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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“Based on the National Population Health Survey 2022, close to 40% of women in the 50 to 69 years age group went for breast cancer screening through a mammogram in the last two years. Under the national subsidised screening programme, the number of breast cancer screenings from the first half of 2024 has increased by almost 50%, compared to two years ago. One key reason is because of Healthier SG, where eligible enrollees can go for free breast cancer screenings.”
“Medical social workers in public healthcare institutions do not refer patients directly to doctors in polyclinics and public hospitals. Patients typically make direct appointments with polyclinics or are referred by family physicians to see specialists.”
“Many Junior Doctors, including House Officers, Medical Officers and Residents, are employed by the Ministry of Health Holdings (MOHH) and rotated through our public healthcare institutions (PHIs), including during the COVID-19 pandemic. The bulk of Junior Doctors who served during the pandemic have been awarded the COVID-19 Resilience Medal (CRM). However, many were also not nominated by their employing organisations because they were not in a single place of practice throughout the pandemic. We recognise that many of these Junior Doctors who were on rotation as part of their training had also contributed significantly to our pandemic response, and the Ministry of Health has worked with MOHH to review and nominate additional healthcare workers for CRM. Other than Junior Doctors on rotation, Medical Officers who had served in our PHIs but subsequently re-enlisted for National Service during the pandemic period have also been nominated. The updated list of awardees will be published in the latter half of 2024.”
“The Ministry of Health does not track data on suicidal ideation. The 2016 Singapore Mental Health Study estimated lifetime prevalence of suicidal ideation at 7.8%. Young persons 18 to 34 years old are more likely to have suicidal ideation, compared to those 50 and above. The top three mental health conditions associated with suicidal ideation are Bipolar Disorder, Generalised Anxiety Disorder and Obsessive Compulsive Disorder. Among other factors associated with suicidal ideation are being divorced or separated, and having a physical illness. Due to the complex nature of suicide, it is often not possible to attribute an individual’s suicidal ideation to any particular circumstance or condition.”
“Under the Pre-implantation Genetic Screening (PGS) pilot, any woman enrolled in an accredited in-vitro fertilisation programme who is 35 years old and above, who has suffered two or more recurrent implantation failures or experienced two or more pregnancy losses, is eligible for the screening test. Since the last update in February 2024, a total of 605 patients have been enrolled in the study, among which 199 patients were tested for PGS. The Ministry will need to review the clinical outcomes and safety of the pilot to determine if PGS should become mainstream. In the meantime, we will continue to recruit consenting patients into the study. Based on research literature, the risk of aneuploidy, which refers to an abnormal number of chromosomes, increases significantly from 35 years onwards. As such, lowering the age limit of 35 is not clinically appropriate, taking into account the risks and limitations of the PGS procedure.”
“We launched the Shared Stay-in Senior Care Services sandbox in September 2023 to test out more ways to enable seniors to age in the community and support families with caregiving, without resorting to institutional care as a default. The sandbox provides work pass flexibilities for participating companies to try out different models of manpower deployment to senior care. The caregivers need not be professional healthcare workers. Eligible companies can arrange for the training and tap on the Agency for Integrated Care’s Learning Network or Community Care Training Grant to train their workers in caregiving. Companies have been onboarded since the start of this year and, to date, four participating companies are serving about 200 clients. We will review the scheme at its one-year mark, before determining the next steps.”
“We can do more to help consumers better understand insurance, how a hospital bill is covered by subsidy, MediShield Life, MediSave and private insurance, so that they know what they are paying for and can make better choices. Co-payment instils discipline in the system and keeps the inflation of hospital bills and insurance premiums in check. Today, there is already co-payment. However, those who bought riders can minimise their co-payment to 5% of the hospital bill, up to a limit of $3,000. These are parameters we have to constantly review. There are complex interdependencies across the healthcare system, the private insurance industry, as well as all of us, as patients and policyholders. If we are to break the vicious cycle of runaway healthcare costs, unaffordable premiums and increasing anxiety, all stakeholders must play their part to treat, insure and consume responsibly. MOH will have to carefully consider appropriate interventions.”
