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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“Individuals referred to the Institute of Mental Health (IMH) by the police for further assessment under the Mental Health (Care and Treatment) Act are attended to quickly and there is no significant wait. For other referrals, the mean and median waiting time for new subsidised psychiatrist appointments at IMH for each of the past five years are shown in the table below. IMH employs a triage system to ascertain the urgency of the conditions of patients. Those with conditions which are more severe or who require more urgent assistance are given earlier appointments. IMH also supports various service providers in managing individuals with mild to moderate symptoms in the community to ensure that individuals with mental health needs have prompt access to appropriate care.”
“This question has been addressed in my reply to Question No. 46 to 49 for written answers on the Order Paper for 6 November 2023. [Please refer to "Mental Health Insurance Coverage", Official Report, 06 November 2023, Vol 95, Issue 115, Written Answers to Questions section.]”
“My response will also cover the matter raised in the question by Miss Rachel Ong1 who filed a Parliamentary Question which is scheduled for a subsequent Sitting. Age Well SG is a national programme to encourage seniors to lead active lifestyles and stay socially connected in communities. This is critical to ensure their well-being and stave off sickness. The Ministry of Health will be expanding and improving Active Ageing Centres (AACs) in communities to achieve this. AACs are to organize a wide range of activities and volunteering opportunities that meet the interests of all seniors. However, AACs can succeed only if it collaborates with all community partners, including grassroots organisations, the Health Promotion Board and various associations and groupings on the ground. Indeed, our experience has been that it is more difficult to persuade male seniors to participate in community activities and stay active. To increase their social participation rate, AACs organise activities like communal meals, group walks, pool playing and guitar jamming which tend to attract a larger male following. Initiatives like Silver Clubs will be very useful and very welcomed.”
“National Healthcare Group Polyclinics will be carrying out renovation works at Hougang Polyclinic in early-2024. The polyclinic will remain operational during these works and efforts will be taken to minimise disruption. The works involve adding additional capacity to meet the medical needs of patients and is targeted to complete by the second quarter of 2025.”
“Our mental health professionals need to be able to manage patients who are struggling with their sexual orientation or gender identity, in a clinically appropriate and also sensitive way. In this regard, the Ministry of Health has put in place two key measures to support mental health professionals. Firstly, education and training. For example, psychiatrists-in-training undergo residency teachings and discussions and clinical training that enable them to practise effectively as psychiatrists and care for a wide spectrum of persons needing care. This includes patients who might identify as LGBT and are diagnosed with Gender Dysphoria or other mental health co-morbidities such as Mood Disorders. Secondly, we have developed a set of best practice guidelines for professionals working with such individuals. These guidelines have been developed for Counsellors and relevant professionals working with youth on sexual orientation issues. The last update was 2015 and we are in the process of updating it further, in consultation with relevant professionals in the fields of Psychiatry, Psychology, Counselling and Social Work.”
“The Interagency Taskforce on Mental Health and Well-being recently launched Singapore's National Mental Health and Well-being Strategy, following a comprehensive review of cross-cutting issues requiring multi- and inter-agency efforts to tighten the nexus between healthcare interventions and social support for various population segments. The Ministry of Health and the Agency for Integrated Care (AIC) had worked with the Social Service Agencies (SSAs) to establish 68 Community Outreach Teams (CREST) that raise awareness on mental health and identify individuals, including seniors, with mental health needs and provide basic emotional support and service linkages to other parts of the ecosystem according to their needs. Active Ageing Centres (AACs) are community nodes for seniors and if the AAC staff come across seniors with mental health needs, they too will refer such cases to CREST teams. We understand that some seniors experiencing mental health issues may be reluctant to seek help or accept support due to stigma. Should the Silver Generation Ambassadors come across these seniors during their home visits, they would share about mental health resources in the community and encourage them to seek help.”
