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.”
The complete record
Every one of 494 lines we hold for Loh Meng See, in date order, each linked to its source. Free to read, in full, without an account. Page 8 of 10.
“But, do not forget that they too have contributed to the prosperity of Singapore. Some of them might be from the low-income group, but they are, nonetheless, part of us. When they are sick and they require medical care, should it not be the responsibility of the Government to look after them? They should be given the assurance that when they are sick, they will be given proper medical care, even if they cannot afford to pay for the medical expenses. But here, we have Medifund which can only pay the medical bills of those who are in need if the Fund can generate revenue. Furthermore, even an eligible applicant is not assured that his or her application for waiver of medical bills will be granted. Is this the safeguard that the Government is providing for the people of Singapore? Do not tell me that this is what the Government meant when it promised in its Next Lap that it will "continue to provide free medical service to the poor and indigent"? Mr Speaker, Sir, if the Government is sincere in fulfilling its promise of "providing free medical service to Singaporeans who are poor and indigent", as stated in its Next Lap, then the Government should make good use of the money to provide the people with good and proper medical safeguards, with a clear statement as to the circumstances under which medical assistance would be available, so that those Singaporeans who genuinely cannot afford to pay for their medical expenses and who stay in C class wards will not have to worry about the ever rising cost of medical care.”
“Under clause 15(5) of the Bill, even if an applicant satisfies the conditions as laid down under clause 13 to become an eligible applicant, the Medifund Board of the hospital or the persons authorized to approve such application may not necessarily approve the application by the eligible applicant. What then are the criteria for any Singaporean who cannot afford his medical expenses to be entitled to make use of Medifund to pay for his medical bills? How can the Government ensure that the persons who are authorized to approve such applications are exercising their power fairly and justly? More importantly, in the case of those who cannot afford to pay their medical expenses and whose applications to make use of Medifund have been rejected, what would happen to them? Do they just hang on and wait for time to die or for the Government's letter demanding payment of their medical bills, and even be made bankrupt because they cannot afford to pay for their medical expenses? Mr Speaker, Sir, from the points that I have raised, we can see that Medifund cannot truly ensure that the poor people in Singapore can get the proper medical care that they need. With the increase in wages, rising cost of medical services, and the fact that Government hospitals have to be responsible for their own profits and losses after privatization, coupled with the Government's long-term target of subsidizing only 80% of class C ward charges, we can expect hospital charges to keep on going up. Some Singaporeans, particularly the older ones who have no Medisave account, or with inadequate amount in their Medisave account, will have trouble meeting their expenses once they are sick and have to be hospitalized. Among these people, some might have retired.”
“Supposing one of the approved hospitals has more patients who cannot afford to pay for their medical bills, and hence exhausted the money in its account, does it mean that the patients in this particular hospital will be unable to get financial assistance? If that is the case, then will the hospital concerned allow the patients to check the amount standing in its Medifund account before their admission to the hospital? The Bill states that so long as a hospital is approved by the Minister, it will be entitled to maintain and operate a Medical Endowment Fund. I would like to ask the Minister which are the hospitals that he will be approving for this purpose. For example, if a patient stays at Mount Elizabeth Hospital, can he consider Mount Elizabeth Hospital as an approved hospital? Concerning the application for use of Medifund, clause 13 of the Bill merely states generally that anyone who is a Singapore citizen staying in an approved hospital and who cannot afford the hospital expenses can make application to the Medical Endowment Fund Board. My questions are : (1) If the patients who stay in class A and class B wards cannot afford to pay for their hospital charges, can they apply to make use of the Medisave? (2) If a patient has stayed in an approved hospital for some time and he subsequently succumbed to his illness, leaving a hefty hospital bill outstanding, then can the medical social worker of the hospital apply to make use of Medifund to pay for the outstanding bill? Then the hospital will make a profit instead of a loss, and the Government will not have to end up with the bad debt.”
“" Mr Speaker, Sir, now the Medical Endowment Scheme Bill introduced in this House allows the Government to set aside a sum of money for investment and to get the revenue of the investment to help those patients who cannot afford to meet their medical expenses pay their bills. Clause 15(1) of the Bill clearly states that it would depend on whether there is money in the Hospital Medifund Account to effect the said payment. This Bill does not tie in with the Government's original promise. Singaporeans who cannot afford to pay for their medical expenses cannot expect the Government to keep its promise of writing off their outstanding medical bills. They have to pray that the investment committed by the Medical Endowment Fund would reap big profits all the way, and that the Medifund Account of the hospital which they are admitted to is also receiving profits from all sources of investment, so that they will have a chance to make use of this Fund. Can this be truly said to be a form of protection? I have yet a number of other doubts about the Bill. Firstly, if unfortunately, the investment does not yield any profit, or even suffers losses, then Medifund will have no money to pay the medical bills of those people who cannot afford to meet their own medical expenses. What will happen to these people? Although the Minister said that in the first year the Government will make available the money for the Fund, what if, in future, the investment is not getting any positive returns? Secondly, under the Bill, the Government will allocate the money to the approved hospitals to set up their own Medifund accounts. What will be the criteria for the allocation of funds?”
