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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“The Member asked, for those who upgrade, later on in their stay, can they appeal. Of course, everyone has the right to appeal, but having said that we are trying to stop a certain behaviour, which we do not think is right. At the beginning of every hospital stay, patients will be counselled financially and they will make those decisions with their eyes open. When a patient medically requires isolation, we will isolate them. And if they have chosen a lower ward class to start with and then require isolation, they will be given higher subsidies, not withstanding being in the isolation ward. As for those who come back later and wish to downgrade and are not allowed, actually there is a very established process of means testing. So long as they meet the means testing criteria, they can downgrade. I think the specific cases the Member might have come across, might be a case where they did not manage to meet the means testing criteria. Having said that, for anyone with affordability issues, there is always MediFund as a last line of defence, a last safety net, so that they can always afford a hospital stay in the public health institutions.”
“Mr Speaker, Sir, my response today will also address the oral question filed by Mr Leong Mun Wai, on retroactive charging for upgrading wards, for a subsequent Sitting. When patients stay in a higher ward class and then downgrade to a lower ward class towards the end of their stay, they will receive subsidies based on the respective ward class. This is fair. In fact, where the request to downgrade is due to unaffordability because of complications or unexpected additional costs, public hospitals will find ways to support these patients financially. This is for downgrading of wards. For upgrading of wards, there is a different consideration. We have to discourage patients from selecting lower ward classes to secure more subsidies for more costly treatments, such as surgery and the Intensive Care Unit (ICU) at the beginning of their stay, and then switch to higher ward classes once these treatments are completed. Many of these patients are not of lower income and could have chosen the higher ward class from the outset. That is why if a patient upgrades, the level of subsidies will be adjusted retroactively.”
“CareShield Life (CSHL) payouts started at $600 per month in 2020 and increase by 2% annually until 2025. An individual who makes a successful claim in 2024 will receive monthly payouts of $649 and will not need to make further premium payments for as long as he remains in severe disability. CSHL is administered by the Government on a not-for-profit basis, with premiums sized based on actuarial principles. An important characteristic to take note of is that the scheme is designed on a lifetime basis, where premiums are frontloaded when someone is young and unlikely to become disabled and claims will most likely happen when the person is old, after which payment of premiums will be suspended. As most of the policyholders are relatively young and many have yet to make claims, it is not appropriate to use the premium-to-claim ratio to assess the pricing and economics of the insurance scheme. An independent CSHL Council will regularly review and recommend changes to premiums and payouts, in accordance with an actuarially sound adjustment framework.”
“The answer to part (a) of the question has been addressed in the Circular for Written Answers published on 6 November 2023. [Please refer to "Mental Health Insurance Coverage", Official Report, 6 November 2023, Vol 95, Issue 115, Written Answers to Questions section.] The Government does not fund private hospitals to deliver subsidised care for mental health, as Singaporeans can receive subsidies of up to 80% for mental health services at public hospitals and polyclinics. We will continue to expand the capacity of mental health services in the public hospitals and polyclinics. In the primary care setting, Community Health Assist Scheme (CHAS), Pioneer Generation and Merdeka Generation cardholders are eligible for subsidies for mental health conditions – including depression, anxiety, bipolar and schizophrenia – at selected private CHAS General Practitioner (GP) clinics, under the Chronic Disease Management Programme (CDMP). Individuals may also tap on MediSave to pay for their CDMP treatments at these GP clinics. Today, over 450 GPs in GP clinics are trained to support persons with mental health needs under the Mental Health GP Partnership Programme. We target to make mental health services available at 1,350 Healthier SG GP clinics by 2030.”
“Consent in medical practice is a shared decision-making process by both the patient and clinician. The clinician provides medical information and the patient exercises his autonomy to make decisions about his treatment. These principles apply to mental health treatment and services. The Government received feedback that the need for parental consent for children and youths below 21 years old may hinder their access to mental health support. MOH is studying this feedback.”
“The wait time to the first appointment to consult a specialist for assisted reproductive treatment at public hospitals has come down over the last five years. In 2023, the median and mean wait times across the public hospitals were no more than seven and 12 days respectively.”
“Kidney failure cases are driven mainly by Singapore's ageing population and risk factors, such as diabetes and hypertension. Hence, to slow down the growth of kidney failure cases, we need better preventive care. In this regard, Healthier SG is now a national priority, which promotes healthier lifestyles, participation in screening for diabetes and hypertension and improves the management of diabetes and hypertension. To cater to patients with kidney failure who require dialysis, the Ministry of Health has been working with providers to expand our national capacity. We are also encouraging suitable patients to opt for peritoneal dialysis, which can be administered at home and accords patients greater independence.”
“Shingles is not a notifiable disease and the Ministry of Health (MOH) does not track shingles cases. MOH also does not actively monitor the uptake of shingles vaccination, as the vaccine is currently not on the National Adult Immunisation Schedule's list of recommended vaccines.”
“Fractures vary in their severity. Simpler fractures are already managed in polyclinics, for example, through splints, arm slings and appropriate medication to relieve pain. More complex fractures may require additional investigations and specialised procedures to manipulate the fracture and restore bone alignment, before casts are applied. These cases are managed at the Accident and Emergency departments or Urgent Care Centres, where specific equipment and materials are available and healthcare professionals are trained for such conditions. The polyclinics have in place, guidelines for management of fractures. This includes protocols for referring patients to a specialist or emergency services.”
