Ong Ye Kung
Singapore
“The Ministry of Health (MOH) recently enhanced the Community Health Assist Scheme (CHAS) dental subsidies, which are tiered by income, for common preventive and restorative procedures.”
“Healthier SG GP clinics may also refer their enrolled patients to Active Ageing Centres and Community Health Posts to fulfill their social prescriptions and for subsidised services, such as medication management.”
“Public hospitals, such as the National University Hospital, the Singapore General Hospital and Tan Tock Seng Hospital, have deployed robotic-assisted surgical (RAS) systems for minimally invasive soft-tissue surgeries.”
“The Health Sciences Authority (HSA) welcomes drug producers to choose Singapore as part of their first-wave filings. As long as a pharmaceutical product is approved by at least one regulatory agency, such as China's National Medical Products Administration (NMPA), it would also qualify for the abridged route.”
“A decrease in estimated glomerular filtration rate in patients with diabetes can be due to multiple reasons. Doctors will first investigate the underlying cause before determining whether the patient should be referred to a specialist. Some causes are reversible and cause transient reduction in renal function.”
“Information on the Lasting Power of Attorney (LPA) cannot be made visible on the National Electronic Health Record system as it is protected under the Mental Capacity Act. Such information may only be disclosed by the Public Guardian to specified persons upon satisfactory submission of evidence(s) required under the law.”
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“We have set up 214 Active Ageing Centres (AACs) thus far, including 60 new AACs since January 2024. As a result, the number of seniors living in private housing estates that are within the service boundary of an AAC have increased by about 10,000 to around 29,000 in the past year alone. A key challenge of setting up new AACs is to find sites that are accessible to seniors, especially in the private estates. Besides accessibility, we will also consider whether the sites have adequate space and basic utilities needed to run programmes for seniors.”
“There have been various Ministry-funded research done on ageing and caregiving, such as those conducted by the DUKE-NUS Centre for Ageing Research and Education (CARE); Retirement and Health Study by the Central Provident Fund Board; the National Council of Social Service's Quality of Life of Caregivers study; and the Agency for Integrated Care's regular engagements with caregivers. Caregiving involves significant sacrifice and commitment and there have been many initiatives to support them.”
“While the Singapore Civil Defence Force (SCDF) ambulances are activated for life-threatening medical emergencies by calling 995, private ambulances are activated for less urgent cases. Hence, Ministry of Health does not track response times for private ambulance providers arriving at the patients' locations. That said, we regulate private ambulance services, which must, at all times, maintain valid certification, undergo periodic re-certification every two years as well as ensure that their personnel are properly qualified and attend regular skills refresher training. Importantly, licensed ambulance providers are required to properly triage a patient before conveyance. Where the provider assesses that it cannot safely convey the patient, the provider must make appropriate alternative arrangements, such as calling for an SCDF ambulance, for the safe and timely conveyance of the patient. In the event of a life-threatening medical emergency, the public should call for an SCDF ambulance in the first instance.”
“Various agencies, led by the Ministry of Health (MOH), have been working together to improve effectiveness of enforcement against vaping. We stepped up enforcement operations at the land, sea and air checkpoints, heartland areas, malls and central business district as well as at major events, such as the Formula 1 race, National Day Parade and music festivals. We also streamlined the processes, so that enforcement officers from the Singapore Police Force, National Environment Agency or National Parks Board can issue digital Notices of Composition on the spot to vaping offenders. At the same time, the Health Sciences Authority has stepped up enforcement against online advertisements and sales of e-vaporisers and has worked with platform owners to remove about 6,000 offending listings in the first three quarters of 2024. In 2023, a total of about 3,000 listings were removed. Among those penalised for vaping-related offences, about 15% were repeat offenders. Enforcement against vaping is a long-term effort. Many studies have shown that vaping is at least as harmful, if not more harmful, than cigarette smoking. Yet, we are fighting against an industry that is deliberately targeting young people, disguising harmful substance as cool lifestyle habit with a fruity taste. We will need more effective public education efforts, to inform the public of the harms of vaping. This would include working closely with the Ministry of Education, schools and Institutes of Higher Learning.”
“The cost of in-vitro fertilisation (IVF) cycles at public Assisted Reproduction (AR) centres has increased by about 2% a year over the past decade. The Ministry does not track the cost of IVF at private AR centres.”