“As announced earlier, the Ministry of Health (MOH) plans to table the Health Information Bill to Parliament in the coming months, to mandate the contribution of key selected health information by licensed healthcare providers to the National Electronic Health Record (NEHR). If it passes, from end 2025, MOH will phase-in the requirement for licensed healthcare providers to start submitting to NEHR. A perennial obstacle to mandate contribution to NEHR has been that private healthcare providers do not have NEHR-compatible IT system. MOH has rolled out the Early Contribution Incentive scheme since December 2022, which provides one-time funding support to licensees to defray the cost of upgrading and integrating their IT system with the NEHR.”
“The Ministry of Manpower provides more work passes on flexible criteria for sectors facing urgent needs, in consultation with the relevant agencies, such as in healthcare, where demand cannot be fully filled by our local workforce. These healthcare professionals are also required to meet the standards for practice in Singapore. Beyond hiring more manpower to support mental health services, we need to strengthen support in the community by tapping on frontline personnel and volunteers, as well as building up the competencies of existing service providers to better care for persons with mental health needs. That is why we have introduced the Tiered Care Model under the National Mental Health and Well-being Strategy to better organise mental health services across the health and social sectors, according to the severity of individuals' mental health needs. This will lay the foundation for further strategic enhancements to the mental health ecosystem and improve access to care.”
“In general, with an ageing population and higher patient load post COVID-19 pandemic, there is a general healthcare capacity crunch around the world, including in Singapore. It is both in terms of physical facilities, like hospital beds and stepdown care and also manpower, including nurses, pharmacists and allied health professionals. To overcome manpower shortages, the Ministry implements a range of measures. This includes expanding our local training pipelines, introducing recruitment incentives, keeping remuneration competitive to reduce attrition, developing upgrading pathways for in-service staff or mid-careerists and augmenting our workforce with suitable foreign manpower, as well as redesigning healthcare job roles to make the work more meaningful. To improve working conditions in our public healthcare institutions, we have adopted a zero-tolerance approach towards harassment and abuse and implemented measures to improve staff well-being.”
“I thank the Member for asking all these questions on behalf of your Clementi residents. [Laughter]. It is, right? He did not say that? Okay. But I thank the Member for the persistence and I know Dr Tan Wu Meng has been knocking on this door for a long time. Like all policies, it takes time for us to look at it and find ways to implement it in a way that everyone can accept. So, I think persistence does pay off and I know Dr Tan has also been equally persistent in asking for the elderly who are immobile, in terms of the portability of their subsidy as well of their MediFund eligibility. These are valid suggestions. We will have to look at them. One way is to go digital and make things easier, but that also introduces its own impediments. But it will be a useful channel for the immobile or home-bound patients to also apply for medical and financial assistance. The other is that we have now implemented Healthier SG and also Age Well SG with a whole network of active ageing centres (AACs) throughout our communities. We want to double the number, expand the network, deepen the kind of help they can extend to our aged residents. So, they can also be a channel from which I would not rule out that, in time to come, they can also be a channel for us to guide our aged and seniors to apply for assistance there. So, these are all the possibilities. We will take them in. Persistence does help. So, keep on putting forward such suggestions to us.”
“The second change is a mutual recognition arrangement within the same healthcare cluster for outpatient treatment. For example, if a patient is receiving MediFund at an outpatient institution, say, a polyclinic, and he goes to another MediFund institution within the same healthcare cluster, say, a specialist at a Specialised Outpatient Clinic, he will automatically receive support from MediFund and does not need to re-apply for his outpatient bills another time. This automatic support will be valid for a year from the time MediFund is first extended to him at the outpatient setting. Last, more support for ComCare graduates. Today, MediFund assistance is automatically extended to needy patients who are under ComCare assistance. MediFund assistance is withdrawn when the patients graduate from the ComCare scheme. So, there is a bit of a cliff effect. So, to strengthen support for these ComCare graduates on their journey to self-reliance, MediFund support will continue for three months after graduation from ComCare. I should clarify that under the law, MediFund Committees of each healthcare institution continue to have full discretion over the application outcome and extent of support, to prioritise support towards those who need it the most. Notwithstanding, MOH has been engaging them to agree to support the changes that I just mentioned. MOH will be issuing these guidelines to the MediFund Committees. These enhancements should help smoothen the experience for MediFund beneficiaries as they transfer or seek care in different healthcare settings, and we expect them to come into force by March 2024.”
