Michael Lim Chun Leng
Singapore
“Mr Speaker, Sir, I would like to ask the Minister, in the light of scientific evidence to show that as many as half of the people who are presented with a heart attack at a hospital do not have any critical stenosis or narrowing in the heart artery, but actually only have a very minor narrowing in the heart artery, and as a result of tear…”
“My question is: in the light of things evolving, whether for specific high-risk individuals, we should actually look at other means of identifying them. On the second point about AED, if we reach the A&E for a sudden cardiac death, of course, your mortality is more than 90% because it takes a long time to reach it.”
“Clinical practice guidelines help doctors to manage patients in the most optimal way. They do not help doctors manage patients in a most cost-effective manner. Ultimately, most Singaporeans want to have the cake and eat it. Let us not raise the expectations too high. Let us keep healthcare bills in the public sector affordable.”
“The Ministry had spent millions of dollars on IT cost, man-hours and employing new staff. Yet, till this day, few believe that it has translated to any real tangible improvements in the healthcare delivered to the man-in-the-street.”
“Mr Speaker, Sir, I am getting a bit confused here. I am trying to understand the process. Can I check with the Minister? Does it mean that an operator can seek approval from PTC and PTC, based on a certain set of criteria, has approved the routes or what they are supposed to do, and then the operator can decide not to follow what PTC has…”
“Sir, I would like to ask the Minister how can there be more predictability if one took an express bus from point A and reach point B on the same express bus vis-a-vis someone who has to take a bus to the MRT station, drop off at another MRT station and then take another bus to his destination. How can there be more time predictability?”
The complete record
Every one of 361 lines we hold for Michael Lim Chun Leng, in date order, each linked to its source. Free to read, in full, without an account. Page 2 of 8.
“Mdm Halimah Yacob asked the Minister for Manpower in view of the highly contagious nature of the SARS virus and bearing in mind the language and other difficulties faced by foreign workers and their living conditions, some of which may not have proper sanitation facilities (a) what measures are being taken including screening and education programmes to prevent the spread of SARS among foreign workers who are already working in Singapore; (b) will the intake of foreign workers from SARS-affected areas be tightened; and (c) if there is an outbreak of SARS among foreign workers what measures are in place to contain the spread of the disease.”
“Besides the health declaration forms, parents have been issued with advisories to monitor their children's temperature and health every morning. Clear procedures have been drawn up to handle children or staff who fall sick while in the centre. We will close the centres for 10 days if sick children or staff are found to be suspected or probable SARS patients. We have advised student care operators, who provide before and after school care services for primary school children, to use the same procedures as we have for child-care centres. The People's Association, which runs playgroups and tuition classes, has adopted the procedures as well. As I have mentioned, my Ministry's procedures for child-care operators are available on our website for any pre-school service providers to use. Besides procedures, MCDS has also developed a series of public communication programmes targeted at young children, parents and caregivers. Public education messages were carried in the four languages in the various media. Young children are taught, in a fun way, about basic hygiene. Information packs were distributed to every parent when the child-care centres re-opened. Sir, I would like to conclude by reiterating that the effective control of SARS rests on individuals and parents of young children exercising social responsibility. For young children, the precautionary measures can only be effective if parents act responsibly and not allow their sick children to turn up in child-care centres or schools. FOREIGN WORKERS (Preventive measures on spread of SARS) 14.”
“Can I take it that the Senior Parliamentary Secretary is referring to the site that was last proposed by URA and sent to the HDB's Planning Department for approval? In other words, it was not the original site near Block 205, but it was a reassigned site which URA had put up. I just want to seek confirmation that that is so. Assoc. Prof. Koo Tsai Kee: Arising from the draft Master Plan of 2003, this new site has been selected. So it is a new site. PRE-SCHOOL CENTRES AND CHILDCARE CENTRES (Preventive measures on spread of SARS) 13. Dr Michael Lim Chun Leng asked the Acting Minister for Community Development and Sports what measures are being taken at pre-school centres and childcare centres to (i) educate parents on SARS; (ii) prevent the spread of SARS; and (iii) manage children with fever or cough who are suspected of having SARS. The Acting Minister for Community Development and Sports (Assoc. Prof. Dr Yaacob Ibrahim): Sir, as the regulator of child care centres, my Ministry has worked relentlessly to put in place strict precautionary measures and procedures to minimise the spread of SARS. The children in child care centres are very young and need close supervision. My Ministry has therefore drawn up a comprehensive set of Standard Operating Procedures in consultation with the Ministry of Health and the major child care operators. All 630 child care centre operators were briefed on the procedures before the centres re-opened on 16th April 2003. The details of our procedures can be found at the MCDS websites www.mcds.gov.sg and www.childcarelink.gov.sg. Allow me just to highlight a few key points, Sir. Parents are reminded not to send their children to the centres if their children are ill.”
“Can I seek clarification with regard to the actual site because there were two sites that were mentioned, one near Block 205 and the other along the Sengkang East Road? So I am not sure, because both are near the same road. So which site is the Senior Parliamentary Secretary referring to? Assoc. Prof. Koo Tsai Kee: Mr Speaker, Sir, the site is at the junction of Sengkang East Road and Compassvale Bow.”
“I had the chance to see business plans written by students from Shanghai, Dalian and Qingdao. And I was very impressed by their business plans which were written in impeccable English. While we grow our educational services as an economic driver, we must ensure that standards are maintained and our reputation is preserved. We can perhaps learn from one of the public educational institutions in Singapore which has won respect and praise from students in Singapore. In China, they say that there are three universities in Singapore - NUS, NTU and Ngee Ann University. What they are actually referring to is Ngee Ann Polytechnic. The students tell me that Ngee Ann Polytechnic has established an extremely good reputation as a tertiary educational institution. NAP sets very stringent entry requirements and students have to sit for an entrance examination and those who succeed in the entrance examination have to undergo an individual interview with the panel from Ngee Ann Polytechnic, lasting about 15 to 20 minutes. As a result, only the very best get into Ngee Ann Polytechnic. Students are also known to have given up places in top universities in China for a place in Ngee Ann Polytechnic. What I would like to ask the Minister is whether the Ministry would review this attempt to expand the educational sector by putting in place, perhaps, a more stringent standard, entrance examination, or streaming test, so that we protect our reputation. What measures will the Government take to try to balance the need to grow the educational sector as an economic driver and, yet, ensure that Singapore's reputation as a centre of excellence will not be tarnished?”