“Pharmacists are required to complete necessary training and undergo competency assessments, to participate in the sandbox for influenza vaccinations. The protocols for response to allergic reactions is no different from vaccinations in other settings, i.e., post-vaccination monitoring for 15 minutes, administering adrenaline autoinjectors and referral to further medical help, when necessary.”
“Only licensed healthcare institutions or licensed pharmacies can supply prescription medicines and pharmacy-only medications online. These medicines must also be registered by the Health Sciences Authority (HSA). The licensing conditions include ensuring that electronic prescriptions can be transmitted securely and storing registered medicines appropriately. Compliance and quality checks are conducted on marketed medicines. HSA regularly publicises its advisories through various channels to avoid purchasing medicines from overseas or unknown sources, including online, as these may be unregistered, substandard or counterfeit, posing significant health risks. HSA also monitors local websites and e-commerce platforms to detect and disrupt illegal online sales of medicines. Anyone caught selling these medicines illegally can be fined up to $50,000 and/or jailed for up to two years.”
“4 billion in MediSave top-ups, which can also be used to help Singaporeans offset the impact of both premium and deductible increases.”
“It may be a fifth to a quarter of subsidised bills incurred by Singaporeans, depending on healthcare consumption pattern. But most will be lower-cost procedures that can be covered by MediSave, for which withdrawal limits will also be adjusted. This means that subsidised patients should, generally, not have to pay more cash out-of-pocket due to the changes in deductibles. The Government will also introduce a new outpatient deductible, to future-proof the scheme as its coverage expands to more outpatient treatments and home-based medical care. This is accompanied by significant increase in claim limits. For example, we have increased the claim limit for dialysis from $1,100 to $1,750 per month. We expect the cumulative, annual increase in outpatient claim limits to more than offset the outpatient deductible for most treatments. The net impact on each individual would differ, as it depends on their claim, ward class, premiums and the subsidies and top-ups that they receive. Overall, these changes aim to improve assurance for Singaporeans over large subsidised bills as MediShield Life and MediSave will fully cover 90 per cent of such bills, up from under 80 per cent today. On an aggregate basis, the Government is allocating much more resources to defray cost of healthcare, than the increase in payouts or deductibles. To illustrate, over the next review cycle, the increase in premiums amount to $1.8 billion and changes to the deductibles reduce MediShield Life payouts by $0.6 billion. These additional outlays for policyholders will translate into higher payouts, especially for bigger hospital bills. In addition, the Government will provide $4.1 billion in support measures, including $3.”
“Let us take a step back to explain the need for deductibles first. One of the truisms of healthcare is that, ultimately, people always pay. Some systems offer healthcare for free, but they are not really free, as people ultimately pay through high taxes. Others use insurance, but people also ultimately pay through premiums. We have concluded that through a mix of subsidies, insurance and co-payment, mostly through MediSave, we can minimise the ultimate burden on the people while delivering good health outcomes. This is the second truism of healthcare, which is how we pay determines how much we pay. In particular, co-payment by patients, including deductibles, helps keep the system lean and more efficient. Deductibles, as a feature of insurance, in particular, sieve out the small bills so that insurance claims can defray a large part of the big bills. Further, deductibles also help sieve out the unnecessary procedures or over-servicing, which can add up to a lot of wastage. Deductibles, therefore, serve a good purpose in our healthcare financing system. The MediShield Life Council, which was tasked to review the system, noted that our inpatient deductible has not been adjusted since 2015. With rising medical bills, the deductible has, therefore, become less effective in sieving out smaller, more affordable bills which can be paid for by MediSave. The Council, therefore, proposed an increase in deductible, which the Government accepted. Without the changes to the deductibles, MediShield Life premiums will need to increase by an average of 31 per cent, instead of 22 per cent in the latest round of review. It is difficult to estimate the number of inpatient bills where co-payment by patients will increase due to an increase in deductibles.”
“We recognise the challenges single unwed mothers face in shouldering the caregiving and financial responsibilities for their children, which raise their risks of physical and mental health issues. Our public hospitals, particularly the KK Women's and Children's Hospital and the National University Hospital, provide single unwed mothers with comprehensive support by a multidisciplinary team, comprising doctors, nurses and medical social workers as well as mental health and community support, where relevant. This includes doing a complete medical assessment, facilitating counselling services, financial assistance and providing educational resources to kickstart their parenthood journey. They also proactively identify those who are at-risk or need more help and link them with community agencies, such as the Social Service Offices, Family Service Centres and social service organisations. Our public and private healthcare systems treat all mothers equally, providing antenatal and postnatal care based on individual needs.”