“If they are still not satisfied with the outcome, they may tap on the Clinical Claims Resolution Process for Integrated Shield Plan (IP) claims disputes of a clinical nature and the Financial Industry Disputes Resolution Centre (FIDReC) of a contractual nature. The Claims Management Office set up by MOH also uses complaints on unreasonable medical bills as a basis to identify cases for potential claims adjudication. These cases usually comprise hospital bills covered by private insurance. The Claims Management Office also develops claims rules to guide doctors in making appropriate MediShield Life claims for common procedures or those more susceptible to complaints. While claims rules are developed to govern MediShield Life claims, private health insurers also reference them when assessing IP claims. It is also useful to remember that regardless of any disputes with insurance companies, all policyholders will be able to access subsidised care in public hospitals. Our public hospitals may vary subsidies based on means-testing but will not deny access to care. So, the request to restrict private insurance policyholders to unsubsidised or private care is not consistent with our fundamental policy of ensuring universal accessibility to healthcare. It is natural for policyholders to want better coverage, greater access to care, more choices of doctors and lower premiums. But in today’s situation that MOH has explained, these are not likely achievable. We need to break the current cycle of overly generous terms, over-charging and over-utilisation, leading to rising hospital bills, escalating claims, higher premiums, which then result in policyholders demanding better terms. Members have put forth questions that may be part of the solution. First is education.”
“To contain costs, insurance companies introduced panels, comprising doctors who charge responsibly. Due to public feedback, insurance companies have expanded the panels somewhat. But expansion beyond a certain point will likely mean less ability to contain costs. Since each insurer publishes their list of panel doctors on their websites, it will be better for policyholders to enquire from their agents or seek out the latest information on the insurance companies’ websites than for MOH to publicise the information. Third, and in a similar vein, it will be better for consumer groups to establish platforms and fora for sharing of insurance experiences, not different from how such fora are set up for various services, from retail and restaurants to hotels and point-to-point private transport. Fourth, there are questions on whether MOH can ensure policyholders have access to necessary care, control coverage for private health insurance and set up avenues of recourse for private insurance claims disputes. As mentioned, private insurance policies are commercial contracts that policyholders enter into with insurance companies. It is very important for policyholders to know what treatments are covered and what are not, before they enter into the contracts. If they are looking for something with very wide coverage, it will most likely fetch higher premiums. The Monetary Authority of Singapore and MOH require insurance companies to uphold their contractual obligations and process claims in a fair manner. Insurance companies that fail to do this can be subject to penalties, such as warnings, offers of compositions and sanctions. Policyholders who wish to dispute a private health insurance claim outcome may appeal to their insurer.”
“My response will also cover the matters raised in the written question by Mr Yip Hon Weng1 which is scheduled for today's Sitting. Before addressing the specific queries, let me reiterate the current health insurance situation, as explained in my public speech last month. Our assessment is that the health insurance industry is very competitive, so much so that insurance companies are offering very generous terms to compete for market share. It is only human nature that when terms are too generous and someone else is paying the bill, the behaviour between patients and doctors changes and a buffet syndrome is created. The health insurance industry is at risk of becoming a race to the bottom. Claims and, in turn, premiums, are rising fast and the system is in danger of becoming unsustainable. The questions raised by Members reflect this deeper issue. Embedded in the questions are many requests to make claims easier, coverage better and premiums lower. We all wish for such better deals. But we also know it is highly impossible. They will probably make the system even more unsustainable and the current problem even deeper. To be more specific: First, there is a question on whether the Ministry of Health (MOH) can ensure premium increases are fair. Indeed, as claims escalate, insurance companies are under pressure to raise premiums. For national health insurance, namely, MediShield Life, we can increase premium subsidies or provide MediSave top-ups to make premiums affordable. However, private health insurance is commercially offered in a free market. What MOH can do is to continue to publish premiums and coverage annually to facilitate policyholders making the right choices. Second, is the request to expand doctor panels.”
“If the Member has come across specific cases that may be deserving of the Home Caregiving Grant (HCG), we suggest that he surfaces them to us for consideration. The ability to perform Activities of Daily Living (ADL) is a sound, objective basis for assessing the eligibility for a broad-based scheme like the HCG. Instrumental ADL involve a different set of activities, such as managing finances, preparing meals and housekeeping. Other schemes are available for those who require support in these domains.”