“Sir, around 30% of the MediFund beneficiaries received MediFund assistance from more than one institution within the same public healthcare cluster, and around 40% received MediFund assistance from more than one institution across public healthcare clusters. The Ministry of Health (MOH) has devolved MediFund approvals to the MediFund Committees of individual healthcare institutions. This is to enable the Committees to exercise greater discretion in assessing MediFund applications and, thereby, improving their accessibility to these funds. However, this also inevitably leads to multiple assessments for the same patients across institutions: you transfer from acute hospital to community hospital, you go through one more round of assessment, and that adds to their inconvenience. We need to strike a balance between these two objectives of flexibility and convenience. In line with that, MOH has reviewed the MediFund application process to make it more seamless with limited impact on the flexibility and discretion of the MediFund Committees. And we will be implementing the following changes by March 2024. First, a mutual recognition arrangement between acute hospital and step-down care. This means that when a patient benefiting from MediFund is transferred from an acute hospital to step-down care, he or she will continue to benefit from MediFund without having to re-apply again. As the medical bills, social and financial circumstances of patients may vary over time as they transfer from one institution to another, this automatic extension of MediFund will be for three months or until the receiving institution reassesses the patient’s eligibility for continued MediFund assistance.”
“The total number of visits made to psychologists in the public hospitals for each of the last five years are shown in the table below. The Ministry of Health (MOH) does not track the number of visits made to private mental health providers. MOH does not track the consultation costs for private psychologists and counsellors.”
“The Ministry of Health does not track data on the number of or the subsidies utilised by CHAS cardholders who are persons with special needs. In general, healthcare subsidies are provided based on the medical conditions of the patient and tiered based on their income level, so that more help can go to the lower-income.”
“All Singaporeans and Permanent Residents are covered under MediShield Life (MSHL). MSHL provides coverage for hospitalisation, including inpatient mental health treatments and selected costly outpatient treatments. Integrated Shield Plans (IPs) and other private health insurance plans offer optional coverage on top of MSHL. Today, all IP insurers offer plans that cover inpatient mental health treatment, with varying claim limits. Coverage, underwriting decisions and premiums are subject to insurers’ actuarial and commercial considerations. Insurers assess risks based on reliable information relevant to the risks being insured, which may include medical reports, clinical surveys or studies. Insurance is useful for financing costly but low-incidence treatments. For outpatient treatments that are more frequently accessed and less costly, for example, treatment for chronic diseases, such as diabetes, hypertension and mental health conditions, insurance may be less useful. Instead, individuals may tap on subsidies and MediSave. If one is still unable to afford their mental health treatment despite Government subsidies, insurance and MediSave, MediFund is available at public healthcare institutions as a safety net to assist needy Singaporeans. The Ministry of Health will continue to regularly review our financing schemes to keep pace with evolving medical practice and patient needs.”
“The recent data breach by the Academy of Medicine Singapore (AMS) did not affect Ministry of Health (MOH)’s operations and data security, as there are no system connections nor Government data shared between MOH and AMS. The incident was reported to the Personal Data Protection Commission Singapore and investigations are currently ongoing.”
“Since October 2022, the Claims Management Office (CMO) has adjudicated 32 claims, and another 70 are currently being adjudicated. Out of the 32 claims processed, 29 were assessed by relevant panels of specialists from the public and private sectors to be inappropriate and which amounted to about $400,000. Where inappropriate claim behaviours are found, the Ministry of Health (MOH) will take required enforcement action under the terms and conditions of the MediSave MediShield Life Schemes. For serious cases, providers may also be referred to the Singapore Police Force for further investigation or to the Singapore Medical Council for professional or ethical breaches. MOH and the Monetary Authority of Singapore (MAS) do not track the number and quantum of Integrated Shield Plan claims that have been denied by insurers. MAS requires insurers to be fair in their treatment of policyholders. Policyholders who feel that their claims have been wrongfully denied can seek recourse with the Clinical Claims Resolution Process and the Financial Industry Disputes Resolution Centre.”