“Under the National Mental Health and Well-being Strategy, we aim to train over 130,000 frontline personnel and volunteers to provide basic mental health support by 2030. These include the ability to identify individuals with mental health needs, provide early intervention and support, and refer them to appropriate services, where necessary. The training should include caregivers of seniors and special needs individuals. Eligible households can tap on the Caregivers Training Grant of up to $400 per year to attend approved courses.”
“There are various features of MediSave that are salient to Singaporeans. A key one is MediSave withdrawal limits for co-payment of hospital bills, which are reviewed as part of our review of the MediShield Life scheme. As this is a holistic review, it is typically done once every three years. Other MediSave features, such as Flexi-MediSave, are also reviewed periodically. This approach is favoured over automatic annual adjustments, to better account for other healthcare financing adjustments and enhancements that are continuously being implemented.”
“Based on national claims data, around 40 patients were diagnosed with craniopharyngioma between 2014 and 2023. The Ministry of Health does not collect morbidity- or disability-related data specific to craniopharyngioma. Patients with craniopharyngioma can qualify for subsidies, MediSave and MediShield Life coverage like all other patients, including for cancer drugs, if they require them. This includes subsidies of up to 80% plus MediSave and MediShield Life for their inpatient stays, surgeries and outpatient radiotherapy. Patients who face difficulty affording their healthcare bills after subsidies, MediSave and MediShield Life can approach medical social workers at our public healthcare institutions for further support.”
“The nursing support staff to nurse ratio in the public healthcare institutions have remained around 1:11 for the past 10 years. It is not meaningful to compare nurses to administrative staff, as they perform separate functions. The Ministry of Health will continue to work with public healthcare clusters to attract and retain healthcare workers to meet service demands.”
“The review of the cost effectiveness of the shingles vaccine, Shingrix, has been completed. At the price proposed by the manufacturer, the vaccine is not considered cost-effective for the prevention of shingles at the population level. We will continue to discuss with the manufacturer and monitor their pricing.”
“The Agency for Care Effectiveness under the Ministry of Health adopts internationally established techniques for conducting Health Technology Assessment (HTA) methodology to assess the clinical and cost effectiveness of therapies, including cancer drugs. The assessment includes direct and measurable health-related costs and the patient’s health outcomes, including quality of life. Non-health related costs and benefits are typically not included in HTA assessment as they are subjective and harder to measure. That said, the thresholds for passing HTA assessment can be suitably set to take into account these factors.”
“The Ministry of Health does not collect or track data on Singaporeans seeking dental treatment in Johor Bahru or the costs of dental procedures there. From 2019 to 2023, the number of dental clinics in Singapore increased by over 10% from 1,091 in 2019 to 1,228 in 2023. Cost of doing business in Singapore is higher than Johor Bahru. That said, we will continue to ensure that dentists are well-trained and competent and dental services in Singapore are safe, of high quality and, through various support schemes, remain affordable for Singaporeans.”
“There is currently insufficient evidence on the usefulness of Body Roundness Index as a predictor of obesity and related health risks for Asian populations. The Ministry of Health will continue to monitor research findings and, in the meantime, use predictors, such as waist circumference and body mass index, for our national screening programme.”
“The integration of Traditional Chinese Medicine (TCM) into our hospitals will need to be evidence-based and carried out cautiously and progressively. Today, the only acupuncture service offered as a mainstream treatment in our public hospitals is in the area of lower back and neck pain management, and how it was done offers a clear indication on the approach moving forward. To start with, there is clear evidence supporting its efficacy. Further, there are clear protocols, with the roles and responsibilities of both mainstream healthcare providers and TCM providers well-defined. For example, the patient must be first assessed by the medical specialists and a referral made for acupuncture treatment for lower back and neck pain. After a course of acupuncture treatment, patients have to be reassessed by the referring medical specialists who will decide whether to have another course of acupuncture treatment or discontinue the treatment. We expect further TCM treatments that will be incorporated into public health institutions to undergo a similar approach and process rigour.”
“As MediShield Life is a basic health insurance scheme which protects Singaporeans against large subsidised medical bills arising from accidents or illnesses, general maternity expenses are not covered by MediShield Life. Instead, the Government provides subsidies of up to 80% for maternity expenses, and MediSave use through the MediSave Maternity Package. MediShield Life coverage does kick in for the treatment of serious pregnancy and delivery-related complications. Beyond subsidies for maternity expenses, the Government also provides significant additional support for parents, such as the Baby Bonus Cash Gift, and the MediSave Grant for Newborns, which will be increased from $4,000 to $5,000 from 1 April 2025.”
