart disease and chronic bronchitis. Sir, I must admit that I had the earlier hesitation in determining whether it was right and prudent to ban smoking completely for those under 18 years old. There appears to be a contradiction. If smoking is that bad, it should be banned for all, irrespective of ages. Why still provide the choice to take the puff on reaching 18 years old?”
“Sir, may I know how are the students selected for such overseas scheme and who are financing their stay overseas?”