“Sir, Singapore has an excellent reputation for being a centre of excellence for education. As Singapore strives to grow the education sector as an economic driver, we have relaxed our education policy to enable more foreign students to study in Singapore. By allowing foreign students to study in Singapore, we will be able to tap on a larger talent pool. However, liberalisation of policies can also cause unintended problems. Two of the major issues that have arisen as a result of the relaxed entry of foreign students are as follows. Firstly, we have the issue of accompanying mothers. Certain students are allowed to have mothers accompanying them when they study in Singapore. There have been reports that these mothers have deviated from the intended role to look after their children and care for them while they study in Singapore. Instead, many have taken up jobs in health clubs, massage parlours, etc. Some have also used the excuse of sending their children here for study to come to Singapore when their real intention was actually to find a job in Singapore. This may result in social problems. Secondly, we have the issue of ensuring standards in education. There have been Chinese students who have studied in private educational institutions in Singapore and when they went back to China, they claimed that, despite spending their time studying in Singapore, they have not learned to speak proper English and did not have a good programme. This can damage our reputation as a centre of educational excellence. However, I have had very positive feedback from Chinese students who have studied in public educational institutions in Singapore. Many of them speak fluent English and have won many prizes. They not only perform well academically, but are also entrepreneurial.”
“Clinical data require special in-depth knowledge and also end user experience which is not available in HSA. So I do not believe that HSA has the resources or the ability to view these documents in a timely fashion. Neither do I believe that they have the expertise to understand all the technical data, the clinical data that they have requested the manufacturers to submit. If that is the case, why does the HSA want such voluminous amounts of data?”
“We must not follow blindly and make our system the most stringent of all regulations. We do not have a big market and neither do we have the resources. We cannot, and must not, act like the FDA. While the manufacturers are prepared to spend tremendous amounts of money and resources to get their devices accepted in the US or EU market, they are not likely to want to spend significant resources for a small market like Singapore. Even FDA-approved products and CE-marked products from EU will be subject to our stringent regulations and are not exempt as well. Feedback from manufacturers and distributors indicate that the Singapore market is too small and, if they were to be subject to all these additional paperwork and cost, it will not make any economic sense for them to bring in some of their medical products. I wish to ask the Ministry, firstly, why do we need to change the system? What are the shortcomings in the current system that have resulted in the desire to change it to a highly tedious and onerous system? Are there medical device failures in the past that have compromised healthcare outcomes in Singapore where the manufacturers have not taken responsibility? I hope that this is not a case of finding more work to do, so that more revenues can be generated. The second question is that the new regulation states that it will expedite availability and access of new medical device technology to patients, consumers and the clinical community in Singapore, while preventing the entrance of unsafe and ineffective devices into the Singapore market. However, does the Ministry or the Health Sciences Authority (HSA) have the resources to perform these duties diligently, professionally and without delay in its review process? I have serious doubts.”
“Sir, the Ministry of Health has provided Singaporeans with a high standard of healthcare comparable to the best in the world. This is possible not only because we have access to good doctors but also because we have access to the best in medical technology and devices. The Ministry must be careful about putting in place healthcare policies which will add to healthcare cost. Some of its policies may have the unintended effect of raising cost of healthcare for Singaporeans. One recent policy, ie, the change in the regulation for the control of medical devices in Singapore, will eventually translate into higher healthcare cost for Singaporeans. The policy aims to control the use of medical devices, and medical devices include all products used in healthcare for the diagnosis, prevention, monitoring or treatment of illness or handicap, but exclude drugs. The stated aim of the new regulation is to strike a balance between ensuring product safety, quality and effectiveness, and providing the public with timely access to medical devices. It further states that it will expedite availability and access of new medical device technologies to patients, consumers and the clinical community in Singapore while preventing the entrance of unsafe and ineffective devices into the Singapore market. On paper, it looks fine. But, in reality, what are its implications? The submission format is extremely tedious and onerous and requires substantial data to be submitted. The requirements are even more stringent than that of FDA requirements. If we do follow these regulations, we will probably become the most tightly regulated market in the world for medical devices. I would advise that this is not one of the things that we should aim to be number one in the world.”
“It only adds to the cost. So maybe the Minister of State can enlighten us as to how the Ministry translates all these very good policies into real cost-saving measures on the ground.”
“Mr Speaker, Sir, the Minister of State has said that a large part of the cost is mainly manpower cost. But, as a doctor, he is also aware that, really, the cost increases as the consumption of services and drugs increases. This definitely has an impact, more so than the manpower cost itself. Is there in fact any system to ensure that there is no over-consumption of services or drugs? I am not aware of any system at this point in time. Secondly, when the Ministry looks at subsidies for the patients, I wonder whether depreciation costs are considered, because if they factor in depreciation costs for the hospitals, then actually the man-in-the-street has to help fund expensive hospitals as well when they pay their part of the share of hospital charges. Thirdly, while the clusters increase competition, does it not also cause duplication? For example, I am aware that, in the past, we used to centralise the services, eg, National Skin Centre. Now, with these clusters, many hospitals also want to set up similar services and they are in fact dangling carrots to the consultants in the National Skin Centre to duplicate these services in other hospitals. While it is claimed that there is competition and, therefore, better use of resources, it seems that, on the ground, it is otherwise. There is duplication of resources. This means more equipment, more services. So how does all this add up to the Ministry being on top of this cost-containment exercise? Last but not least, similar to what one hon. Member has mentioned, the Ministry has also put in other administrative measures, eg, casemix, which, we know cost quite significantly in terms of software, hardware and manpower costs. But I do not think casemix results in a higher subvention in the total sum for the hospitals.”
“Why do they want to increase the cost for the subsidised class?”
“Sir, while we agree that in the long term, healthcare cost will continue to increase, I think what is needed is more transparency and also clearer justification. I would like to ask the Minister of State to perhaps clarify some of these apparent contradictions in the healthcare system. For example, he had said that part of the cost increase was due to new drugs, and yet in the same breath, one of the clusters had said that there was 10-15% decrease in the cost of drugs. And we all know that for non-standard drugs, in other words, new drugs that are in the hospitals, usually they are hardly subsidised. I am not sure how new drugs actually result in an increase in the cost of healthcare. Secondly, another contradiction is he said that there is financial counselling in hospitals. But I was just given a very good incident where one of the grassroots leaders brought the mother to the hospital and was advised by the hospital doctor not to go to B2, but to go and see the tua luo koon to get better care, because the suay luo koon could not give good care, and was asked to go to a paying class. So, how does he ensure that this seemingly attempt for them to provide financial counselling is operational at the ground level? Third contradiction is that while we build beautiful hospitals and we say that we have under-utilisation of assets, that means it is very expensive to maintain these under-utilised assets, and that will actually translate to increased cost as well. My question is: are we over-providing also for infrastructure as well? Last but not least is that in this price increase, what I could not understand is if the Ministry's concern was for the subsidised class, why did they not make adjustments to the paying-class first?”