“Our public hospitals’ Emergency Departments (EDs) handle a large number of patients, some urgent, others less so. They have to triage patients to prioritise the urgent cases, provide initial treatment and decide if patients require life-saving interventions, admission, further diagnostic tests or outpatient treatment. ED physicians, in particular, play an important role in guiding these decisions. They assess and manage patients based on established treatment protocols, guidelines and clinical judgement. EDs are, therefore, a critical touchpoint. That said, not all tests leading to a definite care plan need to be performed in the ED; they can be performed later during the inpatient hospital stay based on the clinical assessment by the inpatient care team. The operations of ED are complex, high paced, deal with a wide range of patients and are constantly in flux. Treatment protocols are, therefore, regularly reviewed, taking into account the available clinical evidence and established best practices. Relevant process and outcome indicators are closely monitored to ensure clinical quality and patient safety.”
“The Seniors’ Mobility and Enabling Fund (SMF) and Assistive Technology Fund (ATF) provide eligible seniors with means-tested subsidies of up to 90% for hearing aids. On average, of the 4,000 unique seniors who applied for SMF subsidies for hearing aids annually since 2019, more than 99% were successful, with most of them receiving 90% subsidy. In 2024, the Annual Value and Per Capita Household Income criteria for means-tested subsidy schemes, including SMF and ATF, were revised, to ensure that Singaporeans with greater needs continue to receive support Seniors who do not qualify for SMF or ATF subsidies and require financial assistance for hearing aids can approach the Agency for Integrated Care, SG Enable or medical social workers at our public hospitals. Depending on their individual circumstances, the seniors can be matched to other forms of financial support available, including from Social Service Agencies and charities. The Government does not track the applications made by Singaporean seniors for such alternative funding for hearing aids. The Government will continue to review SMF and ATF regularly to ensure that the schemes provide adequate support to those in need.”
“MediShield Life is our national health insurance scheme to provide basic healthcare security to our population for life. For the scheme to work, all Singapore Citizens and Permanent Residents need to participate in the risk pool. In the spirit of collective responsibility in an inclusive society, everyone contributes so that everyone benefits. There is, therefore, no opting out of this scheme. The scheme enhancements that were recently announced ensure that MediShield Life protection remains adequate amidst rising healthcare costs, and as one grows older and consumes more healthcare. To help Singaporeans manage the premium increases, the Government will provide an additional $4.1 billion in support measures, which will more than offset the total premium increases of $1.8 billion over the next three years. The support package includes enhancements to means-tested premium subsidies and MediSave top-ups. Overall, more than nine in 10 Singaporeans will receive premium support that fully cushions their premium increases over the next three years. For example, all Pioneer Generation and Merdeka Generation seniors are among those who will not see a nett premium increase for the next three years. There is also Additional Premium Support to help Singaporeans who still face difficulty in paying their premiums.”
“The Singtel landline outage lasted about three hours and did not disrupt patient care services in our Public Healthcare Institutions. However, the outage disrupted calls to the three public healthcare clusters’ contact centres, which usually handle appointment-related requests, such as rescheduling, booking, cancellation of appointments. In total, an estimated 2,300 calls, or 10% to 30% of daily call volumes, were unable to be completed during the outage. Mobile and broadband services were not affected. Patients were able to use alternate channels, such as the Healthhub and Cluster Apps, Livechats and Online Contact Centres and email channels during the outage.”
“This is a pilot project to encourage individuals to lead healthier lifestyles by allowing them to redeem their Healthpoints for discounts on their premiums. This pilot is targeted at individuals aged 40 and above because it is in support of Healthier SG, which targets the same age group. By focusing on this age group, we are also more likely to see clearer correlation between healthy lifestyles and good health and provide the evidence to consider if it can be a permanent feature of MediShield Life.”
“But what I mentioned earlier, if there is accreditation and people are confident of TCM practitioners' assessment, employers are free to exercise discretion to recognise them. These are the Member's first two questions. The next two questions are what I had addressed in my speech recently and in my reply. I will just reiterate the key points. There is now a lot of research, scientific research on TCM. We will review them. And some of them, I think if we can study them and ensure that they are safe, efficacious, cost-efficient, we can start to integrate them into our mainstream regulatory system, mainstream healthcare system, including the management of chronic disease. It is possible. As we do so, it is quite an involved process. For every disease, we need to bring TCM and Western doctors together, work out referral protocols. They cannot contradict. We must make sure it is well integrated and we can implement them; and when we implement them, if they are integrated just like acupuncture for lower back and neck pain, it is and it can be subsidised. It is subject to MediSave withdrawal. So, we are taking this step by step and as we do so, I think they will also learn from each other, which is a good thing.”