“The Tables below provide the breakdowns for the financial years where data is available:”
“The Ministry of Health regularly reviews our demand for dentists, considering factors, such as demographic changes and oral health trends, to ensure adequate access to dental care for all Singaporeans. The number of dentists in the public healthcare sector grew by about 40%, from around 400 in 2013 to around 540 at the end of 2022. Going forward, we will continue to increase the number of dentists in public healthcare institutions to meet growing demand.”
“The Government has enhanced support in recent years for caregivers of seniors, including those with dementia. For example, the Home Caregiving Grant was enhanced in 2023 to provide more help with caregiving expenses. The Agency for Integrated Care (AIC) has also expanded the range of training courses for caregivers. We expanded dementia day care and home personal care services for custodial support, allowing caregivers to take breaks. This includes the Night Respite service which provides night-time care for seniors with dementia. Specifically, for caregivers of seniors with dementia, since 2021, the Post-Diagnostic Support Community Outreach Teams have provided dementia-related resources to newly diagnosed seniors and their caregivers, equipping them with coping skills and linking them to other services. The Community Resource, Engagement & Support Team – (CREST)-Caregivers – provides self-care advice to dementia caregivers who have or are at risk of developing burnout and link them up with support networks. We will continue to review support measures to meet the needs of caregivers of seniors with dementia.”
“MediShield Life (MSHL) coverage does not cause healthcare cost to rise proportionately. The logic is the reverse. That means healthcare cost is rising, largely as an external trend; and to protect Singaporeans against large and expected medical bills, we intend to expand the coverage of MSHL. Nevertheless, the Ministry of Health has implemented several measures to ensure overall healthcare costs remains sustainable. This includes greater emphasis on population health, implementing value-based care in healthcare institutions and encouraging right siting of patients to reduce the demand for acute hospital care. Health Technology Assessment also ensures that subsidies and insurance coverage extend only to clinically- and cost-effective treatments.”
“In 2022, the National University Hospital renovated its in-vitro fertilisation laboratory, to increase its capacity for Assisted Reproductive Technology (ART) treatment. There are also upcoming plans to increase ART treatment capacity progressively at KK Women's and Children's Hospital and Singapore General Hospital, over the next few years. When completed, the ART capacity at these public hospitals would have increased by about 20%.”
“Singaporeans requiring root canal treatment are eligible for subsidies at Public Healthcare Institutions and under the Community Health Assist Scheme (CHAS) at participating dental clinics. Furthermore, Pioneer and Merdeka Generation seniors enjoy additional subsidies. Subsidised patients who cannot afford their dental treatment after government subsidies can approach medical social workers to apply for financial assistance, such as MediFund. Despite this, there have been calls for the Government to allow the use of MediSave for root canal treatment. We will review this suggestion. However, extensions of MediSave use need to be considered carefully, to strike a balance between increasing affordability and ensuring that our seniors have enough MediSave to meet their healthcare needs.”
“From 2018 to 2022, about 85% of nurses granted Permanent Resident (PR) status were from the public healthcare sector. The remaining were from private healthcare providers, including voluntary welfare organisations. The Ministry of Health values and appreciates the dedication and contributions of all our healthcare workers. Our healthcare workforce comprises a sizeable majority of Singaporeans, complemented by foreign manpower from many countries who have become an integral part of our healthcare team. They serve patients alongside each other and go through crisis together. For those who become valued members of our healthcare community and demonstrate commitment to Singapore, we will continue to grant them PRs and anchor them in our healthcare system.”
“Those who wish to purchase additional optional coverage in the form of Integrated Shield Plans (IPs) may also access a comparison of benefits and premiums across IP insurers on MOH's website.”
“The main purpose of the MediShield Life (MSHL) review is to better protect Singaporeans against large and unexpected medical bills. Claim limits for MSHL will therefore need to increase, even substantially. This is the main driver of premium increases. Ground-breaking treatments like Cell, Tissue and Gene Therapy Products (CTGTPs) are likely to be very expensive. However, because of infrequent usage, it is a minor factor in driving up premium increases. We should start to include them in MSHL because it is a fast-evolving medical field, which is likely to become mainstream treatment in time to come. As a society, we want to ensure that Singaporeans have a chance to access these potentially effective treatments. MSHL can play a useful role, as it works by sharing the financial burden of high-cost, low-incidence treatments through risk pooling. To ensure the scheme remains affordable and sustainable, coverage may only be extended to treatments that are assessed to be clinically and cost-effective. The MSHL Council is reviewing this and will share more details later this year. The Ministry of Health (MOH) will also study how to help policyholders cope with MSHL premium increases and ensure that these remain fully payable by MediSave. There includes premium support for those who are in financial need and who may not have enough MediSave, as well as MediSave top-ups for certain segments of the population. No one will lose MSHL coverage due to a genuine inability to afford the premiums. We will continue to support individuals in understanding their premiums, coverage and support available under MSHL.”