“Mr Speaker, Sir, my name did not appear on the display board even though I pressed the button.”
“Sir, I would like to seek clarification because the Minister of State has not answered my questions as to whether the Ministry will let us know what forms of alternative medicine can be practised here, and whether the Ministry will clamp down on unsubstantiated claims like curing diseases or being able to treat particular diseases.”
“Sir, alternative medicine is also widely practised in western countries like the USA, so it is not surprising that alternative medicine is also a choice of therapy for many Singaporeans. While the Ministry finds it difficult to regulate efficacy as it is just primarily regulating safety, the Ministry can perform a role in letting the public know what forms of alternative medicine are allowed to be practised here, because the public does not know what is an accepted form of alternative medicine and what is not. For example: is chelation therapy or other forms of aromatherapy accepted as regular types of alternative medicine? So the Ministry can perform a role by helping us understand what types of alternative medicine can be practised here. Secondly, while it may not be able to regulate efficacy, it can perform a role in preventing unsubstantiated claims from being made. For example, some of these preparations claim that they can cure cancer or diabetes. The danger in doing so is that this will mislead persons into taking the medication, leading to further complications. What I would like to know is whether there are any agencies to look into these advertising claims. While I can understand that some of these alternative treatments can claim to improve well-being, I think that is fine. But once they start making claims about curing diseases, the Ministry has to draw a fine line. Otherwise, it can easily result in harm to our people who know no better.”
“Mr Chairman, I would like to seek some clarifications with the Minister. The Minister said that night polyclinics are a good thing but in the next breath, he himself said that the GP market is a very competitive market, there is an over-supply and they are struggling. At the same time, he said that there are not enough medical officers in the service. He appears to be contradicting himself because this is an over-supply situation, and you are not allocating resources properly. Secondly, I would like to seek clarification with the Minister whether the $20,000-$60,000 deposit that is required, in the example I quoted, is the norm that they ask of foreign patients who get admitted to KK Hospital as well. Because in the private sector, none of the private hospitals do that. They accept patients from other countries and they never ask for $20,000 or $60,000. If they do that, they will all shut down! Thirdly, in the example I quoted, where the surgery can only be done at a public hospital, does it mean that if the family cannot fork out the expenses and no guarantor was available, the public hospital will not accept this particular patient and would rather let the patient perish in the private hospital? Fourthly, another clarification is that, as the Minister pointed out very correctly, most of the patients in our hospitals are subsidised, yet our consultants are spending more and more time looking after private patients. I cannot see how the consultants have so much time as I have told him, from the ground, already the consultants are telling me that they do not have time for subsidised patients. I am not sure how he can balance the limited resources, encouraging private sector practice for the consultants and, at the same time, most of his patients are subsidised patients.”
“Sir, there is a nursing shortage in our hospitals, and this is acknowledged by everybody. Everyone knows that nurses play an extremely important role in our medical healthcare services, being partners with the doctors and carrying out doctors' orders and working with the doctors to perform procedures and surgeries. Currently, the two main sources of nurses are through the educational institutions, like Nanyang Polytechnic and ITE, or direct recruitment by the hospitals. Having recruitment directly from many countries, like Malaysia, China, Myanmar, Philippines, and having a sizable intake of about 600 students through Nanyang Polytechnic, it puzzles me why there is still a significant shortage of nurses. If that is the case, perhaps we should look at what is the rate limiting factor. If it is because our institutions are not able to provide adequate places for people to study nursing, then perhaps we should look at either expanding Nanyang Polytechnic or allowing other institutions, or even hospital groups, to start nursing colleges to provide for this absence of educational opportunities to train nurses. The other way to manage this problem is to allow the private and public hospitals to increase their direct recruitment of nurses from elsewhere to join the hospitals. I understand from them now that the Ministry has significantly restricted the number of nurses that they can recruit directly. I cannot see the reason for this though. Will the Minister advise us as to what measures are currently being considered or undertaken to resolve this problem of nursing shortage?”
“But I would like the Minister to share with us on the progress of this scheme, how pervasive it is, and whether there are ways we could improve the scheme to reach out to more people. I gather from feedback that some doctors are not willing to come on to this scheme, because they find there is a lot of bureaucracy and a lot of paperwork. Could the scheme be extended to people from age 60 onwards, instead of 65? Could this primary healthcare scheme be also extended to cover chronic illnesses, and not just simple illnesses like cough and flu?”
“But we do hear that more and more people, especially those in the lower income who believe that this is so. Sir, I think the Ministry should take this seriously and find ways on how to assure our people that, in fact, there are enough healthcare schemes to cover them. I know of a case of a person who came to see me at the MPS, and told me a sad story. Her father fell ill, and she thought that she would just send him to hospital for observation, maybe for 2-3 days. Thinking that the father had done so much for the family and made a lot of sacrifices, she admitted the father to a First Class Ward. And before she knew it, the father's condition got worse, and he was sent to the ICU. The case got protracted, and the family was shocked to receive a bill of $70,000. In fact, she came to see me and tried to get some help. She said that they may have to sell their flat to settle the bill. Sir, I think there is a serious problem of people who actually do not know the full picture, or the ramifications of the cost of medical care. I think hospitals and the Ministry must try to make sure that they know the consequences of such a decision. Another case I know of is quite a well-to-do couple. Their home had been paid for but, unfortunately, they had a child with a heart problem and had to go for surgery. They appealed for use of their CPF, because Medisave was not sufficient to meet the bills. We applied to the CPF, and as expected, CPF said no because of the policy. Sir, I think one calls for more information, and the other calls for flexibility. Sir, the other point I would like to raise, is about healthcare for the elderly - the senior citizens. I know we have a primary healthcare programme, which is growing in terms of its reach.”