“The Ministry of Health (MOH) and the Ministry of Social and Family Development (MSF) do not have the data, as there is no universal definition of a high- or low-quality meal. MOH and MSF adopt a multi-pronged strategy to ensure that lower-income families have access to nutritious meals. To raise awareness, MSF has implemented programmes, such as the "Healthy with KidSTART" programme, to increase access and educate lower-income households on health nutrition. Similarly, the Health Promotion Board (HPB) works with community partners under the Healthy Living Passport Programme, to hold nutrition talks that provide tips on how to prepare affordable and nutritious meals at home. To enable healthier choices, HPB partners food businesses, under the Healthier Dining Programme, to make heathier meals accessible across different settings and budgets, including at hawker centres and food courts. HPB also works with supermarket chains, under the Healthier Choice Symbol programme, to increase the variety of healthier house brand products, which are typically more affordable.”
“The question has been addressed in my Oral reply to Parliamentary Question No 82 on the Order Paper for 2 July 2024. [Please refer to "Assessment of Need for Health Controls Given Recent Increase in COVID-19 Infections", Official Report, 2 July 2024, Vol 95, Issue 137, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]”
“In the past three years, the Ministry of Health has provided about $1.6 million to the Institute of Mental Health for two research studies, which are designed specifically to understand the risk factors for suicide and self-harm as well as the mitigating factors for prevention and/or reduction of self-harm. Both studies are ongoing. Outcomes of the studies are projected to be ready by end-2025.”
“Gender reassignment surgery has always been offered by the public hospitals for those seeking medically necessary care, but it has not been part of any subsidy scheme.”
“The questions have been addressed in my Oral reply to Parliamentary Question Nos 28 to 32 on the Order Paper for 2 July 2024. [Please refer to "Future Plans for Family Nexus Centres and Other Key Initiatives in Child and Maternal Health and Well-Being Taskforce Report", Official Report, 2 July 2024, Vol 95, Issue 137, Oral Answers to Questions section.]”
“The question has been addressed in my Oral reply to Parliamentary Questions Nos 97 and 98 on the Order Paper for 2 July 2024. [Please refer to "Annual Cost of Taking Risdiplam for Treatment of Spinal Muscular Atrophy and Decisions on Drug Advisory Committee Recommendations", Official Report, 2 July 2024, Vol 95, Issue 137, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]”
“We will try to change this over time. After all, flu and pneumococcal vaccination rates have gone up since the rollout of Healthier SG. We will encourage more Healthier SG clinics to come on board to provide COVID-19 vaccination. By leveraging the relationship between family physicians and residents, we can hopefully keep up societal resilience against COVID-19, which will be here to stay.”
“As of June 2024, only about 15% of seniors aged 60 and above, have received more than four doses of COVID-19 vaccinations. Many Singaporeans are reluctant to take further doses of COVID-19 vaccine. Much of it is because of vaccine fatigue and wanting to put the crisis behind us. This is, in turn, due to the perceptions that COVID-19 is no longer a severe disease and there are side-effects to taking the vaccines. Seniors and vulnerable individuals are recommended to stay updated with their vaccination, which means that they ought to take the vaccine once a year to keep themselves protected. COVID-19 did not become mild all of a sudden, it is mild because we have taken the vaccines earlier, which protected us against severe illness when infected. Side-effects are inevitable for any medications, but local and international evidence continue to show that severe side-effects from COVID-19 vaccination are infrequent and, even then, most recovered by themselves. Many people, due to various reasons, including years of lifestyle habits, have developed chronic illnesses that progressed into heart attacks and strokes. Others, due to ageing, also developed various medical conditions. There is a tendency to conflate these diseases with the taking of COVID-19 vaccines. It is much more important to lead a healthy lifestyle to prevent these diseases. We are undertaking various measures, such as fully-funding COVID-19 vaccinations, sending out Social Media Service reminders and deploying mobile vaccination teams, to encourage vaccination especially amongst seniors. However, it is difficult to go against the current public perception and bring about a high vaccine uptake. Unlike many Western countries, we do not have a strong vaccination culture among adults.”
“The Ministry of Health have been benchmarking against best practices around the world. For instance, in the case of the scope of practice for psychologists, the Tiered Care Model under the National Mental Health and Well-being Strategy was developed with reference to mental health care models overseas, such as those in Australia.”