“I did not realise there are four questions. So, I am now trying to take stock what are they. The first question is about accreditation, when will it be done? As you know, TCM is a self-regulatory system, so it comes under the TCM Practitioners' Board chaired by Dr Teo Ho Pin. So, they are working very hard. I am afraid I have to give you an answer not different from how Minister Chee gave the answer on Bukit Panjang LRT which is, I think, as soon as possible, hopefully, next year, sometime next year. I do have to clarify even with the accreditation system, this is an accreditation system under a self-regulatory framework. So, it does not follow that if you are accredited, your MC will be recognised. Be mindful. We are taking a very practical approach here. All round the world including in China, the regulatory system is a Western-centric one. It is a result of the Renaissance. But TCM, on the other hand, lots of people use it, I agree. I use it myself. But if we say let TCM be regulated under today's healthcare regulatory regime, I think it will wither and die because the Western regulatory system is just not compatible with TCM. Therefore, we take a practical approach to say "take you out of the system and you self-regulate" and then you can thrive. But it comes with some catches. Once you are outside of the mainstream system, there is no subsidy, there is no MediSave, your MCs are not recognised. So, it is part of the arrangement. It comes as a package. You are allowed self-regulation, you can thrive, you can serve a quarter of Singaporeans but some of these privileges, including recognition of MCs, do not follow.”
“The accreditation will ensure good governance, adherence to established protocols and the maintenance of professional competencies for high quality and safe TCM practice. At present, under the Employment Act, employers are legally required to recognise medical certificates issued by registered medical or dental practitioners after proper clinical assessment for the purposes of granting paid sick leave. Although TCM practitioners are not registered medical and dental practitioners under the Act, employers have the discretion to also recognise medical certificates issued by them. Next, is acute hospital settings. Today, only acupuncture for lower back and neck pain are integrated into our public health institutions. There has been much scientific research on TCM and we should review them and explore the possibility of further integration, provided that the interventions are proven to be safe, efficacious and cost effective. If and when we decide to do so in a public hospital setting, proper referral and review protocols will be established, no different from the integration of medical subspecialties that are ongoing.”
“In my speech at the Public Free Clinic Society's 50th Anniversary Charity Dinner, I announced the Ministry of Health's (MOH's) plan to carefully integrate selected Traditional Chinese Medicine (TCM) interventions into our mainstream Western-centric healthcare system, as we have done for acupuncture for lower back and neck pain. Our effort will focus on two areas: first, for preventive care under Healthier SG; and second, for acute settings in hospitals. Let me start with preventive care. About 20% of Singapore residents aged 40 and above visit TCM practitioners every year. TCM clinics are hence, useful touch points to engage residents to join Healthier SG and practise good preventive care. I mentioned in the speech that under Healthier SG, health screening, vaccinations, chronic disease management, being Western medicine interventions, will have to be performed by general practitioners (GPs). Where TCM practitioners can play a useful role is lifestyle changes, given the holistic approach to health in TCM. MOH will consult Western doctors and TCM practitioners on how they can collaborate to care for our residents. The training and support for TCM practitioners under Healthier SG will depend on the eventual model of collaboration. A fruitful collaboration should lead to an increased uptake of preventive care, such as screenings and vaccinations, as well as adoption of healthier lifestyles among Singaporeans. MOH and the TCM Practitioners Board will be launching a voluntary accreditation system to accredit TCM service providers that can participate in Healthier SG collaboratively with Healthier SG clinics.”
“Mr Speaker, Sir, my response will also cover the matters raised in the questions by Dr Wan Rizal1 and Mr Yip Hon Weng, which are scheduled for a subsequent Sitting. I will invite Members to seek clarifications at the end of my answer, if need be. If the questions have been addressed, it may not be necessary for them to proceed with the questions for future Sittings.”