“On the one hand, the Government encourages Singaporeans to become entrepreneurs and take risk, and yet in the healthcare sector, it is willing to provide an umbrella for the public sector doctors, so that they will not have to brave the rain and the sunshine, or to be subjected to the financial risk of a private sector practice. If we want to extend this even further, the Government might as well run private hospitals for private patients and justify this by saying that it will help them retain their consultants in the public sector. If Government is serious about growing healthcare as an economic driver, it does not make sense to use public sector resources to eat into the same private sector pie in Singapore. Growing healthcare, as an economic driver, goes beyond attracting foreign patients to come to Singapore. Healthcare services in Singapore have to expand beyond its shores to where the patients are, by expanding services to overseas facilities. It will expand our patient pool and give our doctors increased experience through a greater caseload. If the Ministry's aim is to retain specialists in the public sector, I fear that the moves it has taken will cause more harm than good for the public healthcare sector in the years to come. An unintended effect of this is the demoralisation of other specialists who are unable to participate in these schemes. In the end, the Ministry may have retained the specialists it wants, but the policies adopted will result in the loss of innocence, a diminution of their passion for the subsidised patients and skew their value systems. Mr Zainul Abidin Rasheed: Sir, we have heard the expression "It is cheaper to die than to fall ill." That, of course, is an exaggeration.”
“The use of public sector resources to do private practice beyond its traditional confines has far-reaching consequences. First, it will strain the existing resources. With the consultants spending more and more time in serving private patients, how much time will subsidised patients get from consultants? How much time will there be for consultants to train and teach the Registrars and the junior doctors? Already, some of the consultants tell me that they have no time to see new subsidised patients in their clinics. Registrars in the public hospitals have told me that they did not have any structured training programmes, and these will be the consultants of the future. Second, there is also non-optimal utilisation of existing resources. In the specialist private sector, the public sector is competing where there is an over- provision of hospital beds. With the public sector being unable to fill its own private beds, and occupancy of the private beds in the public sector ranging from about 50-70%, it does not make sense that the public sector consultants should be encouraged to use services in private hospitals, resulting in further under-utilisation of public sector resources. In the general practice sector, where there is an over-provision of services, the operation of night polyclinics further exacerbates the over-provision of services. The night clinics will also require more doctors, and this will exacerbate the shortage of medical officers in the public sector. Third, this is a contradiction of Government policy. The move to allow public sector doctors to practise in private hospitals in public sector funded private clinics creates an anomaly which has gone against the grain of what Government has preached.”
“Sir, I must first declare that I am a doctor in private practice. Healthcare in Singapore is at the crossroads. The White Paper on Affordable Healthcare set the policy directions for the 1990s. Notably, there was no emphasis on Singapore as a centre of medical excellence. The present decade shows a marked shift in the direction of our healthcare policy. While still holding on to the principle of affordable healthcare, the public healthcare system has now set on two very divergent courses, which are set to strain its resources, and create an identity crisis. The public healthcare system was funded on the basis that basic healthcare service was to be affordable and accessible to all Singaporeans. There is little doubt that healthcare service has improved over the years in tandem with the improvement in the quality and standards of living in Singapore. This policy is the cornerstone of our healthcare system. In recent years, there has been a marked shift in public healthcare policy. In the 1990s, the Ministry of Health was content with letting its specialists earn private fees from patients who were seen within the hospitals. Recently, it has allowed some of its specialists to do part-time private practice in the private sector, through its Faculty Practice Plan. It has also set up night clinics to compete with the over-crowded and highly-competitive family practice clinics in the heartlands. Next, the public hospitals have set up private clinics in private hospitals, such as Mount Elizabeth Hospital and Gleneagles Hospital. The public hospitals are now looking to provide services for new private hospitals, who lack certain specialist services. These policy shifts have tremendous implications for the future of the public healthcare system in Singapore.”
“Would our public hospitals let the Singaporean baby suffer and perhaps, even perish, as long as the parents were not able to raise the money or no one was able to provide a guarantee? Are Singaporeans to be denied access to our public activities because they are unable to meet the high fees demanded of them? The final letter I got from the hospital was that if I wished to pursue the case further, I should know that the hospital was a cost centre, and economic consideration was an important factor. I am extremely saddened by the entire incident and I hope it does not signal a policy shift in our public hospitals. Can the Minister reassure all Singaporeans that they have a right of access to taxpayers' funded public hospitals and affordability will never be the reason for denying them admission to a public hospital?”
“For most patients, the last six months of their lives is the period when their medical bill will be the highest. MediShield should be revised to provide adequate coverage for major catastrophic illnesses and to take into account this fact as well. Finally, it is important that our public health institutions must realise that their aim is not to make money from Singaporeans. I wish to quote a case which has troubled my heart greatly. A resident had come to see me at the meet-the-people session because his child was born premature in Mount Alvernia Hospital and required intensive care and surgical treatment. He sought my assistance to have the child transferred to KK Hospital. KK Hospital's specialist told him that the child needed surgery that could not be performed in Mount Alvernia but only in KK Hospital. After their appeal, KK Hospital agreed to have the patient transferred to them provided that the family put up a $20,000 deposit to the hospital. The young couple was at their wits' end and had to borrow the $20,000 from friends and relatives. Just when they thought they had solved the problem and they went to the hospital, they were told by the hospital's administrators, "No, no, not enough. Now we need $60,000 as a deposit before we are willing to take your child". They came to see me, utterly devastated. Finally, the patient was taken only when Mount Alvernia Hospital had given a guarantee. I wonder how this event would have turned out if Mount Alvernia Hospital did not provide a guarantee. Our public hospitals have rallied to the cause of foreign patients with poor prognosis, such as in the widely publicised surgery of the Siamese twins and the Indonesian child with hydrocephalus.”
“Sir, affordable healthcare has been a key policy of the PAP Government. Medisave, MediShield and Medifund (3M framework) have been the three main pillars of our health payment schemes. I am glad that the Ministry will be improving on the 3M framework, a review that is long overdue. Primary healthcare services continue to be affordable for most Singaporeans due to the significant presence of general practitioners in the HDB heartlands together with the polyclinics. This has resulted in a very affordable primary healthcare system. It is when Singaporeans go to hospitals that their cost start to escalate. This is not unexpected in hospitals where highly-trained staff, expensive up-to-date equipment, well-trained specialists and branded drugs are commonly used. What the Ministry needs to do is to review the 3M framework to help Singaporeans meet the cost of hospitalisation and outpatient specialist care. Medicine has come a long way, where in the past, heart disease, kidney failure or cancer spelt a dismal outcome or even death for many Singaporeans. Modern medicine has enabled many to be treated, with a good quality of life. The only problem is cost. As such, the Ministry should consider allowing the use of Medisave for diagnosis or management of major chronic illnesses, on an outpatient basis. This should include conditions like heart disease, kidney failure, cancer and diabetes. The Medisave withdrawal limit, for many of the procedures done in the hospitals, has not been revised for a very, very long time. As a result, many of these procedures that have become routine, have not been adequately covered by the Medisave withdrawal limit. It is time for it to be reviewed.”