“As of October 2023, there are a total of 66 licensed day surgery centres in the public and private sector. The annual number of surgeries and procedures performed at day surgery centres has risen from 509,000 in 2019 to 565,000 in 2022. All surgical procedures, including minimally invasive procedures, should be performed in an appropriately equipped day surgery centre, as long as the patient is assessed by a competent doctor to not require a hospital admission for perioperative monitoring and care and is not at high risk of post-procedural complications.”
“As part of the Ministry of Health's efforts to extend preventive health to the population, community functional screening was launched nationwide in 2018. Called Project Silver Screen (PSS), it is available to all Singapore Residents aged 60 and above, at a cost of $5 or less. Excluding the COVID-19 years when the programme was suspended, on average, about 28,000 seniors participated in PSS each year. The number and proportion of Singapore Resident seniors who were prescribed assistive devices and purchased assistive devices from 2019 to 2022 are as follows: We provide each senior who requires assistive devices with a voucher of up to $200 per set of device, regardless of household income. This is over and above Government support, such as the Seniors’ Mobility and Enabling Fund, for eligible seniors. We do not have the breakdown of actual Government subsidies provided based on assistive device type. We will continue to work with our partners to encourage seniors to participate in PSS and facilitate the take-up of required assistive devices.”
“Dedicated calm or quiet spaces have been set up in several places, such as the National Gallery, National Library branches, dementia day care centres and the Institute of Mental Health (IMH), as an adjunct measure to provide a private and safe space for individuals to calm down. In our dense urban environment, through land use planning and building codes, we have ensured that there are public places of peace and quiet available for all to take a moment to relax and seek calm. There are no plans under the Strategy to introduce public "calm spaces" dedicated to a single client group, but we welcome such ground-up efforts to promote mental well-being. All of us play a part in improving the mental health and well-being of our population.”
“Traditional Chinese Medicine (TCM), being holistic by nature, can play an important role in preventive health. To this end, we have been discussing with members of the TCM Practitioners (TCMP) Board as well as the wider TCMP community on how TCMPs may better support Healthier SG. This will involve strengthening its self-regulatory regime, and qualifying certain TCM clinics or practitioners, to participate in Healthier SG and deliver lifestyle or social prescriptions. The Ministry of Health will announce details when they are ready.”
“Patients who fail to attend their appointments will be checked on and followed up with phone calls. Higher-risk patients will be assigned designated case managers to closely monitor their appointment and treatment adherence. If required, IMH staff will perform a home visit. Patients who are required by law to undergo treatment at IMH may be admitted mandatorily for inpatient management if they default on their appointments and fail to adhere to the outpatient treatment plan.”
“Delirium refers to an acute and sudden change in brain function that causes a person to appear confused or disoriented or to have difficulties maintaining focus and thinking clearly, typically with a fluctuating time-limited course. This is unlike dementia where the onset is generally slow, chronic and progresses over years. Delirium can be the result of many different causes, including medical conditions, infection, recent surgery and certain medications. The Ministry of Health does not track the number of patients with delirium. Studies show that delirium occurs in about 10% to 30% of elderly patients admitted to hospital for acute medical problems. The key measures to manage delirium are to treat the underlying medical illness that may be causing it and to address factors known to aggravate delirium, such as pain, dehydration and certain medications. Patients with delirium generally improve and recover when the underlying cause of delirium has been treated.”
“Currently, about 80% of our population have achieved minimum protection of at least three doses of COVID-19 mRNA vaccines. For persons aged 60 and above, about half have received an additional dose beyond minimum protection. The protection from vaccines wane over time. As COVID-19 has become an endemic disease, it is more important that seniors and medically vulnerable individuals keep their vaccination up to date, that is, taking a booster around once a year, to reinforce their own protection. As COVID-19 is a relatively new disease, we will continue to study its disease characteristics and vaccination recommendations, before considering it for the national immunisation schedules which are stable long-term recommendations.”