“Is it based on historical experience that we have so far with the number of waivers or is it based on the number of beds of subsidised wards? I welcome the inclusion of community leaders in the Hospital Medifund committee. The Minister had said so in the past and he has put it into practice, and we certainly look forward to the participation of these local community leaders in helping out in the decision-making and in approving applications for Medifund from the less able Singaporeans. One last point, Sir. We understand that there is a cost involved in the auditing and administration of the accounts. We know that the respective hospitals are to maintain their accounts. We hope that the hospitals do not have to levy a high charge in the administration of the accounts which will take away money from these people who are in need. Sir, I support the Bill. Mr Low Thia Khiang( In Mandarin): Mr Speaker, Sir, in March last year, during the debate on the budget for the Ministry of Health, I told the Minister for Health that people in Singapore had described our medical service as one in which "people can die but cannot fall sick". I wanted the Minister for Health to assure the House that the Government would pick up the medical bills for any Singaporean who could not afford to pay the medical expenses. At that time, the Minister for Health replied that the Government was already subsidizing 80% of the class C ward charges, and that if the patients cannot afford to pay for the remaining 20% of the charges, Medifund would pay for them. I quote (in English): "And for those who cannot afford to pay the remaining 20%, we have Medifund to help them.”
“Mr Speaker, Sir, I rise to support this Bill. I am very happy that the Government has finally come up with this proposed Bill. It is indeed a very important safety net to the less well-to-do Singaporeans. They can count on the Government to help them in time of need. The Minister mentioned that the amount spent in waivers and remission of fees in 1991 was $1.7 million. We do not know what the amount was in 1992, but certainly the initial sum of $5 million is a generous one. Sir, I think there is concern when the amount of capital money added each year is made dependent on budget surplus and economic growth because the concern is one that there is a need by the less able Singaporeans. And if you were to tie it to economic growth and budget surplus, it means that we are not addressing that need. One difficulty is that medical condition can be recession-proof and people do get sick under all economic circumstances. I presume what the Minister has said is that the eligibility for such assistance will only be confined to patients admitted to Class B2 and C wards and it will not be for any other wards. So maybe the Minister would like to clarify and confirm the class of ward eligibility. The Minister has not told us what those approved hospitals are likely to be. Is it mainly the Government restructured hospitals or will they include the new community hospitals that we are going to have? Because in the new community hospitals, we believe they are built to provide for more affordable hospitalisation of patients. We would like to know, at least in preliminary terms, how the grants will be allocated to each of the hospitals and on what basis we are likely to be depending on in allocating the grants to the various hospitals.”
“The Minister said that the students have prior working experience. Does it mean that he will rule out those without working experience but with Polytechnic diploma qualifications?”
“Sir, will the Minister consider increasing the intake of polytechnic graduates into our universities because there are a large number of them going overseas for further studies?”
“Sir, when the Ministry considers the enforcement of a ban on smoking in public places for the under-18 youths, will it be such that there will not be the social stigma of treating them as criminals, and could some lenient measures be considered in the legislation?”
“Sir, I did not hear from the Minister that there will be a possible ban on smoking in public places for these under-18 youths. Can he confirm that?”
“Question No. 7, Sir. INCREASING NUMBER OF SMOKERS AMONG YOUTHS (Plans to reverse trend) 7. Mr Loh Meng See asked the Minister for Health what are his Ministry's plans to reverse the trend in the increasing number of smokers among our youths.”
“I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.”
“Sir, I beg to move, That the sum to be allocated for Head P be reduced by $10 in respect of Code PA 1500 of the Main Estimates. Sir, on the question of the manpower situation with regard to health professionals, there has been much debate on the correct number of doctors for Singapore. But the point that I would like to make, Sir, is that we have got an ageing population and we have also to take into account the large expatriate and foreign worker population in Singapore, not counting the number of patients that come from neighbouring countries and tourists who come to Singapore for medical treatment. I hope that the Ministry will recognise that there is the other large portion of patients that needs to be looked after besides Singaporeans, and that an adequate number of doctors should be available. The point I would like to comment is that, with the restructuring of hospitals and many voluntary welfare organisations manning the institutional care, I hope the Ministry will not reduce its fervour to try to have as many health professionals being trained and recruited, because I am concerned that once the Ministry has less direct control of the manpower, they may leave it entirely to the private sector or to the non-Ministry sector on this matter.”
“Sir, can I move on to the second amendment because the Minister has touched on Medisave? The Chairman: I would prefer you give Dr John Chen a chance to make his speech on the same subject. Are you speaking on your first subject?”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, I would like to differ from Dr Tan. The problem is not really with the primary health care. I think we have got a wonderful record as far as primary health care is concerned. Here, the problem is with regard to hospitalisation needed for the sick. But I would like to ask why the Minister has not commented on the revised consultancy fee scheme.”
“In addition, the Ministry of Health should conduct regular checks on Chinese herbal and patent medicines, with proper regulatory measures, so as not to hamper the development of Chinese medicine. I hope that the Ministry of Health would treat this as a matter of importance. Dr Michael Lim Chun Leng (Cheng San GRC): Sir, in view of the time constraint, I will withdraw my amendment and raise the issue on another occasion.”
“As such, I would once again urge the Ministry of Health to legislate the control of Chinese physicians and the basic facilities required of their clinics for them to practise Chinese Medicine, so as to avoid a repeat of incidents such as the misuse of western medicine by the Chinese physicians. I suggest that the Ministry of Health invite "National Grade" Chinese physicians from China and Taiwan to come over here to discuss the matter, and together with the established local bodies of Chinese medicine, form a "Chinese Medicine Examination Board" to conduct a national examination for all the Chinese physicians in Singapore. This will prevent those who have received just two or three months of training from practising and passing off as qualified Chinese physicians. In order to give the practising Chinese physicians more time to prepare themselves, psychologically and professionally, the Ministry of Health may consider implementing, after a certain date in a few years' time, the ruling that only those who have passed the National Chinese Medicine Examination may practise Chinese medicine, and recognizing the medical certificates issued by these qualified Chinese physicians. I am sure those bona fide and experienced Chinese physicians are supportive of the move to uphold the reputation of traditional Chinese medicine. They will not be afraid to undergo this examination process to prove their worth, and to enhance the image and reputation of Chinese medicine. At the same time, I would suggest that this examination be conducted in Chinese for the convenience of the many Chinese physicians.”