“However, more importantly, we must take into consideration that functionality and practicality must not be forgotten. Much money will have to be spent to correct these design problems. In future, the Minister may wish to consider a feedback committee formed from the community organisations or town councils, which will give feedback to HDB before these designs are approved in the new estates. This will ensure better designed public flats which are both beautiful and functional. Secondly, designation of land use. In this age of increased transparency, URA and HDB should openly state the designated use of land, eg, for churches, temples and mosques. Flats next to a designated religious site may have less appeal for many but at least those who choose these flats do not feel that they have been given a big surprise and will be better adapted to the environment. The Ministry should pre-designate religious sites in advance of flat selection. This transparency will bode well for new flat owners.”
“Sir, the new towns, such as Sengkang and Punggol, are lovely to look at. However, like all new towns, they were initially beset with the problem of lack of physical facilities and social services. On this note, I must commend and thank the Minister for the town development task force which he set up in Sengkang. This pilot project, which has brought together more than 20 Government agencies and different community organisations, has made it possible for residents in Sengkang New Town to have significant improvements made to their living environment, and a rapid response time to many of the problems that they have faced. The improved coordination and better understanding between the different organisations have vastly improved the quality of life of the residents in Sengkang town. There are two other areas where further improvements can be made. 2.00 pm Firstly, better designs. One of the problems of the new town is that although the facade looks beautiful, there are many problems with the designs which have become regular irritants to many of the residents. The block signs are so aesthetically designed and well concealed that they cannot be easily seen by visitors or residents. The sheltered walkways are bright, airy, with beautifully-designed roofs, but leave the user with little protection from even a gentle drizzle. The drop-off points are strategically placed with arching canopies that invite rain to fall into the shelters, making one wetter than if one stood under an umbrella. The lift lobbies are so cosily designed that you can hardly see each other in the day time, unless the lights are switched on. The lift buttons blend so well that you cannot figure out the numbers. I am all for creativity and aesthetic designs.”
“Sir, I like to raise the issue of heavy vehicle parking. Owners of heavy vehicles often face the problem of finding parking space near their homes. As a result, many of them get fined very frequently and these fines eat into their meagre income. It is not uncommon to find many of the heavy vehicle drivers who have a parking lot which is very far away from their homes. So someone who lives in Jurong may have his parking lot in Tampines, and vice versa. The Ministry may want to consider a once-off rationalisation exercise to allow heavy vehicle owners to change their parking lots so that they can opt for a space nearer their home. This will go some way towards alleviating the problem for these drivers. In the new towns like Punggol New Town and Sengkang New Town, it is surprising that there are no plans for heavy vehicle parks even though there are plans for a light industrial estate on the southern fringe of Sengkang town. Furthermore, there are large tracts of land which are not likely to be used for the next 10 years. Surely, it is better to put a piece of empty land to productive use, rather than to leave it idle for the next 10 years. If the MPs in Pasir Ris-Punggol GRC and Ang Mo Kio GRC cannot be convinced by the reasons given by HDB and URA that there is no space available for heavy vehicle parking in Sengkang or Punggol, how can we convince our residents that that is so?”
“HDB should consider making available smaller flat units for singles to meet this demand. Lastly, the rental market. HDB has a stringent policy for rental flats. HDB should review their rental flat policy to meet the needs of families who have lost their homes as a result of financial reasons, or families which have had to sell their flat because of court ordered sale of the flat following a divorce. For these categories, HDB should not put a time bar on them, as their public flat was not sold to make a profit, but because they have to do so. We should recognise that while home ownership is actively promoted, there will be some families who will be better off with rental flats in the interim. There is no better time than now to review our public housing policy. We must make bold changes. I do not fear for those who can buy private homes, but I worry for those on the lower end of the social ladder, who find that their once prized asset has now become their greatest burden.”
“The house which has been their largest asset and their largest investment has now become their largest burden. To address this, HDB should consider making available flats with a shorter tenure for these lower income families. HDB should perhaps consider 30-year leases, with an option to renew for another 30 years, for lower income families and lower-middle income families. 30 years would be about the time when flats might be suitable for consideration for Selective En-bloc Redevelopment Scheme (SERS). This will make the cost of housing much more affordable. Replacing the 99-year old tenure with a shorter tenure can perhaps help these families retain their homes. HDB should also review its policy of not allowing owner-occupied flats to be sold in the open market within five years. Those who are in dire financial straits, and who are unable to meet their mortgage payments, should be allowed to sell their flats in the open market and be allowed an allocated rental flat upon sale of their flat. Forcing them to keep their flat will result in further default in mortgage payments and repossession of the flat, which will be worse off for the family. HDB will need to take a major paradigm shift to meet the challenges of the new economic and social environment. Thirdly, making housing available for singles. While we advocate marriage, there is an increasing number of singles who are unmarried or who have divorced. Not all of them can afford a private home. While our policies are pro-family, we cannot ignore that the changing social milieu has made singles a significant minority in our population. Given the slack demand for public flats, it is time for us to consider the needs of this group, many who are highly mobile and are also important contributors to our economy.”
“HDB should focus on becoming a regulatory body, ensuring that the supply, standards, quality and design of public flats are both in keeping with the aspirations of a modern Singapore family, and to accommodate the needs of family units which have become smaller. It should focus on providing affordable housing for those who need it most, including young and low income families. It should consider hiving most of the development and building of high-end flats to other entities or the private sector. Secondly, making public housing more affordable. The boom years of the mid-1990s, coupled with the demand for bigger and newer flats have resulted in the escalation of the prices of public housing flats. Families which have placed bookings for flats find that the flat prices have escalated by more than 50% by the time they reach the front of the queue, but their incomes have not increased correspondingly. In the past few years, the battered Singapore economy has seen significant job layoffs. It has also seen significant depreciation of flat prices. Over the last year, I have had many new flat owners coming to see me because they were unable to service their housing loans. Many of these families have breadwinners who have lost their jobs. They are in a quandary and are unable to sell their flats because they have not met the 5-year occupation period. They have difficulty meeting their mortgage payments, utility bills, conservancy charges, and even school fees. The problems of these families cannot be resolved so easily. It is time for HDB to review its policy to make public housing more affordable. For many of these once proud home-owners, their homes have become a millstone around their necks.”