“Over the last ten years, the total number of referrals from polyclinics and general practitioner (GP) clinics to specialist outpatient clinics (SOCs) in public hospitals are 3.9 million and 0.74 million respectively. Specifically, the number of referrals from GPs have increased significantly, from 65,000 in 2014 to 88,000 in 2023. Patients who are Community Health Assist Scheme (CHAS), Merdeka Generation (MG) or Pioneer Generation (PG) cardholders referred from CHAS GP clinics are eligible for subsidised care at public SOCs, based on their citizenship and means-test status, similar to patients referred from polyclinics. Should these patients be hospitalised subsequently, they are also similarly eligible for subsidies based on their citizenship and means-test status and choice of ward class.”
“Patients who are ineligible or not supported by Rare Disease Fund (RDF) may be supported by other charity funds. We encourage members of the public to donate to RDF, so that more Singaporeans with rare diseases can be supported. Every dollar donated to the RDF will be matched by three dollars from the Government. As for caregivers, there are various initiatives they can draw support from, such as the Caregiver Support Networks (CSNs). Caregivers can also call the Agency for Integrated Care's (AIC's) hotline or approach a nearby AIC Link for assistance.”
“The Ministry of Health does not track the number of Singaporeans diagnosed with young onset dementia (YOD). Nevertheless, there are programmes and services to support these young patients and their families. Singapore Citizens and Permanent Residents with YOD can receive means-tested subsidies of up to 80% at our Public Healthcare Institutions. They can tap on MediShield Life and their Integrated Shield Plans, if applicable, when they receive inpatient treatment. For outpatient treatment, they can tap on the Community Health Assist Scheme and can use their MediSave for payment. Eligible persons with YOD may also tap on schemes, like the Home Caregiving Grant or CareShield Life, to alleviate caregiving expenses. The Post-Diagnostic Support Community Outreach Teams provide such families with resources on caregiver support and equip caregivers with coping skills. The Agency for Integrated Care has been raising awareness of dementia through the Dementia-Friendly Singapore initiative in the community for early identification and treatment. Community Outreach Teams conduct outreach activities, including early and basic detection of dementia.”
“That was a very good question from Clementi residents. DORSCON stands for Disease Outbreak Response System Condition, it has four colours. It was used by the Public Service for agencies to coordinate response and to plan resources. It is actually internal. But during COVID-19, somehow it became an external communication code and it triggered all kinds of reactions in supermarkets. With this change, now that we have the new Act, we have four levels of alerts, which is: Baseline, Outbreak, Threat and Emergency. I think it is more intuitive and clearer. So, amongst the agencies, through our Homefront Crisis Executive Group (HCEG), we agreed that this new four tiers will replace DORSCON, both for internal planning as well as our external communications.”
“Thank you, Speaker. I just want to add a comment to the amendment to section 23. We are keeping section 23 because it is still relevant for those who are infected, or think that they are infected, that they continue to have an obligation to inform. At the same time, the Bill provides an exemption for those who have tested, sought treatment and then lower themselves to an undetectable and untransmissible level. We think this combination best protects public health. Other countries might have come to a different combination, but MOH has studied together with the experts, and we find that this combination probably best protects public health. As Senior Parliamentary Secretary Rahayu Mahzam has answered all questions, I have nothing further to add.”
“As of 1 February 2024, all COVID-19 related personal contact tracing data derived from TraceTogether and SafeEntry has been deleted; with the exception of TraceTogether data pertaining to a murder case in May 2020, which will be retained by the Police indefinitely. With the deactivation of TraceTogether and SafeEntry, and the deletion of personal contact tracing data, Part 11 is no longer required and we will therefore repeal it. As for the future, with the rapid advancement of digital technology, precision medicine and artificial intelligence, it may not be wise to pre-judge what we may or can do in future pandemics. We may collect different kinds of data digitally. We may use them differently to fight the pandemic. The public may need new forms of assurances. Part 11 is bound to be obsolete when the next pandemic hits us. In the event of a future pandemic crisis and should we implement a digital personal data collection tool to be part of our arsenal to fight the pandemic, we will need to address data protection concerns and provide assurance to the public. To do so, the Government will come back to Parliament to pass legislation, if necessary. In the meantime, we will closely monitor the technologies available, their possible use cases and relevance for future pandemics. This will allow us to quickly determine, at the onset of the next outbreak, whether and what tools should be deployed as well as the relevant safeguards to be implemented to ensure that an individual's personal data are used with discernment. Mdm Deputy Speaker, besides the amendments relating to pandemic management, there are also other refinements to the IDA. I will now pass the time to Senior Parliamentary Secretary Ms Rahayu Mahzam to elaborate on these amendments.”
“Fourth, "Public Health Emergency", being the most dire of public health crises where even stricter measures, such as curfews or requisition of resources, may be implemented. These four public health postures will inform the application of the IDA henceforth and will greatly facilitate nimbler management of different stages of an outbreak or pandemic. They will also become our common language. As part of this Bill, the Government will be proposing the repeal of Part 11 of the COVID-19 (Temporary Measures) Act, in short, I will refer to it as Part 11. Part 11 was introduced in 2021 to provide assurance to the public that personal contact tracing data collected during digital contact tracing systems, including TraceTogether and SafeEntry were limited for the purposes of contact tracing for COVID-19 and for criminal investigations and proceedings in respect of serious offences. TraceTogether and SafeEntry have not been active for about a year as we transitioned to treating COVID-19 as an endemic disease and SMMs were stepped down. Senior Minister Teo Chee Hean, as the Minister charged with the responsibility for digital Government and public sector data governance, in consultation with MOH, determined that these digital contact tracing systems would no longer be required after 5 January 2024. TraceTogether and SafeEntry have since been removed from the app stores and the backend digital infrastructure supporting the TraceTogether and SafeEntry systems have been dismantled. The TraceTogether and SafeEntry websites have also been shut down.”