“The proportion of Singapore residents who visited a dentist in the past 12 months remained stable from 2019 to 2023. We do not have statistics before 2019. Among those aged 18 to 49, the proportion increased slightly from 59.4% in 2019 to 61.6% in 2023. Among those aged 50 to 74, the proportion remained stable between 53.0% and 53.7% in the period 2019 to 2023. The Ministry of Health (MOH) does not track dental benefits enjoyed by private sector employees. Public sector employees enjoy $120 of dental benefits at outpatient settings per year and these are reviewed periodically by the Public Service Division. The regulations for outpatient dental services were reviewed and promulgated under the Healthcare Services Regulations in June 2023. MOH reviews dental policies, including financing, from time to time.”
“The annual cost of risdiplam in Singapore is currently about S$375,000. Following the Drug Advisory Committee's (DAC’s) recommendation to subsidise risdiplam under the Medication Assistance Fund subsidy framework, eligible patients in public healthcare institutions can receive up to 75% subsidies for risdiplam from 1 August 2024. Patients who face affordability concerns after subsidies may apply for financial assistance, such as MediFund, at public healthcare institutions. The estimated cost impact to the public healthcare system of listing risdiplam for subsidies is derived from the projected number of patients that require risdiplam in Singapore and the cost of treatment. DAC is a standing committee that regularly makes evidence-based recommendations to Ministry of Health (MOH) for drugs to be subsidised. These recommendations are based on objective considerations, such as clinical need of patients, clinical and cost effectiveness of the treatment, and budget impact. Recommendations are surfaced to MOH three to four times a year. Thus far, MOH has accepted these recommendations.”
“There are 320 Healthier SG general practitioner clinics providing COVID-19 vaccinations as of 24 June 2024, in addition to the five Joint Testing and Vaccination Centres around the island.”
“My response will also cover the matter raised in Parliamentary Question No 46 for Written Answer by Mr Liang Eng Hwa for today’s Sitting. The current COVID-19 wave, which started in mid-April 2024, has been on a steady decline. It peaked in early May 2024 at around 26,000 cases per week, while the hospitalised COVID-19 cases peaked two weeks later with 370 beds occupied. The weekly estimated number of COVID-19 cases has since declined to 8,700 cases, as COVID-19 hospital bed occupancy has dropped to around 130. The average number of cases in the Intensive Care Unit remains low at four cases. The Ministry of Health (MOH) has taken some measures to protect our healthcare capacity, but we have ridden through another wave without having to impose any additional restrictions. This is consistent with our intention to live with COVID-19 as an endemic disease, just like influenza or chickenpox. Vaccination remains important to reduce the risk of severe infections. As of 23 June 2024, about 60.5% of our total population did not receive any COVID-19 vaccination in the last two years. On the other hand, countries like Denmark are able to get the broad majority of their population to take the updated COVID-19 vaccine. This is a cause for concern because we know that vaccine protection will wane with time, and as the virus mutates further, at some point, there can be escalated risks of many infected patients falling severely sick, just like at the beginning of the pandemic. MOH is thus encouraging individuals, especially vulnerable ones like seniors, to take their COVID-19 vaccination. We are bringing on board Healthier SG clinics to provide COVID-19 vaccination.”
“The Childhood Developmental Screening (CDS) checks are conducted to identify children at risk of developmental delay and allow for early intervention. Between 2020 and 2022, more than 70% of children aged two attended at least four out of the recommended five CDS checks at polyclinics and the Community Health Assist Scheme's general practitioner clinics. During the same period, around 40%-50% of children aged three attended at least five out of the recommended six CDS checks at subsidised primary care settings. This does not include CDS checks conducted in other private healthcare settings. Inclusion Coordinators at preschools work with their fellow early childhood educators to identify children with potential developmental needs for further assessment at CDS. Polyclinics will also opportunistically remind parents with young children of the CDS touchpoints and the importance to follow up. Parents are also encouraged to refer to the child’s Health Booklet for age-specific developmental checklists to monitor the growth and development of the child and seek help accordingly should they notice a delay.”