“Sir, the strong aspiration for Singaporeans towards home ownership and the increasing wealth of many Singaporean families in land-scarce Singapore over the past few decades, have resulted in an escalation of home prices, in the view that the home is an investment whose value will increase with time. The Asian financial crisis, followed shortly by the global economic recession, were instrumental in making many Singaporeans review the aspiration to buy new flats or upgrade their homes. With uncertainties in the disposable income of families and the downward pressure on home prices, queues for public housing have virtually evaporated, and the visit to the Meet-the-People sessions to appeal for early allocation of HDB flat is virtually unheard of now. Buying a public flat is no more an investment with guaranteed increase in the value of the flat. The highly illiquid nature of homes and the high percentage of home ownership present new problems. In an economy where many have lost their jobs and are unable to service their loans, the absence of a pent-up demand for public housing, and the presence of a glut in public housing, presents an opportune time for the housing policies to be reviewed. There are a few areas I would wish the Minister to consider. Firstly, reviewing the role of HDB. HDB was created to meet the housing needs of Singapore during its early years. It no longer builds 1- or 2-room flats, but has now evolved to build public flats, which are not too far in quality from that of private flats. This is most evident in new towns like Punggol 21. With the queues for public housing fast disappearing, and most Singapore families owning a home, HDB has to ask itself what is its role in this current economic and social milieu.”
“Mr Speaker, Sir, I would like to ask the Minister of State that since there is such a great pressure on subsidised beds and since lately, the Ministry of Health has also openly announced that they will go all out to court private patients as well, there seems to be mixed signals. On one hand, are we trying to say that there are a lot of extra paying beds and therefore we should go out to court paying patients but the subsidised beds are very full and we should try to discharge so-called "perceived overstayers"? Should the Ministry then not consider converting more paying beds to subsidised beds and ease the pressure on subsidised beds?”
“Mr Speaker, Sir, I would like to ask the Minister of State, in the acute hospitals where there is great pressure on the beds, doctors are often asked to do what we call "discharge rounds", in other words, doctors will go and do a round in a ward to discharge patients primarily to have new beds to admit acute patients and some of these patients are not again what we would determine as optimally cured or treated at that point in time. In the light of this, how is the Ministry going to prevent this practice from happening where you discharge patients primarily because you want to free beds to take in acute patients?”
“Mr Speaker, Sir, I would like to ask the Minister of State, in that case, if the Ministry's thinking is that everything should be left to the doctors to decide when a patient is fit for home, then why is there a move over the last one or two years for the Ministry of Health to ask professional bodies to draw up clinical practice guidelines. I happen to chair one of these as well. Obviously, the Ministry's purpose is to ensure that there are perhaps clear guidelines for the management of certain diseases. So I would like to ask the Minister of State, if that is the thinking of the Ministry, then why are they asking doctors to draw up practice guidelines? Obviously, the reason is that medicine is very subjective and it is very, very difficult to determine when a patient is well enough to go home or how he should be treated.”
“Mr Speaker, Sir, I practise in a hospital, so I understand the system very well. The problem of overstaying, if I may ask the Minister of State, if I am correct, is very subjective because, really, medicine is as much a science as it is an art. So, are there going to be very clear fixed parameters in which you can determine that a person has already reached a stage where he should be home and therefore if he stays any further he should be considered an overstayer? I think this is going to be very, very difficult to determine. So I am not sure on what sort of criteria or whether there are certain international guidelines he is going to use to determine that a patient has overstayed his due period of stay in the hospital.”
“The representative replied that a study was being conducted and the report had already been submitted to the Minister, but there was no confirmed plan to build a polyclinic then. The representative was then reminded that the minutes would be made available to the Minister in charge. Upon hearing that, the representative immediately retracted the statement and said that the report had not reached the Minister. Despite the stonewalling by the civil service, I am glad that, finally, after all the lobbying by the MPs in the GRC, the Minister for Health supported the justification to have a polyclinic built in Sengkang and also at an earlier date. It is time for the civil service to show more transparency and accountability. It is time for them to see themselves as part of Singapore Inc to improve the quality of life for our residents, not to obstruct our entrepreneurs, and to work with MPs to improve Singapore's future. Yes, the economic challenges we face are daunting. We have the resources and the means to meet these challenges. Let us not set up roadblocks and obstacles for ourselves. I am confident that if we have a Government which will listen and be more open, we will be able to sail through this economic turbulence and steer ourselves to a brighter future. To overcome these serious daunting challenges, we need all Singaporeans to pull together. Together, we will succeed.”
“When he wanted to develop the land, the URA officer in charge had left, and a new officer had taken his place. The new officer claimed that the previous officer had given him a wrong computation and, hence, URA decided to unilaterally increase his development charge. It has been several months since an appeal was sent to the Ministry of National Development but, to date, no official reply has been received. This stalling has made it impossible for him to proceed with his planned development. As a result, he had no choice but to pay URA according to what URA wanted so that his licence can be approved, otherwise his interest cost and land-holding cost will become a major burden to him. He has yet to receive a reply from the Ministry of National Development. I wonder when they will give him a reply. It has been six months since. Where is the transparency, where is the accountability, where is the pro-business Government? It saddens me that our bureaucracy can hold our entrepreneurs to ransom. Our civil service needs a major change in mindset. Time is cost in the business world. Increasing Government transparency and accountability is a key area where the Government can make a real improvement. Finally, the civil service must remember not to hide the truth from the politicians. We are here to work together to make Singapore a better place for all. Not only do ordinary Singaporeans and businessmen face this stonewalling by the civil service. Even MPs sometimes face the same problem. During our Sengkang Town Development Committee meeting, a representative from the Ministry of Health was asked by the MPs on the likelihood of a polyclinic in Sengkang town.”