“Further details on amendments to enhance operational efficiency during a PHT and PHE will be elaborated on by Senior Parliamentary Secretary Ms Rahayu Mahzam. In effect, with these amendments, our public health response will comprise four postures. First, "Baseline". This is a peacetime state where routine disease prevention and control measures, along with public health surveillance programmes, are in place. During peacetime, the primary objective is to detect outbreaks early to prevent and mitigate disease spread. Second, "Outbreak Management", where there are signs of an emerging infectious disease overseas, upstream measures, such as pre-departure health requirements, temperature screening or stay orders on persons entering Singapore, may be implemented to prevent the disease from being introduced into Singapore. This will help prevent disease importation and transmission and buy us time to understand the new disease. In the event of a local outbreak, measures such as testing, treatment and contact tracing, may be implemented. This is what we did recently at Bukit Merah due to a local tuberculosis outbreak. The IDA does not explicitly mention "Baseline" and "Outbreak Management" situation tiers. These measures are already well-established and routinely carried out and for these two tiers, they are already legally backed by various sections in the IDA; but these two are useful lexicons for us to remember. Third tier is "Public Health Threat", which I have described to be for situations that may require more widespread or prolonged measures, up to and including those that were imposed during the circuit breaker.”
“We can envision that in a situation when Disease X strikes, the Minister may need to acquire private hospital beds, medical equipment, ambulances and manpower to shore up resources to tend to our population who may otherwise not be able to receive care expediently. Parties affected by such requisitions will be appropriately compensated under the RORA. PHT and PHE declarations can be in force for a duration of up to 90 days and the duration is extendable. Drawing from our experience with epidemic waves – including that of COVID-19 – 90 days will provide sufficient time for the effect of measures to kick in and for MOH to review and assess the impact on the public health situation. If needed, the duration can be extended. If the situation subsides early, the declaration may be revoked early. The measures under a PHT and PHE can be intrusive and disruptive, so they need to be triggered only when necessary to protect lives. These decisions will only be taken, following careful consideration based on prevailing scientific evidence and risk assessments and at the highest level of Government. There will also be safeguards in place. The Minister must first, by order, declare a PHT or PHE and publish a notice to bring the order to the public's attention. All orders to declare or extend a PHT or PHE and any regulations made during a PHT or PHE, must be published in the Gazette and presented to Parliament as soon as possible. Parliament has the authority to scrutinise the order or regulations and if unsatisfied with the decisions, vote to annul them. To sum up, what I have just described can be found under clause 22 of the Bill, which inserts into the IDA a new Part 3A on the control of infectious disease during a PHT and PHE.”
“These are envisioned to be much more stringent than the measures, including a circuit breaker, provided under a PHT. For example, the Minister may impose an island-wide curfew during specific time periods of the day or limit the number of persons that may leave a home every day. During COVID-19, some countries had imposed such curfew-like measures. For example, in parts of India, persons were restricted from leaving the home overnight; and some China provinces restricted the number of persons per household who could leave the home and then only to obtain necessities. Fortunately, we did not need to impose any of these highly-restrictive measures during COVID-19, partly because our hospitals, while strained and stressed, were never overwhelmed like in many other countries where a big number of patients had to be left unattended. But we cannot be complacent and assume that we will be as fortunate in the next pandemic. There is a need to be ready for a situation where more stringent measures are needed to avoid a public health catastrophe. Second, the Minister for Health will be able to exercise relevant powers under the Requisition of Resources Act 1985 (RORA) for the requisition of necessary resources to secure the safety of human life and health. The RORA can already be exercised by the Minister for Defence during a PHE. What we will be doing with the amendments to the IDA is to also allow the Minister for Health to exercise requisition powers in a PHE. This is consistent with the overall objective of RORA, one of which is to provide for requisition of resources as necessary for the securing of the safety of human life and health in the event of a PHE.”
“The outbreak of COVID-19 in Singapore in 2020 would have been considered a PHT under the new provisions. Minister will also have the powers to make regulations to implement measures to respond to the PHT as we had. These include movement restrictions; prohibitions of gatherings or events beyond a specified group size; or the suspension of non-essential businesses; up to and including a circuit breaker. All these powers are currently found in Part 7 and will be ported over to the IDA, as powers under a PHT – a threat. Then, what constitutes PHE? A PHE will trigger powers in the most dire of situations. Declaration of a PHE is already an existing provision in the IDA, but we are finetuning the criteria of a PHE and proposing to make adjustments to the powers of the Minister under this situation. We have enhanced the existing criteria for the declaration of a PHE, by factoring in the state of our healthcare systems and resources, in addition to the epidemiology of the disease. The amended IDA will empower the Minister to declare a PHE if he or she is satisfied that the actual or likely incidence and transmission of an infectious disease in Singapore constitutes a serious threat to public health and he additionally finds that the disease poses a substantial risk of either: one, a significant number of fatalities or incidents of serious disability of persons in Singapore; or two, a severe shortage or impairment of healthcare services and supplies in Singapore. A PHE declaration, if done, will unlock two additional powers for the Minister for Health. First, based on the current PHE powers in the IDA, the Minister will be able to declare the whole of or any area in Singapore to be a restricted zone and impose curfew-like measures in those zones.”