“The primary mode of enrolment to Healthier SG is via SMS invites. Healthier SG ambassadors are deployed to assist our elderly residents who may be less tech-savvy or without smart devices. Over 500 Healthier SG ambassadors are deployed across 136 locations, including community clubs, polyclinics and Joint Testing and Vaccination Centres. They are also deployed at Healthier SG roadshows and community events. Besides assisting seniors in enrolling with their preferred Healthier SG clinic, the ambassadors address queries on Healthier SG and direct residents to social activities in their precinct. As we progressively complete our roadshows and more seniors progressively enrol in the months ahead, the Healthier SG ambassadors will be redeployed to focus on community outreach activities, polyclinics and selected community clubs. These will include constituency-level health and sports events.”
“We do not track the time taken for medications to be dispensed to newly admitted patients at public hospitals. Patients will be triaged and managed by healthcare staff in a timely manner, according to the urgency of their conditions. Medications will be dispensed and administered expeditiously, after the doctors have reviewed and assessed the patients and sent the medication orders. This first assessment by a doctor is important to establish present diagnoses as well as medical history of newly admitted patients, taking into account existing medications, allergies, potential side effects and drug interactions before prescribing appropriate medications as part of the treatment plan. Working in collaboration with doctors, trained Advanced Practice Nurses who are certified collaborative prescribers are empowered to prescribe medications for the patients within their care.”
“It is important to note that the COVID-19 virus is not a mild disease. We are able to live with it as an endemic disease because we have become more resilient due to vaccinations and safe recovery from infection. However, protection will wane and it is important to keep up vaccinations to maintain our resilience, especially for vulnerable individuals and seniors. Nevertheless, demand for vaccine have been falling and the scale of our vaccination operations will need to adapt to this reality, while retaining the ability to scale up capacity should the need arise.”
“Healthcare subsidies are means-tested using per capita household income (PCHI) to account for the overall financial resources of the household to support the household members. This helps to ensure subsidies are targeted at those who need them the most. Elderly or retired persons living with their family may be means-tested into a higher PCHI tier. This is because the PCHI framework recognises that such seniors are likely to have access to financial support from family members in the same household. At the same time, these family members may also receive higher subsidies compared to those who have no elderly dependants, as the PCHI framework similarly recognises that they are supporting their elderly household members. We recognise that PCHI may not adequately proxy the family circumstances of some patients. Those who face difficulties in paying for their healthcare expenses after subsidies, MediShield Life and MediSave may apply for discretionary financial assistance, such as MediFund, at public healthcare institutions, where a broader set of factors beyond PCHI, would be considered.”
“The 2016 Singapore Medical Council Ethical Code and Ethical Guidelines (ECEG) set out the components of informed consent for medical procedures involving minors. The relevant principles in ECEG are consistent with international best practice standards, including having parents or legal guardians being adequately informed about the risks and benefits involved in a particular procedure. At the same time, ECEG also makes clear that if a parent or legal guardian objects to a procedure that is medically necessary, the doctor must act in the best interest of the child and not the parent or legal guardian. Separately, each licensed provider under the Healthcare Services Act 2020 must also establish and implement an appropriate system to obtain informed consent that is in line with prevailing laws and ECEG.”
“The Rare Disease Fund (RDF) is a charity fund where the Government matches donations 3-for-1. As at end-FY2022, the size of RDF was $143 million. For FY2023, the RDF’s projected investment income and expenditure for existing RDF beneficiaries are $4.8 million and $2.4 million respectively. Expenditure is often lower than income because new treatments are only listed for RDF coverage if the projected investment income is adequate to support all known patients requiring that treatment. While RDF predominantly operates as an endowed fund that relies on investment income to support beneficiaries on lifelong, high-cost treatments, its coverage was recently expanded to include Cell, Tissue and Gene Therapy Products (CTGTPs) which are higher-cost one-off treatments. For CTGTPs, donors can specify that the principal sum of their donations can be drawn down. The RDF Committee will evaluate each CTGTP application on a case-by-case basis, taking into consideration the circumstances of each patient and fund availability.”
“The Department of Sexually Transmitted Infections Control (DSC) Clinic suspended its Women’s Clinic in February 2020, at the start of the COVID-19 pandemic, to create isolation facilities for patients. However, due to the attrition of female healthcare workers at the DSC Clinic, it became difficult to maintain a dedicated Women’s Clinic at DSC Clinic. Whilst the Women’s Clinic is not in operation, the full suite of the clinic’s services remains available. This includes a women-only care team comprising of female doctors and nurses. Female patients can request for the women-only care team at the point of registration. The DSC Clinic will continue to explore the feasibility of resuming the Women’s Clinic in the future.”