“Following that, the department relented and the flat owner was allowed to sell his flat without further alterations. This is just an example of the problems faced by residents. The civil service cannot be a bureaucracy that does not exercise its sensibility, empathy and initiative. The civil service must remember that it is not a sin for businesses to make money. Let us not kill the goose that lays the golden egg. If the businesses fail, jobs will be lost and it will be worse off for everyone. The civil service uses a technique called "stalling for time" to squeeze the genuine businessmen to capitulate to its demands. I will illustrate this with two examples. A businessman had applied to participate in a Government land tender put up by the Singapore Land Authority. He complied with the conditions and eventually won the tender. To his horror, when he applied to the URA, he met with a stonewall as URA had claimed that the usage of land, as put out in the tender document, required their consent as well. As a result of this, his application to start work on the land was stalled. After paying several hundreds of thousands of dollars to the Government and having been delayed for a year, he was brought to his knees and was at his wits' end. He finally sought my assistance to appeal to the Government. After writing to the Ministers concerned, I am glad that his appeal was allowed. However, through no fault of his, he had lost time and money. Another case. An entrepreneur-developer, who is also a community leader, encountered a similar problem. He had applied to the URA for information on a development charge (DC) on a piece of land before deciding on the purchase of that piece of land. Acting on the information on the DC given by URA, he went ahead to purchase the land.”
“This new era of openness will bode well for Singapore if Ministries can see that they do not have a monopoly of ideas. It remains now for the Government to show that there is resolve and earnestness to remake the Government. If we cannot remake the Government, how can we talk about remaking Singapore? Next, the civil service must learn to adopt a pro-people, pro-business mindset. There must be greater transparency and accountability in our civil service. Our Government departments continue to be a formidable barrier to both the business community and the ordinary Singaporean. The civil service gives the perception that it is wrong to empathise with the ordinary Singaporeans, it is a sin for businesses to make money, and it is best not to give the politician the full picture. The civil service must remember that it is not wrong to empathise with the ordinary Singaporean. A resident of mine came to see me regarding the sale of his flat. He had applied to HDB to remove a half wall of his service balcony so that he could extend his kitchen. He wanted to sell the flat and the HDB officer who inspected the flat said that the flat owner had only applied for permission to remove the half wall, but had not applied for permission to remove the low kerb adjoining the wall. As a result, he insisted that the owner put back the kerb before he could sell the flat. I could not believe my ears when I heard this. It is ridiculous to have a small kerb jutting out of the kitchen floor as it will be a perfect recipe for tripping over and breaking one's bones. The engineering department insisted that the kerb had to be put back before he could sell the flat. As I saw no sense in this matter, I wanted the department to give a good explanation, failing which I will raise this further up.”
“As a result, many of the Chinese parents feel secure in sending their children to Singapore for studies. Many of the students studying in Singapore on Government scholarships, grants or on personal expenses, come from families where their parents are well-placed or are important Government officials. We should actively build bonds with Chinese students who study in Singapore. The friendship and bonds will strengthen the bonds between Singapore and China. We must not underestimate the value of these bonds. There is another pool which we have not tapped on. These are Chinese nationals who have either become permanent residents or citizens. Their intimate knowledge of the Chinese way of doing things and the good relations they have with their friends and relatives in China, can potentially smoothen our access into the Chinese market and shorten our learning curve. Improving the Government and the civil service To face these economic challenges, we not only need new engines of growth, but we must ask ourselves how can we improve the internal operating milieu in Singapore. We must improve the Government and the civil service. Government must accept that it is not always right. Ministries which put up legislation in Parliament or which discuss policy issues with MPs should not only explain policies but must also be willing to acknowledge differences in opinion whenever there is room for improvement. I am glad that the Government will allow more debates on legislation and policies that will give more room for consideration of differing views so that improvements that are suggested can be taken into consideration and, subsequently, allow amendments to be made to legislation or policies.”
“Penang has also become a major medical hub for Indonesians. Further afield, the Bumrungrad Hospital in Bangkok has also become an attractive alternative. The difficult visa process runs contrary to our intention to grow our healthcare services. For example, patients from Bangladesh complained that it is more difficult to get their visas to come to Singapore. As a result, they find it easier to go to other hospitals in the region. A patient of mine, recently having encountered this difficulty, decided to fly to a hospital in Bangkok for his medical review and treatment and, subsequently, he faxed his results to me to ask me for my medical opinion. We have to ask ourselves how do we create jobs. The answer is to grow the economy. We have to ask ourselves how do we grow the economy. I think it is time we must also ask ourselves in what areas can the Government remove the roadblocks to the growth of the economy. By putting in place a system for a fast-track visa processing centre for health and educational services, we will be able to grow these sectors rapidly. These will translate into benefits for the property sector, the retail sector, healthcare services, educational services, hotel services and even the tourism industry. Growing our external wing in the China market We must not limit the growth to Singapore but we must also look at growing the Singapore economy overseas as well. Singapore cannot ignore China's growth but we should use our natural advantages to tap into China's growth. Do we have any advantages over others in getting access to the China market? Building Bonds The Chinese have a healthy respect for Singapore's reputation. They like the social environment, the cleanliness and the safety in Singapore.”
“We must not put up barriers unnecessarily. We must make our visa process more efficient. Companies have been asked to send their potential students to our embassy in Beijing to be interviewed. Quite often, the officers in charge have many other duties, and this is not a priority for him. Furthermore, many potential students find it troublesome to fly all the way to Beijing just for an interview. We must not put such roadblocks if we are serious about growing these services. Having Chinese nationals to study here will have economic spin-offs with multiplier effects. If we liberalise our student visas, we will be able to grow the educational sector rapidly. On the other hand, we must be careful to safeguard our good reputation. The recent media reports on the cheating cases involving Chinese students who have rented apartments or Chinese nationals who have remitted money, have sullied our reputation. The frequent media coverage may give the wrong impression that these acts are common. These acts are few and far in between and are done by a few and are not representative of Singapore. We must send the right signals that Singapore does not tolerate such acts and we will continue to ensure that Singapore remains a conducive place for foreigners to live in. If we want to grow our healthcare services, we have to make it less difficult for those who wish to come to Singapore for their healthcare needs, to obtain their visas. We should also actively support the promotion of healthcare services to countries in the region and jointly promote this with the tourism board. Support by the Government for private sector healthcare has seen a large boost in foreign patients coming to Malaysia. Malacca alone attracts about 40,000 Indonesian patients a year to their hospitals.”