“The Health Sciences Authority (HSA) follows the World Health Organisation’s recommendation to implement an appropriate deferral period after ex-offenders have been released from prison before they can donate blood. This is to ensure the safety of the national blood supply as there is a higher prevalence of blood-borne infections in this group. HSA’s current deferral period is aligned with the deferral period in developed countries, such as Australia, Canada and the United States of America.”
“Based on historical claims data, we estimate that two-thirds of Community Health Assist Scheme (CHAS), Pioneer Generation and Merdeka Generation chronic enrollees at Healthier SG general practitioner clinics will benefit from the Healthier SG Chronic Tier. At steady state, this may be about 300,000 residents. As of end February 2024, 760,000 or 60% of CHAS cardholders aged 40 and above had yet to enrol in Healthier SG.”
“This is generally also not anti-competitive because it does not restrict insurers from competing on price, product features or benefits for policyholders. Doctors also may individually decide whether to accept the fees and other terms offered by insurers in return for joining a panel. Patients are also able to choose their doctors, taking into consideration any differences in benefits should their doctor not be on their insurer’s panel.”
“Competition Law, including Singapore’s Competition Act 2004, typically prohibits collusion amongst industry players, or a big market player abusing its dominance to the detriment of competition. The Ministry of Health has consulted the Competition and Consumer Commission of Singapore. The practice cited by the Member is unlikely to fall within the prohibited practices under the Competition Act. There has been no evidence of collusion by insurance companies in the Integrated Shield Plan market. There are seven insurers and the largest insurer only has around one quarter market share and does not appear to be in a dominant position with the potential for abuse that stifles competition among industry players. What the Member raised is a separate problem altogether, which is that industry players are not actively competing for the segment of customers who have pre-existing conditions. This is because their probability of claiming is higher, which means insurers will likely compensate more than what they collect in premiums. Hence, insurers are not vying for their business. The issue is adequate social security for this segment of the population, not a case of a lack of competition. Where the commercial market cannot cater, the Government will have to intervene appropriately. That is why we subsidise care in public healthcare institutions and ensure that every Singaporean is covered by MediShield Life, regardless of pre-existing conditions. Those who still cannot afford their bills can apply for MediFund, which is the ultimate safety net. Separately, the Member also asked about the practice of having a panel of preferred doctors by insurers.”
“These questions have been addressed in my reply to Parliamentary Question No 6 for Oral Answer on the Order Paper for 8 May 2024. [Please refer to "Use of Social Media to Raise Awareness about Harms of Vaping", Official Report, 8 May 2024, Vol 95, Issue 136, Oral Answers to Questions section.]”
“The Ministry of Health does not evaluate private insurance coverage of fertility preservation therapy, as these are optional products subject to insurers' commercial considerations. MediShield Life does not cover fertility related treatments as it was designed as a basic health insurance scheme, covering large bills due to treatment of diseases in subsidised public hospitals. Nevertheless, patients can tap on MediSave for fertility treatments, including egg freezing on medical grounds, subject to the assisted reproductive treatment lifetime withdrawal limit of $15,000 per patient.”
“The Ministry of Health does not have data on the number of young cancer patients who underwent curative intent therapy with potential side effects on fertility, nor the proportion of those young cancer patients who did or did not undergo fertility preservation therapy and their respective reasons.”
“The Ministry of Health does not track the number of pregnancies confirmed. However, we do track the number of teenagers aged 19 and below who sought obstetrics care. This has dropped from about 600 in 2018 to about 500 in 2022. During this time, the percentage of pregnancies managed at public health institutions have also fallen, from 71% to 62%.”
“Elective egg-freezing are offered only by licensed Assisted Reproduction Services providers. Licensees must comply with the regulatory requirements, including storing the eggs in under optimal temperatures. Licensees are also required to implement measures, such as to establish an effective quality management system, provide uninterrupted electrical supply, implement proper monitoring procedures for temperature control, put in place immediate notification, response and investigation protocols for deviations beyond acceptable ranges and address any inadequacies to prevent future occurrences. Licensed providers are subject to routine inspections once every two years; and additional targeted audits or unannounced inspections.”
“This question has been addressed in my reply to Question No 1 for oral answer on the Order Paper for 7 May 2024. [Please refer to "Policy on Charging Patients who Choose Different Ward Classes for Different Hospital Stays", Official Report, 7 May 2024, Vol 95, Issue 135, Oral Answers to Questions section.]”