“I thank the Member for raising this. It is actually the key point here. I thank the Member for working with NHG to use telemedicine for the benefit of his, especially, senior residents. I think when we have new technology, we have an opportunity to make service better, to serve patients and residents better. But just like all new technology, all new business models, someone will try to abuse it. And then, questions will be raised: is the Ministry stepping up audit, enforcement, regulation, doing a clamp-down? There is always a temptation to do so. When you do so, you stop being able to seize the opportunities that new technology can present you. That is why I want to be quite honest with Members. I think the current requirements and standards are valid and our enforcement has been effective. So, something gone wrong, we corrected it straight away. MaNaDr has been notified that their outpatient licence will be revoked. Now is still the period for them to appeal. So, I think it is by good enforcement, following up on our standards, enforcing them, taking necessary actions, then we can fully utilise and leverage opportunities that new business models and technology can offer us. And what Mr Yip Hon Weng mentioned, I think, can come true.”
“I am not entirely familiar with the operational aspects of enforcement, but I think we take the attitude that if mystery shopping is required, we will do so, bearing in mind the public are our eyes and ears. When they see something is wrong, they will usually whistle-blow and let us know. And when you see a pattern of complaints, we will take action quite promptly, which is what happened in this case. Whether there needs to be a review, I do not think so. While telemedicine is due to new technology, post-COVID-19, and it is a new business model, the principles and standards and requirements lay out – whether under HCSA or SMC's Guidelines – I think they are still applicable. For that matter, HCSA was just recently enacted, taking into account technology and taking into account a post-COVID-19, ageing population healthcare system, where technology is being used. I should add one more point. In the polyclinics, we were hesitant to allow telemedicine for acute treatment precisely because we want to be quite careful about the issuing of MCs. So, if you want an MC from the polyclinics, you would still have to turn up in person.”
“The Member asked if there are standards, if there are audits and if we receive complaints and feedback. The answer is yes, yes, yes. I would say, in terms of standards and audits, all the clinics know – we have some doctors in the House – you know the standards, you know we audit you. And if, despite knowing all these, you still fall foul of the regulations and the SMC's Ethical Guidelines, then, you are in trouble, because we will catch you. And even if we do not catch you, people will complain – which is the case here, people complained about MaNaDr, that the turnaround was too fast and MCs are issued; employers are suffering, particularly, because their employees are not coming to work, applying for MCs, sometimes, while they are overseas through telemedicine. So, we took prompt action. Be mindful that while the offence went on for awhile, it was not a long while. It was a matter of months. We investigated, took action and corrected the situation.”
“Telemedicine providers are required to be licensed under the Healthcare Services Act, or HCSA, and comply with requirements and standards. In the case of healthcare, medical practitioners themselves also need to adhere to the ethical and professional standards set out in the Singapore Medical Council's (SMC's) Ethical Code and Ethical Guidelines (ECEG). Under the guidelines, they must obtain sufficient information from their patients, conduct appropriate clinical assessment and ensure that any provision of medical care, prescription of medicines and issuance of medical certificates (MCs) are justified on proper medical grounds. In other words, the regulation of telemedicine is not different from regulation of all other economic activities. We set standards, we require licensing, we conduct periodic audits for each clinic, investigate complaints and take offenders to task. Such regulatory frameworks cannot eradicate offenders – that is not possible. But instead, it ensures that when practices have gone astray, especially with the advent of new technology and business models, they can be corrected promptly. This is exactly what happened with the MaNaDr case. The doctors were issuing medical certificates in a way that fell foul of HCSA and the Ministry of Health (MOH) had made known our intention for MaNaDr's outpatient medical service licence to be revoked. Several doctors also appeared to have breached the SMC guidelines and are therefore referred to SMC for further disciplinary actions.”
“Sir, may I answer Question Nos 1 and 2, and also oral questions filed by Mr Melvin Yong1 and Mr Yip Hon Weng2, and a written question filed by Dr Wan Rizal3 for a subsequent Sitting, on the regulation of telemedicine services, please?”
“The Singapore Nursing Board does not capture the data of graduands who graduated from our Institutes of Higher Learning but do not register to be nurses. Based on the 2022 Graduate Employment Survey conducted by the schools, approximately 90% of the Diploma and Degree nursing graduates who were in full-time permanent employment within six months of graduation practised nursing.”