“Since the launch of Healthier SG in July this year, we have enrolled 15% of the eligible population. Among the ethnic groups, enrolment among Chinese was 16%, which is higher than the national average of 15%, with Malays and Indians at 11%. There was no significant difference in enrolment across genders. The Ministry of Health is working with various community groups, including the People’s Association, Singapore Indian Development Association and M3 (a collaboration among MENDAKI, MUIS and MESRA), to promote enrolment into Healthier SG.”
“The Singapore Medical Council (SMC) developed the Guidelines on Aesthetic Practices for Doctors (Aesthetic Guidelines) in 2008 and updated them in 2016. The guidelines regulate aesthetic practice by stipulating the types of aesthetic procedures that doctors are permitted to perform and the required competencies and qualifications to perform these procedures. These requirements are advised by the Aesthetic Practice Oversight Committee appointed by the SMC. In addition, all doctors are expected to abide by the SMC Ethical Code and Ethical Guidelines (ECEG), such as by practising within their own competence. The Ministry reviews the compliance of doctors to the Aesthetic Guidelines and ECEG during the audits of licensed healthcare institutions. The Ministry and SMC work together to periodically review the Aesthetic Guidelines, with the next review scheduled to complete in 2024.”
“The attrition rates of doctors in the public healthcare sector have generally been stable over the years. In the last three years, it ranged from 3% to 5%, with attrition rates of specialists being generally lower. At this rate of attrition, there is a net inflow of doctors into the public healthcare system. Based on exit interviews, the top three reasons cited by doctors leaving the public healthcare sector were personal factors, better career prospects and moving back to home country. To retain our doctors, our public health institutions will continue to ensure that doctors' remuneration remains competitive, their well-being is taken care of and there are good career prospects and personal development. Many good doctors also decide to stay in the public healthcare sector because of its meaningful contribution to nation and society.”
“Social connectedness is a major social determinant of health. As part of supporting ageing in communities, the Ministry of Health is stepping up efforts to combat social isolation and draw seniors out of their homes to keep them socially connected. Battling social isolation is a multi-pronged effort that involves different public and community agencies. The Silver Generation Office (SGO) under the Agency for Integrated Care is prioritising outreach to seniors who are living alone. Through these outreach efforts, SGO better understands the needs of these seniors and connects them with relevant support or services. Seniors requiring social support will be referred to community partners, such as Active Ageing Centres (AACs), which provide a suite of services. Seniors at greatest risk of social isolation will be offered befrienders or buddies who check in on them regularly. Seniors can participate in a diversity of active ageing programmes across different domains, which can help them forge connections with others and keep them from falling into social isolation. Apart from the AACs, seniors can participate in activities offered at Community Clubs/Centres, Residents' Committee/Residents' Network Centres and join interest groups under the People's Association. SportSG's SportCares also works with community partners to engage isolated seniors living in and around rental blocks through simple morning exercises. For seniors who are willing and able, they can approach SG Cares Volunteer Centres located across Singapore to explore suitable volunteering opportunities. Regular participation in such activities and programmes serves to build stronger community bonds and social support networks for seniors.”
“Based on Singapore Police Force's (SPF's) data in 2022, about 10,000 youths aged 10 to 29 were victims of scams in 2022. SPF and the Ministry of Health do not track the number of youths or young adults who actively seek help after they have been scammed. The SPF's Victim Care Cadre programme provides support to affected victims, including scam victims. Police would activate volunteer Victim Care Officers (VCOs), who work with the Police Psychological Services Department to provide psychological first aid. Where necessary, the VCOs would direct victims to available community and professional resources for longer-term psychological and financial support. Youths and young adults with mental health needs can seek help from Youth Community Outreach Teams, Youth Integrated Teams and Community Health Assessment Teams. In schools, students with mental health issues may seek help from school counsellors and be referred to the Response, Early Intervention and Assessment in Community Mental Health teams if needed.”