“For population-level screening programmes, there is, unfortunately, no known cost-effective screening test for kidney disease. The current medical evidence supports screening higher-risk patients for kidney disease, such as those with diabetes and/or hypertension. This is currently done under Healthier SG.”
“Medical procedures do not have mandatory fee schedules as this depends on the patient's condition and complexity of the procedure. Any fee schedule published will also be done by the healthcare provider and not the insurer. That said, doctors may enter into contractual agreements with Integrated Shield Plan (IP) insurers to provide services at committed panel fees, which insurers can consider publishing. On the Ministry of Health's (MOH's) part, it has developed private hospital fee benchmarks for about 30 common conditions to provide a reference of reasonable fees. Past bill sizes of common conditions can also be found on MOH's website, which is updated annually. Patients are encouraged to refer to them when choosing a healthcare provider. MOH also monitors selected service indicators for private insurance. The claims processing duration for IP claims with payouts and pre-authorisation turnaround time for scheduled treatment for each insurer are published on MOH's website.”
“Public sector doctors, including specialists, are constantly subject to the lure of the private sector. However, many have chosen a career in public sector because of its mission, the learning and research opportunities. As a result, we have been able to retain the talent we need, with the attrition rate of doctors in public healthcare consistent at about 3% to 5% in recent years. Currently, we have a healthy pipeline of specialists to meet our healthcare needs. However, there are some specialties or disciplines with increased demand due to the evolving care needs of an ageing population, such as Family Medicine Geriatric Medicine, Internal Medicine and Rehabilitation Medicine, and we have progressively increased training numbers in these areas in recent years. We have worked with our hospitals and Institutes of Higher Learning to expand the local medical school intakes and will also continue to attract back Singaporeans who are trained in these areas overseas, and complement the medical workforce in our hospitals with foreign doctors, where appropriate.”
“The prevalence of complete edentulism is less than 3% in the overall Singapore population and approximately 13% for those over 60 years of age. Singapore fares better than many countries whose average is about 30% of edentulism for the population above 60 years. Our prevalence of edentulism in the population over the last two decades has remained below 3%. Edentulism presents a significant concern for ageing populations, impacting oral health and overall well-being. The Ministry of Health continues to monitor the prevalence of common oral diseases, including tooth loss, to ensure the continued coverage, affordability, and accessibility of preventive and timely dental care at the appropriate settings. As part of the continuous efforts to broaden preventive health initiatives for the population, functional screening for oral health is available through Project Silver Screen since 2018 to all Singapore residents aged 60 and above, facilitating timely intervention when needed.”
“Over 50% of Singaporeans visit a dentist at least once a year, with 60% stating the reason for the last dental visit being preventive care and 40% for other reactive dental care. The Ministry of Health encourages more proactive and preventive dental care. Hence, we put in place efforts to heighten awareness of common oral diseases and their prevention as well as to continuously ensure timely and appropriate dental care is available to all Singaporeans. We will have to review if dental care should and can be included in Healthier SG, which is designed mostly to manage major chronic diseases and other serious conditions, which have been the top causes of ill-health in Singapore.”
“As shared with this House earlier this year, the Ministry of Health is reviewing the extension of MediSave for non-surgical dental procedures, such as root canal treatments. That said, any extensions of MediSave use need to be considered carefully, to strike a balance between improving affordability and ensuring that individuals have enough MediSave to meet their healthcare needs when they grow old. Nevertheless, patients who cannot afford their dental treatment at public healthcare institutions after subsidies and/or MediSave use, can approach medical social workers for MediFund and other financial assistance.”
“All subsidised patients have access to the same cancer treatments and drugs, regardless of whether they are hospitalised in Class C or Class B wards. There are times when a patient may be transferred from one subsidised class ward to another for the same disease episode. The charges will be different between the wards, because of differences in subsidy rates and treatment and not because subsidies are available in one ward but not the other.”