“According to information given by the Chinese Physicians Association, there are more than 1,500 Chinese physicians, more than 800 Chinese medicine shops, and more than 30 charitable Chinese medical clinics operating in Singapore. This illustrates the esteem given to Chinese physicians and Chinese medicine by the people of Singapore. It also confirms the curative effect of Chinese medicine. As such, I feel that the Ministry of Health should not ignore the need to control the practice of Chinese medicine in Singapore. Today, government leaders in China, such as Deng Xiaoping and Yang Shangkun, live up to 70-80 years old, and are still enjoying good health. It shows that Chinese medicine does have its curative effect. In Singapore, during the examination period, parents would give their children ginseng solution or boil chicken soup with some Chinese herbs to strengthen their bodies and improve their mental alertness. This again shows that Chinese medicine does have some curative effect. Presently, in order to prevent some "quack" doctors from cheating and carrying out improper practice, thereby tarnishing the reputation of Chinese medicine and damaging the health of the people, the Chinese Physicians Association has exercised some self-regulatory measures such as the issue of Practising Certificates for its members to display at their clinics. However, without the involvement of the Ministry of Health and the statutory effect that would follow, this measure may not achieve its desired result.”
“Sir, I would like to know, under this heading "Voluntary and non-medical participation" what kind of help the Ministry of Health is extending to the St. Andrew's Community Hospital and the St Luke's Home for the Elderly Sick to be opened at Bukit Batok. Sir, what about Kwong Wai Shui Hospital, an example of a community hospital run for many years by a clan association? Can the Ministry not give grants to refurbish and put to the hospital to wider use? I understand that there is still capacity at Kwong Wai Shui Hospital to take in more patients. I hope to see more clan associations coming forward to extend their resources to help look after the elderly sick. Finally, I suggest that the CPF Board set up a medical insurance corporation to pool the resources of contributing CPF members. If we have a direct pooling of insurance premiums through CPF medical insurance, we can find some ways to help those unfortunate fellow Singaporeans who need hospitalisation. Also, may I know from the Minister what are the measures that will be taken to implement the recommendations of the Review Committee because ultimately, what is important is that we have the will to implement all the recommendations suggested in the Review Committee's Report. Mr Peh Chin Hua (Jalan Besar GRC)( In Mandarin): Sir, I support the recommendation by Dr Ow Chin Hock yesterday, that the Ministry of Health should attach more importance to the role of traditional medicine. Now, I would like to urge the Ministry of Health to conduct a National Examination on Chinese Medicine to regulate and promote the practice of Chinese Medicine.”
“Sir, yesterday, before the adjournment, I spoke on the subject of consultancy fee scheme. After almost two years of experience in operating the existing consultancy fee scheme, I have no doubt that the Ministry of Health will be able to come out with a fair, equitable and competitive revised remuneration system for doctors and specialists. I would like to hear from the Minister on the revision that he suggests. Sir, there is a wide gap and difference in the recovery rates of the B2 and B1 wards. May I suggest that the Ministry consider providing an in-between category, say, with 50% recovery rate. This will provide for a continuum of recovery rate and the middle income group would be taken care of. Sir, can I move on to the next subject?”
“I now move on to the consultancy fee scheme. Sir, it is important for us to understand that the Government doctors are employees of the Government, and it is puzzling for me as to why the hospitals choose to pay additional fees to the doctors during their normal regular working hours. I understand that it is to provide for the retention of the specialists. On the other hand, coupled with the provision of consultancy fees being paid to the specialists for the non-subsidised patients, ie, the A and B1 patients, it has provided an avenue for the specialists to earn more to treat these non-subsidised patients. I would think that even if a variable consultancy payment is to be given, it should be a smaller proportion than what I understand to be two or three times the monthly base salaries. In other words, I rather have a system whereby we pay them equitable, competitive base salaries, but the additional variable component should be a smaller amount so that we can avoid a situation whereby there is a vested interest on the part of the specialist if he were to earn additional income arising from surgical operations or additional procedures. It is important for us that we do not get overboard in comparing the remuneration package of the Government specialists against the private practice because there is the question of security, there is no financial risk. Also, I think it is equally important that if we provide for internal equity among the specialists within the Government hospital setting -- The Chairman: Order. Moment of Interruption. Thereupon Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House.”
“Doctors can sometimes actually do wonders with limited resources. The point is that the quality of health care may come with a price but it need not necessarily be at a very high price. Sir, the public generally do not begrudge paying our doctors well. The doctors and the specialists provide very personal services with their expertise and competence. Besides paying for the services of the doctors and specialists, the patients have to pay the cost for the use of equipment, the elusive medical technology that the ordinary person does not understand, medicines and drugs, and the building, and all these add to a very large sum of money. What is important is to weigh carefully the incremental value of every dollar spent, whether there are nice, public toilets in the hospitals or the efficacy of drugs being administered. It is important to encourage Singaporeans to adopt a very philosophical attitude and approach towards delaying further the inevitable that must come with a terminal illness. We should care also for the dignity of the patient in his last days. Often the patient is in no position to decide for his own treatment. He is dependent on his kins and relatives to decide on his behalf. With death, the burden of paying the medical bills lies with the surviving kins who realise too late the very high bills that have been piling up, day by day. This is something that we do not discuss easily but it is something that we ought to think a lot about the dignity of the patient in his last days.”