“I will introduce the key substantive amendments in the Bill in my speech. Thereafter, I will pass the time to Senior Parliamentary Secretary Ms Rahayu Mahzam to elaborate on the other amendments to the IDA. The main change to the IDA is to provide for a hierarchy of responses to address outbreaks of differing severity. This was a key takeaway from COVID-19, when we had to step-up responses as the situation escalated and taper down measures when the threat subsided. We need the IDA to provide the Minister for Health the powers to effect relevant measures at different phases of the pandemic. Currently, the IDA is somewhat binary. It is either peace or emergency. It only provides for the declaration of a Public Health Emergency (PHE) by the Minister for Health. This was not declared during COVID-19 because while the pandemic situation was dire, we felt it fell short of an emergency – partly also due to the way we had managed the situation. We would associate an emergency with more extreme situations, like widespread riots, or war; or in the context of a pandemic, a healthcare system that is totally overwhelmed. The IDA will therefore enable the Minister for Health to declare either a Public Health Threat (PHT) or PHE, depending on the severity of the situation. It will also provide the powers for the Minister to respond appropriately, based on each situation. Let me first explain PHT and what it entails. The Minister may declare a PHT if he or she is satisfied that the actual or likely incidence and transmission of an infectious disease in Singapore constitutes a serious threat to public health and it is necessary to take measures to prevent, protect against, delay or control such incidence or transmission.”
“As different variants emerged and various infection waves hit us, Part 7 enabled the implementation of many measures, including the circuit breaker, various gradations of safe management measures (SMMs), vaccination-differentiated SMMs and it also facilitated the implementation of TraceTogether and SafeEntry systems. As our population was increasingly protected by vaccinations and safe recovery from infections, we cautiously reopened our society and economy. Part 7 continued to provide the agility and allow us to calibrate our SMMs and to ease restrictions according to risk assessments. The Government conducted a comprehensive review of our responses during the COVID-19 pandemic crisis and its findings were released as a White Paper and debated in this House in March 2023. One of the key recommendations of the White Paper was the need to review and amend the IDA. A key motivation behind the recommendation is that while Part 7 served us well for COVID-19, it was intended to be temporary and, in fact, it will expire next month which is why we have to table this Bill today after the Committee of Supply. COVID-19 is not going to be the last pandemic and we need better and permanent tools for the next threat. The pandemic has given us fresh perspectives on the management of infectious disease threats, and our laws, namely the IDA, needs to be reviewed and be ready for the next pandemic. In this comprehensive review of the IDA, various Part 7 powers that continue to be relevant to future pandemic responses will be ported over to the IDA. We have also taken this opportunity to streamline the legislation, iron out kinks and make provisions for operational effectiveness by drawing lessons from the COVID-19 pandemic.”
“Mdm Deputy Speaker, I beg to move, "That the Bill be now read a Second time." The Infectious Diseases Act, or IDA, was first enacted in 1976 and is Singapore's principal legislation for the prevention and control of infectious diseases. It empowers the Ministry of Health (MOH) to undertake a range of public health measures to prevent the importation and spread of infectious diseases. For example, the IDA empowers MOH to conduct surveillance for infectious diseases, isolate and treat the infected persons and quarantine close contacts. The IDA also allows us to investigate and manage outbreaks with measures, such as contact tracing and disinfection of premises. IDA has been an effective piece of legislation and saw Singapore through health crises, such as severe acute respiratory syndrome (SARS) in 2003 and H1N1 in 2009. Then, COVID-19 struck in 2019. Between influenza and SARS, COVID-19 is somewhere in-between. It had a case fatality rate of about 2% to 5% when it first emerged, far higher than influenza, but lower than SARS. However, COVID-19 was far more infectious than SARS, spreading via airborne droplets and by infected persons yet to display symptoms. It became clear that we were facing a new enemy and it was no longer sufficient to solely rely on the approach of "test, trace, isolate", our main takeaway during SARS, to fight this new virus. Nationwide restrictions and community-based measures became necessary to curtail disease spread, reduce deaths and safeguard our healthcare system. Part 7 of the COVID-19 (Temporary Measures) Act – in short, I will refer to it as Part 7 – was, therefore, enacted in this House in 2020 to complement the IDA and provided additional powers to MOH to combat the pandemic.”
“The real issue is whether psychologists should be regulated, given the increased importance of mental wellness as a national issue. This is currently under discussion between MOH, agencies, service providers and professional associations, such as the Singapore Psychological Society.”
“The Health Promotion Board (HPB) screens Kindergarten 1 to Primary 4 children under the National Myopia Prevention Programme (NMPP). The programme aims to delay the onset and progression of myopia in children through annual vision screening, workshops to equip parents with strategies to develop good eye care habits in their children and partnerships with schools, ophthalmologists and eyecare providers in the community on myopia prevention initiatives. HPB tracks the proportion of Primary 1 (P1) school children with uncorrected visual acuity of ≥ 6/12 as a measure of onset of myopia. Since the inception of NMPP in 2001, myopia prevalence rates in P1 children have decreased and stabilised at 26% in 2023, achieving HPB's target of 30% or lower. In addition, HPB monitors myopia severity levels1 in selected primary and secondary schools as an indicator of myopia progression. The prevalence of low myopia in selected primary schools remained stable at 20% in 2023 compared to 19% in 2013. Over the same period, moderate myopia decreased from 9% to 7% and high myopia decreased from 3% to 2%. Similarly, in selected secondary schools, the prevalence of low myopia remained stable at 27% in 2023 compared to 28% in 2013. Over the same period, moderate myopia decreased from 20% to 18% and high myopia decreased from 11% to 7%.”