“The Integrated Women's Health Programme (IWHP) is a cohort study of the associations between menopause and age-related health issues in Singaporean women, such as osteoporosis and sleep disturbances. The National University Health System plans to conduct follow-up studies, which will cover management of these associated health conditions. The development of new clinical guidelines is prioritised yearly based on considerations, such as disease burden and availability of high-quality evidence. There is currently an Agency for Care Effectiveness Clinical Guidance for osteoporosis, a condition that is of importance in menopausal women, with evidence-based treatment protocols. In time, the full IWHP findings will inform us on the need to develop separate guidelines for menopausal symptoms.”
“There are no plans to extend the Award for Nurses' Grace, Excellence and Loyalty (ANGEL) scheme to nurses working in the private sector. The ANGEL scheme is designed to encourage nurses to stay and build their careers in the public healthcare institutions and publicly-funded community care organisations. Private hospitals are welcomed to implement their own retention scheme through self-funding, bearing in mind these are unsubsidised and typically commercially-run hospitals. Private hospitals have their own remuneration practices to reward and recognise their nurses.”
“The National Wellness Committee for Junior Doctors NWC-JD has finalised its recommendations. These include, setting clearer work hour guidelines for junior doctors, enhancing career guidance and promoting a safe and supportive environment for junior doctors. The recommendations are being progressively implemented and Chief Wellness Officers have been appointed in our public healthcare clusters to oversee and coordinate efforts to improve the well-being of all healthcare workers. We have expanded and refined the career pathways of doctors in public healthcare and introduced the Hospital Clinician scheme, to meet the care needs of Singaporeans while providing doctors with more career options. Clusters have also successfully piloted measures to improve work hours for junior doctors and will progressively implement these to more departments.”
“The per capita household income (PCHI) should include variable components, such as commissions and bonuses, as they are still sources of income and will help form a more complete picture of the financial resources available to households and ensure that subsidies are targeted at those who need it the most. We recognise that individuals' income may fluctuate over time. Hence, means-testing results are based on the average monthly household income over the past 12 months and are valid for two years. Individuals who face changes in their financial circumstances may appeal to have their PCHI re-assessed. Those who face difficulties in paying for their long-term care expenses after subsidies may also apply for further assistance.”
“While flexible work arrangements may be more easily implemented in some working environments, certain professions, such as healthcare workers, operate on rosters to ensure continuity of service and high standards of care and safety for our patients. As the manpower situation is tight for the healthcare sector, when a frontline staff requests for part-time or fixed shift work, our clusters will consider them sympathetically and objectively based on the needs of the organisation and patients. For office-based work, there is greater scope for flexible work arrangements. In fact, as frontline agencies in the fight against COVID-19, the Ministry of Health and related agencies fully appreciate the value of contingency planning, which incorporates aspects of flexible work arrangements.”
“Healthcare professionals are trained to treat all patients with compassion and respect, including patients who are neurodivergent or have disabilities and their family members. This involves listening and personalising their care, based on their care goals and best interests as well as giving additional time for consultation. The treatment of conditions which give rise to the disability, for example autism spectrum disorders and other neurodevelopmental or learning disorders, would be by care teams who have had additional specialty training. For instance, clinical psychologists are trained to provide psychotherapy and rehabilitative therapies and may work with psychiatrists and other healthcare professionals on treatment programmes. Administrative staff will take note of additional needs and concerns in supporting healthcare professionals and their patients. Patients and family members may also approach Medical Social Workers for psychosocial support and caregiving advice, if they need additional assistance.”
“Unfortunately, the Ministry of Health (MOH) and the Monetary Authority of Singapore do not collect data on the number of insurance application rejections. MOH also does not track the data that the Member asked for, such as the number of people with mental health conditions or disabilities who have paid for hospital treatments without insurance coverage beyond MediShield Life (MSHL). Nevertheless, all Singaporeans and Permanent Residents are covered under MSHL from birth regardless of pre-existing conditions, including mental health conditions and disabilities. MSHL is designed to cover them well, so long as they seek subsidised healthcare in our public health institutions. Together, Government subsidies, MSHL, MediSave and, if necessary, MediFund, ensure that most Singapore Citizens pay very little cash out-of-pocket for subsidised care at public healthcare institutions. What is in question are commercial insurance policies that accord protection over and above MSHL, such as for unsubsidised care in the private sector. These will be subject to the private underwriting arrangements of insurance companies.”
“Mr Speaker, the answer is yes. It was covered in my reply just now.”