“There is the widespread perception, Sir, that the quality of care in Class C is low and maybe the complaints that come from the subsidised patients are not necessarily true that they are not being adequately looked after by the specialists. But here the effect of the consultancy fee scheme may have posed some problems, especially the fee is only being paid to the specialists treating Class A and B1 patients. Sir, what is important with regard to health care is to go back to the basics, in this case, clinical basics. Let me give an example, and this was told to me by an elderly patient. He felt unwell. He had palpitation at the chest area. He consulted a doctor and this doctor recommended a battery of tests to him. Because he is a well-informed patient, he was not sure that the recommendation of the first doctor for a battery of tests was necessary. He consulted another one for a second opinion. This one, a more experienced doctor, did some personal checks, asked a few pertinent questions and narrowed down that it was due to coffee drinking. He recommended that he cut down his coffee intake, and after a while, the ailment went away. The question is, Sir, whether our doctors try their level best to go to the basics, the clinical basics, in their assessment, and not be dependent too much on the machines. Because the danger of being too dependent on machines is that it may give rise to added cost to the patient, and it is important that we encourage our doctors and specialists to avoid that. Though the machines and equipment are useful and important for diagnosis, they are to be the tools and not masters over us. Sometimes, I wonder whether it is better to create some scarcity of resources in our hospitals because that will allow doctors to think of improvisation.”
“But, nevertheless, the NTUC's representative has expressed the workers' concern in this regard. We have the People's Association's Senior Citizens' Club Coordinating Council Chairman in the Resource Panel, and he has expressed the senior citizens' concern, especially the retirees. They are worried that the cost of hospitalisation seems to be going up and up and there is also the need to look after the mental health of the elderly as well. There is the fear and anxiety in being taken ill and has to be hospitalised. Here, I believe the Minister will, most probably, express the view which I share with him that it is a perception problem, which may not be the case, but, nevertheless, this is the perception that has been expressed. The Resource Panel was unanimous that there is a need for public education to remove public ignorance and the lack of understanding in the use of Medisave. For example, there is the lack of understanding that there is the per diem limit in the use of Medisave; and also the lack of understanding that the total hospitalisation cost has many parts that make up the total hospitalisation costs and the cost is not only limited to the ward charges. Here again, there is this lack of understanding of what constitutes the total hospitalisation cost. But there is one thing that they spoke very favourably about, and that is the community hospital concept. It is felt that the community hospital, if run properly, would be useful for the rehabilitation care cases, and it is not necessary to stay in the acute and fully-equipped diagnostic hospital. But what they feel very strongly about is that the community hospital should be of reasonable standard and the cost be kept to the lowest possible level.”
“Sir, I beg to move, That the total sum to be allocated for Head P of the Main Estimates be reduced by $100. Sir, it is very timely that Dr Aline Wong's Review Committee's Report on National Health Policies was published in the early part of this year and it has allowed us to focus the issues involved during the debate in the Committee of Supply. Sir, I wish to commend the Review Committee for a very comprehensive report and the report has actually addressed essentially all the major issues with regard to health in Singapore. What is significant is that we know for the first time that the Committee is represented by a cross-section of people and of different interest groups, especially the non-medical personnel, being represented in the Committee. The GPC for Health has had discussions with the Resource Panel and they have expressed their views on the Review Committee's Report. I would like to share with Members what their views are. Sir, the employers are worried that the Government is trying to shift to them the health cost by steadily increasing cost recovery rates, except for Government and Government restructured hospitals, because the bulk of Singaporeans are employed and any shift in the recovery rates will affect them, particularly at the executive level. The NTUC's representative in the Resource Panel expressed the workers' concern over moves towards greater divestment of health care services to the private sector as this will further strain workers' affordability. There might be a misunderstanding with regard to divestment to private sector. Here it could be easily seen when often we raise this question of private sector participation and I do not think that it is the Ministry of Health's intention to privatise health services.”
“Especially today, Sir, when we are developing the new Growth Triangle of Singapore, Johor and Batam, our businessmen should not use their investment as a pretext to deceive their family members by telling them that they are going on business trips or having seafood there, while in fact they are fooling around in the neighbouring countries. By so doing, they will not only do harm to themselves but to their family members as well. We must not forget that in Singapore, among the foreigners who suffer from AIDS, about 60.8% come from ASEAN countries. This percentage is very high indeed. In Thailand alone, there are 400,000 people who are known to be suffering from AIDS, accounting for 57% of the total number of cases in the whole of Asia. As such, when Singaporeans go overseas for vacation or business, they must make sure that they do not frequent the "redlight area" and run the risk of bringing AIDS back to their loved ones at home. I would also urge the Ministry of Health to take more stringent measures to prevent people who have AIDS or are HIV-positive from committing the offence of rape, because they will harm their victims even more severely. As such, the Government should consider imposing more severe punishment, such as death penalty, etc, on this type of rapists, to serve as a deterrent. I hope the Minister for Health will consider this view.”