“I will ask Senior Minister of State to comment on COMIT and CREST. As for MIC@Home, I agree with you. I think even as a policy of pricing, you want to price it at a gradient so that patients get a strong signal. MIC@Home, I pay less; plus I have S+3M, hospital bill will be less. So our public health institutions take this to heart, they understand and I think they are prepared to do so. But I wrote a careful statement that the price will be equal or less, so to give them some room.”
“Where they are trained and what kind of specialty, how the entire system is run, whether the insurance system of that country or the welfare system is creating oversupply, all these play a part. So we take all these into consideration as we manage our healthcare challenge. As to our own doctor-to-population ratio, it has been increasing. Ten years ago, it was about 2.0, today it is 2.6. So, moving forward, there is some room for three local medical schools to take in slightly more perhaps. There is possibility of having more overseas-trained Singaporean doctors returning, all these we have to consider. Our ratio has been increasing, we are ageing, most likely we will increase further. But I would just caution the European model may not be the model that we want to emulate fully.”
“I do not think we should describe as, whether MOH agrees that UCCs are useful. We came up with UCCs. In fact, the first one that started was in Sembawang Group Representation Constituency (GRC) and over the years, it greatly helped Khoo Teck Puat Hospital's ED, helped them manage their ED load and it has proven to be useful. And as I mentioned, if need be, if we need to set up more UCCs – this is a proven model – we will consider doing so. 1.15 pm But there are competing models. GPFirst in the east has also worked quite well. So, between the two, either or, I think we should consider them. As for doctor-to-population ratio, I explained to some extent in my speech, the European doctor-to-population ratio is somehow just higher than the rest of the world. Even in Asia, comparing developed economies, we are more or less about the same level. I do not know what is the reason, some say it is the legacy of the welfare state, others say they did not plan for manpower. But when you look at individual European countries, it is not that pretty a picture. The Dutch, for example, they have stopped using nursing homes because there are not enough medical personnel nor doctors to man them. So, today, if you are an old person in Holland, in Netherlands, the default care model is actually home care with a lay person, maybe a nurse, maybe an allied professional visiting you twice or three times a day. That is what they have resorted to. Germany, the doctors there told me they are in dire straits. Across the states, the hospitals are not efficiently configured and that is what they told me and therefore they are also, despite having more doctors, not delivering the healthcare that the people need. So, as I mentioned, it is just one number. It is not a numbers game.”
“When we decide to mainstream MIC@Home, we are really approaching it from a clinical angle, which is, we think we are confident enough – by our hospitals – to set up the right equipment, train the caregivers and able to support the patient to recover at home. That is from a clinical angle. But I think Ms Carrie Tan is coming from a different perspective, which is about home care grant and how to support a caregiver who may have to give up their employment and their job. Second Minister Masagos addressed some of these. I think it is something we have to review to see how best we can support caregivers, not just financially, but also in terms of their caregiving duties; giving them respite care services; proper training. These are all things that we will continue to review and as described by the Second Minister.”
“MediShield Life limits withdrawal, I assume you meant for outpatient. For outpatient, we review it from time to time and we have been adjusting over the years. But as for MediSave limits that you can withdraw for big hospital bills, I think there needs to be corresponding adjustments. As claim limits goes up for MediShield Life, whatever that is remaining, you want to make sure that MediSave can also cover them. So, there will be a corresponding review as we increase MediShield Life limits.”
“How to ensure quality of care of MIC@Home is maintained? Do it progressively. Do not be too ambitious and jump to a level that you cannot cope, where doctors and nurses cannot cope. Which is why I explained, from 100 to 300 institutions; feel this is something they can cope and they can maintain the quality. And also select the right patients. Not all patients are suitable for MIC@Home. As for MediShield Life review, how to take into account the blunting effect of Healthier SG, I think it is too early. Healthier SG just started July last year. We are not even one year and this is really a long-term strategy. Hopefully, towards the end of this decade, we can see a blunting or bending of the cost curve as we call it. And at that point in time, of course, we will then take that effect into account as we conduct further reviews of the MediShield Life scheme.”
“I do not have the numbers with me, but you are right, vaping is a problem. And more and more people, especially the young, are vaping. Vaping companies target the young. And it is not just us, it is around the world. Senior Parliamentary Secretary Rahayu explained a holistic way of tackling the problem. How big is the HSA team? HSA is, largely, a scientific organisation. We can collaborate with the ICA to do enforcement at the border; but we rely on NEA, on NParks Board and other agencies, to help us enforce this. So, I think if our enforcement officers can multi-task and I think we can mount a fairly effective enforcement against vaping.”