“Our newer public hospitals are designed for natural ventilation. There are good reasons to do so, from an infection control and cost perspective. This means ensuring adequate air flow through the naturally ventilated areas by optimising building orientation and ward layout and minimising heat gain in the building. They meet Green Mark Platinum standards which have strict requirements to ensure thermal comfort. Older hospitals have progressively implemented mitigating measures, such as spot-cooling, to lower the ambient temperatures when they are remodelled or renovated. In addition, all hospitals take additional measures when the environmental conditions warrant them, such as deploying additional fans, portable air coolers and air purifiers, in the event of a sustained severe haze or heat wave. We do not have specific information on the cost to provide air-conditioning for all B2 and C Class wards in public hospitals. The Ministry of Health will continue to work with the public hospitals to review and implement measures to enhance the ventilation of existing facilities, balancing affordability, infection control and the users' thermal comfort.”
“The KK Women's and Children's Hospital (KKH) and the National University Hospital (NUH) had each seen a handful of postnatal post-traumatic stress disorder patients per year. This translates to a very small percentage of the total number of childbirths in these hospitals. In KKH and NUH, healthcare professionals are trained to identify and manage mental health issues in pre- and postnatal patients. Since 2020, KKH has been providing trauma focused psycho-emotional assessment and interventions for women, including those with pregnancy- and birth-related trauma. Meanwhile, NUH routinely screens pre- and postnatal patients for mental health issues.”
“Based on the National Population Health Survey, the estimated age-standardised prevalence of chronic kidney disease (CKD) among Singapore residents was 7.3% in 2019 to 2020 and 11.4% in 2021 to 2022. We can reduce the incidence of CKD by tackling the risk factors, namely, diabetes, hypertension, cardiovascular disease and obesity. These risk factors are strongly influenced by our lifestyles, which is why the Health Promotion Board has been implementing programmes that encourage physical activities and reduce sugar consumption. Healthier SG will further strengthen existing preventive care efforts to promote healthier lifestyles, screening participation and management of chronic conditions, including CKD.”
“Mobile Inpatient Care at Home (MIC@Home) is implemented in all public hospitals in a limited way, only for patients in General Medicine where their conditions are suitable for management at home. Patients are provided with appropriate clinical monitoring equipment, such as blood pressure monitors, and are trained to use the equipment at home. Hospital care team does daily check-ins via tele-consultation to ensure compliance with treatment plans and medications and, if necessary, conduct an in-person visit for physical assessment or to provide necessary treatment. We are exploring the possibility of scaling up MIC@Home, including to other patient types, such as patients on palliative care, paediatric patients and gynaecology patients.”
“All doctors working in our public healthcare institutions (PHIs) are given an information technology (IT) account to access the Electronic Medical Records Systems. This is primarily for doctors to access patient records to perform their clinical duties, such as ordering medication and documenting treatment plans. Around 90% of new junior doctors typically have their accounts set up on the first day of work. However, this may take up to two weeks for some new junior doctors during surge periods, where more than 1,000 new junior doctors participate in the House Officer and Medical Officer posting exercises in January, April and July each year. Pending the creation of their IT accounts, junior doctors will be supported by their clinical team members who have IT access to ensure that patient care is not compromised. Synapxe, the national HealthTech agency, has been working with PHIs to automate and reduce the processing time to create IT accounts, which will be progressively rolled out starting next year.”
“Currently, MediSave can be used for treatment expenses incurred at any MediSave-accredited hospital, even if the patient is subsequently transferred to another hospital. Such instances will be treated as a single episode for which the relevant MediSave and MediShield Life claim limits apply.”
“Our financing schemes remain adequate for subsidised Assisted Conception Procedures (ACP). To support affordability of ACPs, Government co-funding of up to 75% is available at public Assisted Reproduction centres, with MediSave withdrawals limits of up to $6,000 per cycle. A lifetime withdrawal limit of $15,000 per patient is also in place to avoid premature depletion of MediSave balances towards ACPs. After co-funding and MediSave usage for the first ACP cycle, eight in 10 eligible Singapore Citizen (SC) couples would incur no out-of-pocket expense, while nine in 10 eligible SC couples would pay no more than $500. The Ministry of Health (MOH) will continue to monitor the affordability of ACPs and review our financing schemes if necessary.”