“The Bill will ensure that there will be some form of control over the spread of AIDS so that innocent people will not contract AIDS unknowingly through sexual intercourse with those who are aware that they have been diagnosed to be HIV-positive, and thus getting themselves into grave trouble and misery. At the same time, the Bill will also ensure that those who are diagnosed to be HIV-positive will not be allowed to donate blood or do anything which is capable of transmitting AIDS to others. According to figures provided by the World Health Organisation (WHO), nearly 10 million people in the world are suffering from AIDS or are HIV-positive. 10 million is an astonishing figure. If we do not have effective control over this disease today, the consequences will be disastrous. According to available information, among the 111 AIDS cases discovered in Singapore, 83% are homosexuals and heterosexuals and some 88.2% of the patients are below the age of 40 years. Two-thirds of them are professionals, executives and people in the service industry. This situation is very alarming indeed. The Bill, I believe, will have a positive effect. Therefore, I urge all fellow Singaporeans who go overseas for vacation or business to avoid frequenting the "redlight area" to indulge themselves in women and song, so that they will not beget sorrow through extreme joy and ended up contracting AIDS, and even bring AIDS back to their spouses and children. That will be a great tragedy!”
“It is in fact a very lengthy questionnaire of 15 questions that they have to answer each time. And of course some prospective blood donors think that it is an intrusion of their privacy. We also know that it is important for the blood bank to keep the integrity of the blood supply to protect innocent lives, the very people who needed the blood donation. I am wondering whether the Ministry of Health can differentiate between the first-time donors and the regular donors. Is there a possibility of making it easier for regular donors to have a different set of forms so that we can facilitate the regular blood donors to continue to provide the generous donation of blood to save lives? The other question, Sir, is whether the Ministry of Health can actually work with travel agents to provide information leaflets to Singaporeans travelling abroad to heighten their awareness with regard to this very serious disease. Because if they could be alerted prior to their departure, most probably we can help save some from getting into their high-risk behaviour. Finally, Sir, we do have cases of Sin-gaporeans seeking surgery abroad, and we have learned of cases whereby through such surgery some of the Singaporeans have been infected with HIV. I wonder whether some procedures could be worked out so that such patients could seek counselling and consultation with the Singaporean doctors before they proceed overseas. Mr Peh Chin Hua (Jalan Besar GRC)( In Mandarin): Mr Speaker, Sir, I rise in support of this Amendment Bill.”
“Mr Speaker, Sir, I rise to support the Amendment Bill. Sir, in the case of AIDS, prevention is the only way as there is no cure. In Singapore we cannot afford to be complacent because the numbers have been increasing by geometric proportions. And at the rate that it is going, the numbers can only continue to increase. I read with concern, when the Ministry of Health launched the public education campaign and through the press reports, that among Singaporeans who take short trips to neighbouring countries some believe that they are not likely to be struck down with AIDS because they think that they are not so unlucky, in the sense that they are not lucky enough to strike lotteries and it is not likely that they will be caught with AIDS. I think we have to understand what the Thai Minister Meechai said recently on the dangers of AIDS, how he himself described the very extensive numbers among the Thai people being caught with this disease, and how he claimed that his own daughter is not likely to be able to marry a Thai man free from AIDS. I am very pleased that the Ministry of Health is taking very early action in this regard. Sir, I would like to just ask the Minister a few questions for clarification. First, Sir, we know that Magic Johnson has been treated with a drug called AZT, which is approved by the Food and Drug Administration (FDA), and it is purported that this particular drug can slow down the affliction to full-blown AIDS. I wonder if the Ministry is able to help make it easier for the HIV-positive infected patients to be able to use their Medisave to buy such drugs. If not for anything, we can help them to provide the relief through the use of this drug. Second, Sir, the Minister mentioned about the questionnaire that potential blood donors have to fill in.”
“The civil service has served us well. I am not so sure that the examples of the United Kingdom and Malaysia are good enough reasons for us to follow suit, unless their new experience has been far superior to our existing arrangements. If in making the drastic and fundamental changes to our civil service is likened to the dismantling and breaking up of the Soviet Union, followed by the formation of the Commonwealth of Independent States, then we have to be mindful of the danger and the pitfalls. Instead of cooperation and collaboration, we will find intense competition, a free-for-all situation and, I think, we need stability and security of tenure for the civil servants and for the civil service to operate. The big question is: are our civil servants mentally prepared for the culture shock that will be brought about by the change? Because they have to be mentally attuned to the new changed circumstances and I think they have to be prepared for it. If, as a result of the change, prices go up not because of the free play of market forces but through higher service charges and increased licensing fees to pay for their keep, I am not so sure Singaporeans will welcome this move of the civil service after all.”
“And possibly at the time when Mr Ling checked with the hospitals it could be a period of low demand and because they are private hospitals, the administration could respond to fluctuating demands, like the hotels where during certain periods, the rates are higher. If that is so, there is a case for more private sector participation in providing health care in Singapore and we should encourage more private sector involvement in such cases. I come to housing now, Sir. The response from the HDB shopkeepers has been very positive to the HDB's plans to sell the shops to the tenants. But the big question that they are asking is: what is the market price, what is the price that they have to pay? I hope that the HDB will give due consideration to the financial capacity of these tenants in meeting the instalment payments and in the repayment of the loans taken on the property. For many of them, they may have difficulty in providing the collateral in securing the loan. I hope that there will also be minimal restrictions so that the loans could be easily obtained from financial institutions at competitive rates because the people get uneasy from the experience of their own HDB flats. I hope that the HDB shops will be treated differently from the HDB flats in the financial arrangement, otherwise there will be restrictions on them. They are also hoping that there will be minimum restrictions concerning the transferability of the HDB shops from the existing owners to the new buyers who wish to buy from them. Finally, Sir, the civil service. I think it is perfectly in order to make changes to the management of the civil service and to free its personnel administration. However, I am not so sure what fundamental changes are intended to mean and to be.”