“But as I mentioned, we will try our best to help them pay for it through their MediSave. And I mentioned a few things that we can do: increase subsidies, do top-ups for specific groups if possible, find ways so that we can all manage. And I think this is a better way to manage healthcare costs. The Member mentioned private premiums. These are private and commercially run insurance premiums and they have been going up. I am unaware that we have the third highest premiums in the world. I think we have to be comparing apples to apples, oranges to oranges, because it depends on what kind of insurance plans are they. What do they cover? Apply to which group? I am not aware, but we can take a look. But I do have to say, as I mentioned, with some frustration in my speech just now, despite rising premiums, I still see insurance companies competing for market share, offering terms that are obviously unsustainable. And I really hope that, at some point, they will rein this in and exercise more discipline so that we also moderate private insurance premiums.”
“I fully agree with Dr Lim on the importance of day surgery. Our public health institutions have been trying to convert as many surgeries as possible to day surgery and, like the Member mentioned, outpatient surgery if possible. We will continue to do that. I mentioned length of stay increased pre- and post-pandemic, six to seven days. Without our push to convert many surgeries to day surgeries or even shortened stays, the impact actually would have been far worse. But we managed to contain it to six to seven days. Even that, as I mentioned, is a 15% increase in workload. And we will continue to work on this front. First, on MediSave. The uses of MediSave have expanded. Is it currently enough? We did a study recently. As of now, we think it is quite adequate. But we will continue to monitor the situation, especially if we cannot contain the rise in premiums. Then, I think the drain on MediSave will be quite significant. But it is something we will have to monitor. Dr Lim asked a couple of questions on MediShield Life, private insurance as well as premium. Let me put it straight. What I just announced and talked about is to reduce healthcare cost. Healthcare cost is increased not just because of insurance premium. It has an impact mostly because hospital bills, especially for significant episodes, are getting larger and increasing year by year. Therefore, if we want to control healthcare costs for the families, we need to raise claims limits. That is the whole purpose of this exercise. Increase the claim limits of MediShield Life, which means it is for subsidised patients when they have a major healthcare episode. Increase the claim limits, so that healthcare cost for them is manageable. Of course, this comes with an impact on MediShield Life premiums.”
“The definition of "urgent care" is actually standardised and practised. We have a nomenclature P1, P2 which are considered urgent; P3 onwards not so urgent and it goes up. So, therefore, this is based on a standard definition, and so P3 and above is 40%. I do not have the number on whether it is stable. I am hoping it has come down over time. But we had a pandemic in between. So, even if it is tracked over time, it may not be representative. But we are doing what we can educating the public, having UCCs, having GPFirst programme to reduce this number. So, our concerns still stand, that the worry is that with dynamic information, we are encouraging more P3s, non-urgent, from coming to EDs. Sometimes, when the ED has a breather, maybe we should just let the doctors and nurses have a breather. So, we remain to have a concern. But as I said, we are not rejecting the suggestion, but we always had this concern. As for bed waiting time beyond median, whether we can indicate 75th, 90th percentile, the issue remains this: that if there is urgent care needed, it will be given almost immediately, without delay, at the ED if possible. But I take Mr Singh's point that it is not the most comfortable place. The lights are on. There is a trolley bed, but it is not a proper ward. So, we will have to prioritise. Those who need urgent care in the ward, we will give them immediately. So, it is not just a matter of waiting time. The urgency and the clinical needs of the patient play a big part as well. On overstayers, actually I have addressed that question. We used to have about 300 overstayers at any point in time. It has come down to 200, but there is still room for improvement.”
“And more importantly, by building better health through Healthier SG, we achieve all three aims at the same time and enable people to lead longer, healthier and more meaningful lives. Healthier SG is not a Government programme or a financing scheme. It is a movement for Singaporeans, a new way of life, a new compact between people, the community and the Government. We may not have broken the iron triangle to open a straight and easy line to good health. But we have made a good start and carved our own path to achieve greater happiness and probably prosperity, depending on how you look at it, for ourselves, our families and our nation. [Applause.]”
“That was when Cynthia found out that she might have breast cancer and it was later confirmed through a biopsy. Fortunately, it was discovered early. She has since gone through an operation to remove the tumour and no further tumours were discovered in her body. Cynthia is now resting and undergoing treatment. She is in good spirits. We wish her all the best. She wants me to tell everyone – please push for Healthier SG in your communities. You know how persistent Cynthia can be when she calls for action, because it can change lives and it can save lives. The UK Legatum Institute ranks healthcare systems in the world in a holistic manner. They do not just take into account of your doctor to population ratio or your healthcare capacity, or what kind of state of the art equipment you use, but they also evaluate population health and preventive care systems. They ranked Singapore as having the best healthcare system in the world in 2023. This is a valuable vote of confidence in our system. It encourages us to improve and do better. It is said that there is an unbreakable iron triangle in healthcare. The three aims in healthcare: affordability, quality and accessibility. They are also trade-offs, such that improvement in one area always comes at the expense of the other two areas. I have outlined how, by using MIC@Home and right-siting, we can increase capacity without necessarily building more hospital beds. In other words, improve accessibility, without compromising quality of care. By weaving insurance and co-payment, we reduce out-of-pocket payment for patients, while containing excessive demand for healthcare. Hence, improving affordability, without undermining accessibility.”