“Yes, Chinese companies will wipe out the competition at the lower end. However, if we are not careful, they will also become competitors at the higher end as well. Manufacturing as an engine of growth, especially in the semiconductor industry and the electronics industry, will be seriously threatened. Recently, we have moved into life sciences and chemical industries, but we need to look beyond manufacturing to grow our services industry. Beyond its economic competitiveness, China also becomes a serious threat to Singapore in terms of quality of life. Major cities like Beijing and Shanghai have developed into modern cities with rich cultural experiences and wide recreational choices. In Singapore, on weekends, when we think of recreation, we will visit our neighbourhood shopping centres, perhaps take the children to the zoo, go to Sentosa, play golf or, maybe, go to the beaches. In China, a weekend for a family in Shanghai may mean driving to Suzhou, Hangzhou, or one of the nearby scenic areas. It is therefore not surprising that expatriates increasingly find China a favoured choice for location of their companies. Services will be new growth engines In the face of severe competition to our manufacturing industry, services can be new engines of growth for Singapore. Traditionally, Singapore has been a logistics and financial hub. The telecommunications and IT services have also been key sectors but they have also been affected by the downturn. We have to look at other new growth areas in the services sector. We should consider expanding into other services, including education and healthcare. In education, Singapore remains one of the choice locations for many Chinese nationals. Many Chinese are eager to come to Singapore to learn, study or be trained.”
“Mr Speaker, Sir, I thank you for allowing me to join in the debate on the Motion of Thanks. The Asian financial crisis and the global economic recession took its toll on the Singapore economy. Our four major engines of growth, the US economy, the combined Malaysia/Indonesia economy, the world semiconductor sales and domestic construction work, stalled. As the Singapore economy took a nosedive, job losses continue to mount. The greatest challenge facing the man-in-the-street now in Singapore is jobs and the job situation can only improve if we can grow the economy and create more jobs. As we move ahead, we need to develop new engines of growth. We recognise that China will be a major competitor, but we also recognise that China can be a growth engine. While the world's economy took a battering, China's economy continued to grow, although at a slower pace. Singaporeans must awaken to the serious competition that China will pose to Singapore and the world. Over the last decade, I have had the opportunity to visit China on several occasions. Over the years, I have not ceased to be amazed at the pace of development in China. On a recent trip, I met a Singapore company which makes external claddings for buildings and windows. They have relocated their factories and the entire operations to China. Their cost of production is 18% of the cost of production in Singapore. The Chinese engineers they hired were not less competent than the Singapore engineers. They were willing to work harder and put in longer hours. They were also very eager to learn and were good in research and development. As a result, the company's products have improved at a fraction of the cost that they would have to invest in, if the R&D was done in Singapore.”
“In other words, all we had were two clinics providing primary healthcare service to the entire estate. When I raised this with the different Government departments, it appeared that everybody thought that it was a good thing to locate clinics only in big shopping malls. But I raised the point that when people are sick, they do not want to take buses. They do not want to drive a car to a shopping mall to see a doctor. They want to be able to walk to the nearest clinic which is within walking distance to seek treatment and relief for their illness. At the meetings that we had with the Ministry, I was given to understand that the Ministry does not have any planning advice or planning norms as to what sort of number of clinics that we should provide in the new housing estates. Perhaps the Ministry may want to be more proactive in this area in coordination with other Ministries. Also, as a town grows, there is a growing need for a public primary healthcare service in the form of polyclinics or other forms of public primary healthcare service, to be provided in this growing new town. Perhaps the Minister can help enlighten me as to what the Ministry's plans are for this new town.”
“One must understand that doctors have a very difficult time in the restructured hospitals. And the recent newspaper report, which highlighted the routine of the doctor, does help to give the public an insight into what sort of time lines doctors have to meet. The perception is always distorted because, to the doctor, he has 60 patients to look after. But to a person, his relative is the most important person, and why can the doctor not give him that due attention and that due time that is needed for his relative. Recently, the Ministry of Health has allowed a reverse brain drain, tapping the private sector expertise, and has actually brought in some specialists from the private sector back into the public sector. This has generally been well received by the public for beefing up the services in the restructured hospitals. Ultimately, the aim is to tap on the talent pool so that if we can draw either foreign talent or local private sector talent, we will be able to improve the workload. And that will mean that there is increased quality time for patients, and we will also be able to improve the training of doctors, which means that they can deliver better care to the patients. Perhaps the Minister can tell us whether there are any other plans to perhaps tap the resources outside the public hospitals to improve the workload on the doctors in the public service. Sir, my next cut is on primary healthcare. Because of our involvement in new towns, we began to learn a bit about how primary healthcare delivery is done in the new town. I was surprised that when we had a population of more than 20,000 households, which would be equivalent to roughly half the size of Ang Mo Kio town, we only had two clinics tucked in one corner of the estate.”
“Sir, doctoring is becoming a difficult profession. Many have read in the papers recently that even doctors now are subject to abuse by members of the public. Quite often, not surprisingly, almost every other month, you will read something in the papers that would carry negative and sensational comments during legal suits against doctors, and these reports put doctors in a very negative light. And during legal suits, usually the sensational comments put up by the prosecution would always be highlighted and the defence side is always so boring, because they just relate the facts and are usually not carried. And that gives a distorted image of how doctors perform their duties. One must not forget that doctors are human beings. Yes, they can prolong life, but they are unable to ensure that all outcomes will be what patients expect. Even the best surgeons in the world cannot ensure that all his patients will have good outcomes. We need to put the work of doctors in the right perspective. Doctors work long hours and have very little social life. It is one of the few professions that they have to work virtually every day, including Sundays and public holidays. Doctors do their best to give the patients the best of care. But due to the constraints of time, the constraints of the workload, they may not always be able to give the best that they want to. For example, I am a visiting consultant to one of the hospitals - Tan Tock Seng Hospital - and I can see that in a hospital like that, where the workload is extremely heavy, they have very few consultants. And because of that, the Registrars and the medical officers do not get any formal training programme. Unless we improve the services, we will not be able to lighten the workload, improve the quality of care.”
“There are also inter-departmental differences and these are often resolved at the medical board level (differences between departments, differences between specialties). And because the medical board is an internal board, many doctors or departments may feel that if their head is not holding a significant position there, they may not have a say. One may want perhaps to consider either a board of appeal or seconding doctors from outside that hospital to sit on the medical board to give it a more unbiased perspective. Sir, I think it is time for us to relook at some of these issues because, ultimately, retaining good doctors will help to improve the quality of healthcare in our healthcare services.”