“But for a start, it is better for us to consider revising the maximum ceiling allowed for account holders to use their Medisave accounts to pay for their hospital bills, especially where there are sufficient funds so that he need not have to use cash. I think that would be most welcomed. As for Medifund, I am very happy with it. This should put to rest any fear that the poor will be neglected. They are assured that they will receive basic medical care and that they should not be unduly worried that they really do not have the money to pay for the C or B2 ward charges. I am a little perturbed, like all my PAP colleagues, about Mr Ling How Doong's remarks with regard to the choice of community leaders being invited to sit in the committee to decide on cases being referred for Medifund. I think we ought to give recognition to our community leaders. They have worked very hard all these years to help to make for a better Singapore. As they are community leaders, they know the ground well. They are independent, impartial and neutral. They certainly deserve our trust and confidence that they will be able to decide each case reasonably, with sensitivity and compassion. Sir, another point which Mr Ling How Doong mentioned yesterday is with regard to the comparison of charges between the private hospitals and the Singapore General Hospital (SGH). Of course, the Minister for Health has responded by saying that there is a possibility of loss leaders and that it is better to look at the total bill size. In the President's Speech, he has indicated that the trend is for the private sector to play a bigger role.”
“With strong economic growth and full employment situation in Singapore today, this is the best time to start making all the economically active Singaporeans contribute to the CPF. We may not have such a conducive situation as now to do so in the future. I, therefore, advocate that the self-employed be required to contribute to the CPF. Sir, the move to raise the Medisave contribution rate will have to be studied carefully. By doing so may mean re-channelling the CPF funds from the old age living expenses to maintain the lifestyle that the retirees are used to. Even older Singaporeans who have already bought their homes need to maintain them. We should do away with the thinking and presumption that in times of financial need, the elderly could always sell their property and opt to buy a smaller one. After settling down to a familiar and comfortable place, no elderly person would wish to give up his home easily. My greater concern is that with an enlarged Medisave account, there is the tendency for frivolous spending. This will cause health cost to escalate. We all know that the demand for medical services is inelastic. The Medisave account can be easily and quickly depleted with careless and misguided use. I will support a higher rate of Medisave contribution if there is evidence of patients who have suffered because of the lack of funds in the Medisave account. The extra money which could have bought him better expertise and treatment, or that the patient is helped in reducing his cash outlay to pay his medical bills, instead of coming out cash, he can use the available Medisave funds to pay for his medical bills.”
“It may not be easy for the self-employed to come out with a lump sum cash payment each time that he or his family member is hospitalised. I think the savings through the CPF and the Medisave account will certainly help. The argument has been that any compulsory savings in the CPF will seriously affect the disposable incomes of the self-employed, citing cases of tight monthly budgets and that these people are living from hand to mouth. There may be some such cases but I am very sure that the majority of the self-employed are able to take this first step. Certainly, the details could be looked into as more information is obtained. It is very important right now for this House to agree that it is a good thing to make it compulsory for the self-employed and for all economically active Singaporeans to contribute to the CPF, or to the Medisave account. The number of self-employed is estimated to be in the region of 180,000 persons or about 10% of our economically active working population. From my personal observation, they actually form the bulk of those living in the rented HDB flats. Having spoken to some of them, if they have been given a choice earlier, they would have wished that they have started voluntarily by contributing to the CPF account. But we all know that human nature being such, it is not easy to make voluntary contributions. So we have to guide them and we should help them out of this economic trap because as they get on in years, they will find it very difficult to get out of their adverse circumstances. The fate of the older Singaporeans should not be perpetuated in the younger ones in their twenties, thirties or forties.”
“Maybe one of the difficulties that we have is the monetary award attached to the scholarship that opens the eyes of many others. It is important for us to give equal encouragement and motivation to these students to excel in their studies. Maybe as the Minister for Education has stated earlier, if parents feel that they can support their own children, they should still grant the scholarships to their own children and to free the money in the form of bursaries to other needy children. But I do not think we should deny our good students the award of the scholarships because I feel that in this way we can spur the academic and extra curricular activities (ECA) performance of our students to greater heights. Sir, another area that I would like to talk about is the self-employed because in the President's Speech, there is an indication to ask the self-employed to contribute to the Medisave account. It is a very good plan and we should try to implement it as soon as possible. Of course, there is a very wide spectrum of people classified under the self-employed, from the very well-to-do sole-proprietors, shopkeepers, food stall operators, taxi drivers, contract workers and others. I believe that this was not implemented earlier because of the difficulties involved, but I think it is important that we make a start somewhere and somehow. It is always better that we make a modest start and allow them to accumulate the funds gradually with increasing amounts. Here, I would like to suggest that we make it compulsory for the self-employed to contribute a small flat sum each month to the CPF account, or at least to the Medisave account. The example of the NTUC taxi drivers is a very good one for us to look at because they understand clearly the need to save for the future.”
“But I think what is important to me is not really to focus on the parents. The focus on the Edusave concept should be on the children, irrespective of whatever family circumstances. And I think it is very vital that we treat each individual student as such because it provides good value training to them at a very early age, to teach them how to be independent and self-reliant. More importantly, we hope that it will inculcate in our children to appreciate the value of money because many of our young do not really understand the value of money these days, especially with their extravagant and lavish ways. They live as though money will come naturally, and they take our prosperity for granted. We should not create a situation whereby it becomes a stigma to be well-to-do, that the well-to-do are being despised. As we have heard from the Deputy Prime Minister, how do we draw the line between the well-to-do and the less well-to-do today? Is it the four-roomers or the five-roomers? I think all of us are getting well-to-do. What is important, I believe, is to encourage those who feel that they can afford, to contribute voluntarily and generously to charities, foundations, or organisations with Institution of Public Character (IPC) status. In this way, they are also setting good examples to the children in their caring and sharing ways. So on that basis, it is important for us to similarly consider the award of scholarships to children coming from the well-to-do families. There is a difference between elitism and meritocracy. Students coming from well-to-do homes should not be penalised, nor be denied of the recognition of their scholastic ability and achievement.”