“But what is more important for the long term is capacity expansion in communities and society, in its ability to prevent sickness and build health. We are doing so via Healthier SG, and we are starting to see a change. More residents are coming forward to exercise, cycle, run or brisk walk. People are watching their sugar intake. Sodium takes a while more. Food and beverage (F&B) players are switching to lower-sodium salt. Christine Lock, who sells nasi lemak, she was the first to do so at Bukit Canberra Hawker Centre. She did so voluntarily, because she had a loved one who suffered a heart attack. She said, "I want to take care of my customers." Film Director Jack Neo has started a brisk walking group for seniors, started during the pandemic. It is called "趴趴走". In English, it means walking around for fun. His event is every week, and it will attract almost 1,000 participants, young and old, from all over Singapore. If they descend on one of your communities, you will immediately notice. A thousand people gathering somewhere. For them, brisk walking has become a new habit, and they made new friends. Jack and his team even composed a song about "趴趴走" and incorporated messages of Healthier SG. They did not consult me. So, when I joined them two weeks ago, everyone sang the song. Everyone knew the song except me. Let me also share the story of Ms Cynthia Phua. Many Members will know her, she was a former Member of Parliament. She agreed to let me share her story with you today. She enrolled into Healthier SG late last year, with a GP clinic near her home. The GP noticed that she had not done a mammogram for three years. So, repeatedly reminded her to do. Eventually she did, late last year.”
“This is, in fact, a key aspect of the transformation we are striving for. Whereas sickness often needs to be treated in clinics and hospitals, health almost exclusively has to be built up in communities and in our homes. MOH has been working on this transformation and we have made a few strategic policy changes over the last couple of years. Patient data needs to flow across care delivering settings, from hospitals to clinics, to senior care and rehabilitation centres. This piece of work is almost done. What remains is a new law, which I hope to table in this House in the later part of this year. Regulation needs to move from being premises centric to services centric. So, we do not regulate hospitals or clinics, but the services delivered, regardless of settings. That is why we revamped our legislation to enact the new Healthcare Services Act (HCSA). Financial support needs to be settings and premises neutral. But we cannot simply apply this based on first principles, as it is bound to lead to abuse and unintended behaviour. Instead, we progressively identify the situations and circumstances where premises-neutrality should apply, and then make deliberate rule changes. We made a few changes last year on the mutual recognition of MediFund and extension of MediSave support to manage chronic illnesses via telehealth. This year, I just announced further moves on community hospitals, MIC@Home and MediSave support for telehealth. Most importantly, we need to be decisive and deliberate in making investments in preventive care and health of our population. We often hear calls for investment in hospital capacity, in our medical manpower. This is valid.”
“Together they represent over half of the coffee shops in Singapore, and they intend to start serving "siu dai" or less sugar beverages by default. This means when you order a kopi in future, they give you "siu dai", even though you do not say it. If you want even less sugar, I recommend just drink "kosong". Sodium is the other culprit that can lead to heart diseases and strokes, if over-consumed. It is found in salt, soya sauce, belachan and other sauces. With much effort from the HPB, over 60% of wholesalers of salt are now supplying lower-sodium salt. About 30% of the catering industry are supporting our "Less Salt, More Taste" movement since it was launched late last year. 20% of the food and beverage industry are also doing so. I recently saw an encouraging programme on Channel 8. There were two lady hosts, they went on a 21-day challenge to take less salt and less soya sauce. At the end of the 21 days, their blood pressure measurements had moderated somewhat, but more importantly, their taste buds had become much more sensitive to salt. They could now taste the ingredients better, they never knew when they taste something, there are undertones of garlic, ginger, spices. They used to just taste soya sauce and belachan, and they prefer to eat less salt now. It took 21 days to change a lifelong habit. Remember, because we eat every day, the effect of food accumulates through our lifetimes. Over our lifetimes, food can be medicine, food can also be poison. As a wise traditional chinese medicine (TCM) physician once told me, if you eat well, there is no need for medicine; if you do not eat well, medicine is of little use. Mr Chairman, Dr Tan Wu Meng urged that healthcare needs to be delivered across time and space, which we agree.”
“Currently, your enrolled doctor will co-develop a health plan with you as part of the preventive care consultation. It covers essential action items, such as regular health screening and vaccinations. But on the lifestyle, the advice is always quite generic, such as "exercise more", "eat better". In 2024, we will start to make the advice more specific. For example, it may recommend you do aerobic exercise three times a week. You can then use the Healthy 365 app to identify suitable exercise activities near your home. Key features in Healthy 365 will be made multilingual. Third, we will continue to roll out interventions for our seniors through the Age Well SG programme, which Second Minister Masagos has elaborated. Fourth, we will continue to fight against overconsumption of sugar and sodium. Our Nutri-Grade labelling of pre-packaged drinks have been useful in changing consumer behaviour. I will regularly and personally inspect the drinks in the Members' Room. Some of you saw me do it. [Laughter.] I am glad to report they are all graded "A" and "B", and passed the MOH Ministerial inspection. There is one drink, however, "zero sugar salty lychee". So, I texted my staff to say what do we label this for? For sugar or for sodium? They told me to just drink it. I also encountered students who are asking for less sugar in their bubble tea, so that it qualifies for Nutri-Grade "B". As the Minister for Education, I always tell students, do not be so grade conscious. But in this case, it is good to be grade conscious and go for "A" and "B". We have recently extended Nutri-Grade to freshly made beverages. I met the two key coffee shop associations recently and sought their support. The association leaders are fully on board.”