“This question was addressed in the reply to Question Nos 6 and 7 for Oral Answer on the Order Paper for 19 September 2023. [Please refer to "Revision to Advisories on COVID-19 Vaccinations and Other Measures", Official Report, 19 September 2023, Vol 95, Issue 112, Oral Answers to Questions section.]”
“More than 270 private clinics are accredited to submit MediSave claims for mental health treatment under the Chronic Diseases Management Programme (CDMP). Singaporeans may refer to the Mind Matters Directory Listing on the Agency for Integrated Care’s (AIC) website for some MediSave-accredited clinics offering mental health services. This listing is being progressively expanded to include more clinics that offer MediSave claimable mental health services. Depending on the complexity of their condition, individuals can use up to $500 or $700 from their MediSave annually for outpatient treatment of common mental health conditions under CDMP, comprising schizophrenia, major depression, bipolar disorders and general anxiety disorders. The current MediSave withdrawal limits remain sufficient for most individuals. In 2021, more than eight in 10 individuals who made MediSave CDMP claims for mental health treatments did not exceed the annual limits. The MediSave withdrawal limits will be reviewed regularly to ensure they remain adequate.”
“This question was addressed in the reply to Question Nos 20 and 21 for Oral Answer on the Order Paper for 19 September 2023. [Please refer to "Insurance Coverage for Individuals with Mental Health Conditions", Official Report, 19 September 2023, Vol 95, Issue 112, Oral Answers to Questions section.]”
“In 2022, the Singapore Medical Council (SMC) received an average of one complaint per month for alleged medical negligence by registered medical practitioners in the public sector hospitals. All these complaints were investigated, most of them involved complex cases, and the SMC was satisfied that there was no negligence on the part of healthcare workers. There were no such complaints received by other Professional Boards. The patient intake is well spread out across regional hospitals. However, it is higher at the National University Hospital, Singapore General Hospital and Tan Tock Seng Hospital, due to their higher patient loads and the complex cases they manage.”
“Artificial intelligence (AI) and precision medicine are all major technological breakthroughs that can potentially transform healthcare. Some of the use cases promise to deliver greater cost efficiency and clinical effectiveness. Other potential uses are less straightforward. There may be a promising new precision medicine which may work only on certain individuals and cost significantly more. Having said that, the healthcare sector is characterised by very tight regulation. In Singapore, any new technologies, including the use of AI, are regulated by the Health Sciences Authority (HSA) as medical devices if they diagnose, manage or treat medical conditions. For example, clinical genetic and genomic services will be regulated as part of the Healthcare Services Act in end 2023. Patient data, including genomic data, are already subject to laws and regulation that safeguard patients’ privacy. Many precision medicine technologies are still nascent, with many applications that are experimental in nature. The Ministry of Health (MOH) will continue to develop our governance framework and policies to ensure that we can deploy these technologies in healthcare in ethical and clinically and cost-effective ways.”
“The MediShield Life and MediSave withdrawal limits for hospitalisation expenses are periodically reviewed to ensure subsidised healthcare remains affordable for all Singaporeans. Currently, seven in 10 Singaporeans in subsidised wards do not have to pay any out-of-pocket expenses, while eight in 10 pay less than $100 cash. Limit adjustments to improve affordability will be considered at our next review in 2024.”
“In the second quarter of 2023, the median wait time for a new subsidised appointment at Singapore National Eye Centre (SNEC) is about three months. Waiting time at SNEC has been rising, due to the surge in demand of new subsidised cases following the COVID-19 pandemic and coupled with the attrition of eye specialists. When a referral is made from primary care providers, the central appointment centres of each Healthcare Cluster will assist patients to make an earliest appointment slot at a public hospital under the Cluster. Patients can also call the central appointment centre hotlines to check for earlier available slots. Most importantly, cases that are assessed to be urgent will be prioritised and given earlier appointments.”