“Mr Speaker, Sir, I rise to support the motion standing in the name of Dr John Chen. Mr Goh Chok Tong's Government has clearly indicated in the last General Election's manifesto that The Next Lap will be the PAP Government's programme for the next five years. As we have heard from the President's Address, Mr Goh's Government is honouring its pledge to the people of Singapore. I think what is important is the stated desire to spread prosperity widely to all segments of our population. Programmes like Edusave and Medifund will address and meet their critical needs. They will contribute further progress in our standard of living and quality of life. Sir, the dividends from all the hard work that we have put in all these years are being distributed and shared by all Singaporeans. The future is indeed bright and when Edusave and Medifund are fully implemented, the general well-being of our people will improve further. Yesterday, we heard Deputy Prime Minister, BG Lee Hsien Loong, spoke eloquently on behalf of the Government, with regard to the principles and policy of this Government. What I would like to do is to focus on the main policy issues rather than to discuss the general principles involved because he has provided the most convincing case to all of us Singaporeans. First, Edusave, Sir. Notwithstanding that I am speaking just after the Minister for Education, I would like to contribute my views. When the Edusave concept was first mooted by the Prime Minister, there were many well-to-do Singaporeans who felt that they did not need any Government financial assistance. They could well afford to provide for the education of their own children, and they have indicated that they wish to free the amount, if allocated to them, to help other needy Singaporean children.”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, can I know to what extent are we using these cameras? Are they to be used over a much wider area than currently, or are they for replacement of existing cameras?”
“Sir, I beg to move, That the sum to be allocated for Head Q be reduced by $10 in respect of Code QC 5100 of the Development Estimates. Sir, I have a very simple question. I see that a sum of $1.85 million has been provided for the Traffic Lights Surveillance Camera System. Maybe the Minister would like to explain what use is it for this large sum of money?”
“66 in 1990, a reduction of 33%; in terms of injuries, 455 per hundred thousand in 1984, dropping to 244 in 1990, a drop of 46%. In terms of casualty per 10,000 vehicles, in 1984; 6.66 were killed. This dropped to 4.35, a reduction of 35% in 1990. In terms of injuries, 234 were injured per 10,000 vehicles in 1984. This went down to 122 in 1990, a drop of 48%. Singapore roads are one of the safest. Fatalities per hundred thousand persons in 1988, which is the latest figure we have for comparison with other countries, showed that Singapore's position is very favourable: Singapore - 8.54; UK - 9.15; Australia - 17.23; France - 20.62; Switzerland - 14.28; West Germany - 13.43; and New Zealand - 21.7. So the roads here, Sir, are safe, and when we leave Singapore on an aeroplane, we know we would be leaving a safe area. 2.15 pm”
“This will be for cars that are illegally parked on the shoulder of expressways, cars that are double parked, cars that are parked within zebra crossings and cars that are parked within pedestrian crossings. Police will also look into the possibility of wheel-clamping. On road hogging, the problem is under some control. The number of cases booked has dropped from 6,833 in 1989 to 6,343 cases, which is a reduction of 7.2%. Police will continue with its programme of education as well as enforcement. On jaywalking, the problem has gone worse. In 1989, there were 4,890 cases. Last year, this jumped to 29,329 cases. For the first two months of this year alone, there were more than 5,000 cases. So in answer to Mr Loh's question as to how to discourage this, Police will carry on with an education programme as well as an enforcement programme. On pedestrian walkways, again this is very much a matter within the Ministry of National Development. From the Police's point of view, we would like to see a segregation between pedestrian traffic and vehicular traffic, because this will enhance safety of both road users as well as vehicle users. Road kerbs, as they are now, are high enough. To make them any higher would make it difficult for the less mobile to move from one level to the next. And if cars are pulled alongside the road, a road kerb which is too high would mean that we cannot open our doors and alight from the car. The way to separate the road users from pedestrians in fact is to use guard-rails. The PWD is doing as much as it can. I would like to say, Sir, that our road safety is in general very good. Again, if I may quote some figures. Casualty in terms of people killed per hundred thousand, in 1984; 12.93, which went down to 8.”
“Education is most important in the safety of school children. There is a tendency for some younger children to be excited and to rush over when they are at zebra crossings. In fact, one way of doing this would be the Road Safety Park Programme. The Traffic Police will be increasing its efforts in this direction. Police has also sent out a questionnaire to schools asking them what can be done to enhance the traffic situation in their schools. On the basis of the replies from the school principals, we will try to develop a better programme with them. Mr Loh raised the question of whether we can provide pick-up points near schools. This question should have been raised with the Ministry of National Development. If I may give him a non-answer at this point, we will discuss ways of doing this. Police will liaise with the URA and HDB to see whether pick-up points can be provided in car parks that are currently situated near school buildings. On illegal parking, Police regards this as a very serious matter. Illegal parking causes congestion as well as poses safety hazards. Current measures to discourage illegal parking include composition fines as well as towing. But the problem does not seem to be addressed properly or effectively. In 1989, more than 200,000 cases of illegal parking were booked. In 1990, the figure went up by 36% to 272,000. For this reason, Police will introduce new measures. First, there will be an increase in composition fines. There will also be an increase in towage and storage charges for vehicles. And thirdly, Police will introduce demerit points for parking offences that endanger other road users.”