“There are different types of eye screenings. For seniors, subsidised screening for visual acuity is available under Project Silver Screen (PSS), a community functional assessment programme. This does not require a visit to the doctor. Eligible seniors pay a nominal fee when they attend the first PSS session, that is, $0 for Pioneer Generation (PG) card holders, $2 for Community Health Assistance Scheme (CHAS) Blue/Orange and Merdeka Generation (MG) card holders, and $5 for all other Singapore Citizens. For individuals with diabetes, diabetic retinal photography (DRP) is subsidised at polyclinics. Patients can receive subsidised DRP screenings at various participating general practitioner (GP) clinics based on their CHAS, PG and MG card status. DRP is currently also included under a Healthier SG care protocol for chronic disease management.”
“Details of Youth Community Outreach Team (CREST-Youth) and Youth Integrated Team (YIT) services are shown in Table 1 below. The Ministry of Health does not track the number of sessions CREST-Youth and YIT service providers have with caregivers.”
“We have increased the number of pharmacists and allied healthcare professionals (AHPs) over the years. From 2019 to 2023, the number of registered pharmacists increased by 20%, from approximately 3,400 to approximately 4,100. Registered AHPs increased by 25%, from approximately 6,000 in 2019 to approximately 7,500. Within the public healthcare clusters, we are also innovating and streamlining processes to manage the workload of pharmacists and AHPs. For instance, the National Central Fill Pharmacy system resulted in the redesigning of the supply chain and the roles of pharmacy staff, with routine non-clinical and logistical processing outsourced to a third-party vendor. We have also developed the National One-Rehab Framework to provide clearer protocols for care delivery by AHPs, including resource allocation and tracking of common end-to-end rehabilitation clinical outcomes. Most importantly, we will continue to work with the pharmacy and AHP leadership to find ways to make careers in healthcare attractive and meaningful. With rising healthcare needs and the growth in the community care sector, there are many opportunities to develop an exciting professional development strategy for pharmacists and AHPs.”
“The Positive Use Guide on Technology and Social Media will be introduced in the first half of 2025 to help individuals identify potential harms of technology and social media and learn to use them appropriately. Like many preventive health measures, effects take time and will show up in disease prevalence data. The Guide is targeted at youths, including those not in school. Outreach efforts by various societal stakeholders will be needed to reach individuals of different age groups.”
“When the Government implemented the Cancer Drug List (CDL) policy from 1 September 2022, the Ministry of Health (MOH) discussed with the insurers, who agreed to implement a two-year moratorium on Integrated Shield Plan (IP) premium increases from 2 September 2022 to 31 August 2024. This was in view of the CDL being a significant policy change to reduce the cost of cancer drugs, and hence claims, and to better support policyholders through the transition period. MOH currently regulates the key parameters of IPs, such as the co-payment and deductible, to ensure these products can function sustainably as a key part of our healthcare financing system. However, IPs remain private products. Insurance companies compete in a competitive market and the products need to remain commercially viable. Therefore, MOH’s general practice is not to regulate aspects, such as premiums, service quality or underwriting, which are integral to market competition. The quantum and frequency of premium revisions are subject to insurers’ actuarial and commercial considerations. MOH encourages Singaporeans to make informed decisions about health insurance purchases, taking into consideration their preferred healthcare choices and whether they would be able to continue paying premiums in future. We will continue to publish information on IP premiums and coverage to facilitate consumers in making informed decisions. Regardless of IP coverage, all Singapore Citizens and Permanent Residents are covered by MediShield Life, which will be adequate for subsidised care in public hospitals.”
“The per capita household income and property Annual Value thresholds for means-tested healthcare subsidy schemes have just been reviewed to take into account the rise in household incomes and annual values. Where appropriate, we also review and adjust subsidy levels, taking into consideration healthcare cost increases. For example, we recently enhanced the implant subsidy framework. We have also just announced major enhancements to MediShield Life, to enhance coverage for large healthcare bills.”
“Our healthcare institutions stock a wide range of generic medications to meet patient needs, to keep costs affordable for patients. However, some generic medications may not be available in Singapore, if the pharmaceutical companies’ choose not to bring them in. For example, they may assess that there is inadequate local demand and market potential. Currently, the generic version of Febuxostat is registered with the Health Sciences Authority since July 2024, but the product registrant has not started to bring it into Singapore, presumably based on their own commercial considerations. That said, there are good and affordable alternative generic medications to Febuxostat, such as Allopurinol and Probenecid, available in the public hospitals and pharmacies.”