“And particularly for the senior citizens, could the overhead bridges be more conveniently located, and the stairways be made more easy for them to climb, because it is sometimes very difficult for them to climb the staircases in these very high overhead bridges. Could some gradual sloping stairways be provided for the elderly? I would like to ask the Minister whether jaywalking is a problem in Singapore and what measures are taken to encourage as many pedestrians as possible to use the crossings. In the area of indiscriminate parking, we have read reports about the Traffic Police issuing summonses to motorists for not parking their cars in the proper parking areas. But I think what is important is to ensure that there are a reasonable number of parking spaces for them. If there are adequate parking facilities, then I think the motorists deserve to be summoned for illegal parking. The recent announcement by the Minister for National Development with regard to half-hourly parking should provide one excuse less for motorists for not parking their cars properly. Mr Peter Sung: Sir, yes, the Police is very concerned with road safety. As far as school children are concerned, last year eight of them, aged 14 or under, were killed in pedestrian accidents. What can the Police do about it? We will try to convert some zebra crossings near primary schools to signalised crossings. This will be done in conjunction with the PWD. This year, after the June holidays, the Traffic Police, together with PWD, will introduce a pilot project for school zones. Five primary schools have been selected for the pilot study to see how increased safety can be provided for school children. If this pilot scheme proves to be successful, it will be extended to other schools.”
“The loss of lives and the injury arising from road traffic accident is a sheer waste, particularly to Singapore when we are having such a small population. I think we have been focusing a great deal on the expressways. It is about time that we focused the traffic situation in our housing estates because they are really where the large concentration of people are residing and there is a large human traffic going through these areas. And I think more importantly, Sir, will be the schools in the housing estates, because we have many young school children attending these schools. It is important for us to pay as much attention to the pedestrian crossings, the walkways for these school children and, particularly, the pick-up points for the school buses and for their parents fetching them to and from school, because we have read of cases whereby accidents do happen near schools. I hope that the Traffic Police will work with PWD to try and re-look into the layout of the neighbouring estates and help improve the situation over there. The other point, Sir, is with regard to pedestrian walkways. Is it possible that the walkways be constructed not just next to the roadside but a distance away so that there will be some means of a buffer between the roads and the walkways? And could the kerbs where pedestrians are walking be raised higher so that cars which have lost control would not easily run over the kerbs? We know that there are traffic cameras at the traffic junctions. Is it possible to consider installing cameras at pedestrian crossings, just in case some motorists do not give way to pedestrians at such crossings?”
“Sir, I would like to thank the Minister of State for his reply, and I hope that the members of public will rest assured now that the crime situation in Singapore is very much under control and they should not have undue concern for their own safety. Sir, can I move on to the next subject on road safety?”
“We often hear of residents wanting to have more police patrols and Neighbourhood Police Posts to be located near their homes. I think the message to Singaporeans must also be that they have indeed a role to play towards reducing and solving crimes in Singapore. Maybe the procedures with regard to witnesses helping in crime investigations could be looked into so as to avoid inconvenience to them and they would then be willing to come forward. I hope that the Neighbourhood Watch Scheme could be actively promoted and maybe more resources could be given in this area. For private housing estates, maybe the residents' associations can play their part.”
“Sir, I would like to talk on the subject of Computer and High Technology in Law Enforcement. It is very pleasing to hear from the Minister that the officers and men of the law enforcement agencies and public spirited members of the public have helped to bring the crime rate down. It shows the very high standards of performance in the law enforcement agencies. Sir, achieving success in bringing the numbers down is one thing. The challenge for the law enforcement agencies need to be focused on the qualitative aspects. We have read newspaper reports in the past month of the very violent crimes that have been committed and I hope that as much resources as possible would be put into the early detection and apprehension of the suspects and the quick conviction of those suspects. Sir, the problem of recruitment to fill the vacancies in the law enforcement agencies will continue to remain because of the very tight labour shortage situation in Singapore. I wonder if more attention could be placed in looking into labour saving and time saving devices where practicable. I am glad to note that in the Addendum to the Presidential Address under the Ministry of Home Affairs, it was stated that in the longer term, Police will: 'Upgrade its crime detection and investigation through a computerised criminal intelligence system, voice-print analysis and other scientific means;'. Sir, I hope that it would not be in the long run but it should be as expenditious as possible. Maybe the Minister would like to elaborate further on what all these meant to the members of the public. Sir, if we can move a step further in apprehending the criminals, we can allay the fears of the Singaporean public, because sometimes the feeling of insecurity is in fact baffling.”
“The children of school-going age are of concern to parents, especially when the posting requires the children to resume their studies back in Singapore after the posting. We should have schools in Singapore catering to children of such families where the parents are working and based abroad. The older executives whose children have grown up and are independent of the parents, they are the ones who ought to offer their services to work overseas and the employers should give them the opportunities and chance to do so. We seem to have more younger and less older ones working overseas. Employers should recognise the seniority and status of overseas offices so that the older executives do not deem that they are "being sent to Siberia" when they are posted overseas. It is important that the vision spelt out in "The Next Lap" be disseminated to all segments of our population to enthuse them of our common goals for the future. Let our citizens have no doubt that they are co-owners of these objectives and aspirations. With the unity of purpose, I am sure that all Singaporeans will rally together to bring Singapore forward to the next phase of our growth and development. Like the generation before us who has accomplished much, this generation can take similar pride with their success and achievements and hand over to the succeeding generation of Singaporeans with value-added what we have received from the previous generation.”