“We have not made it a requirement for food and beverage (F&B) establishments to display calorie information. Based on our population disease profile, the Ministry of Health (MOH) assessed it is more important to provide information on nutrients that will be harmful if over-consumed, namely, sugar, sodium and saturated fat. We, therefore, have several initiatives in place to achieve this. For example, larger F&B establishments are required to display Nutri-Grade labels on their menus for Grade C or D beverages that are higher in sugar and saturated fat. Under the Health Promotion Board (HPB) voluntary Healthier Dining Programme, participating F&B establishments may display identifiers on their store fronts and menu boards to inform consumers of the availability of healthier options, including those that are lower in sugar or calories. As of March 2024, more than 3,100 F&B establishments, with over 9,000 outlets island-wide, have joined the Healthier Dining Programme. We are also planning to introduce mandatory labelling of prepackaged products, for example, sauces and seasonings, for sodium and saturated fat content, and will continue to encourage F&B establishments to choose healthier ingredients. MOH and HPB will continue monitoring the impact of existing measures. We remain open to considering further measures, voluntary or mandatory, that are practicable and implementable in our local context, to support Singaporeans in adopting healthier diets.”
“Findings of the National Youth Mental Health Study were self-reported. As such, the severe or extremely severe mental health symptoms reported in the study do not necessarily indicate a mental disorder. Nevertheless, we take steps to ensure timely and appropriate responses to young people with mental health needs. The Response, Early Intervention and Assessment in Community Mental Health teams collaborate with schools to support students with mental health needs. There are ongoing efforts to enhance the capability of school counsellors and upskill community partners, such as social service agencies. For those who require more specialised care, public hospitals, such as the Institute of Mental Health, Changi General Hospital, KK Women's and Children's Hospital, Ng Teng Fong General Hospital and National University Hospital, provide child and/or adolescent mental health specialist services. To facilitate early access to mental health services in the community, community touchpoints, including Youth Community Outreach Teams (CREST-Youth), Youth Integrated Teams (YITs), polyclinics and participating general practitioner (GP) clinics, provide mental health assessment and support. We aim to expand the number of CREST-Youth and YIT teams to 15 teams and extend mental health services to all polyclinics and Healthier SG GP clinics by 2030.”
“As our population ages, we can expect demand for healthcare services and manpower to increase. To attain a healthcare workforce size of 82,000 nationally by 2030, the Ministry of Health will need to recruit about 6,000 nurses, Allied Health Professionals and support care staff annually.”
“Since the inception of Active Ageing Centres (AACs) in 2021, the Ministry of Health and the Agency for Integrated Care have set up 208 AACs1. We will continue to scale this to 220 AACs by 2025. The AACs will be distributed across all parts of Singapore, such that eight in 10 seniors will have access to AAC activities near their homes by 2025. The locations of AACs, when confirmed, can be found on the SupportGoWhere website.”
“Under the Tripartite Guidelines on Fair Employment Practices, employers should not ask job applicants to declare any medical condition, including young onset dementia, unless it is a specific job-related requirement. A confirmed dementia diagnosis will not affect MediShield Life coverage, the Government-run national health insurance scheme which does not exclude individuals with pre-existing illness. It can, however, affect new applications for commercial insurance products, such as life, critical illness and Integrated Shield Plans insurance, which are subject to underwriting based on actuarial and commercial considerations. The Member is right that this can deter them from seeking screening which may result in early detection. Some members of the public, therefore, purchase these commercial insurance products, especially when they are young and premiums are low, before they go for any comprehensive screening tests. If sufficient individuals do that, logically, it will preserve the viability of insurance companies’ risk pools while enabling individuals to practise good preventive care habits. As for raising awareness on the importance of early detection, the Agency for Integrated Care collaborates with various partners to do this, including through mass media, public events, web portals and ground engagement activities, and assists those with related concerns in obtaining assistance from service providers, such as Community Intervention Teams and polyclinics.”
“Regarding Assoc Prof Razwana’s query on measures yet to be rolled out, we will be designating first-stop touchpoints to enable individuals to receive support early and to facilitate access to higher-tier services when needed. For instance, a new National Mental Health Helpline and Textline service will be introduced in mid-2025 to offer psychological first aid to those facing mental distress. Those who require additional support, including crisis management, will be referred to the relevant services. Other upcoming measures include the Positive Use Guide on Technology and Social Media, which will be ready in the first half of 2025. It will guide healthy and positive uses of technology and social media and provide recommendations to mitigate their potential negative impact. In addition, the Ministry of Digital Development and Information and Infocomm Media Development Authority are studying whether further requirements, such as age assurance, are needed to prevent children and youths from accessing age-inappropriate content on relevant online communication services.”