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 data on the number of registered Speech and Language Therapists in Singapore in each of the last five years can be found in the Allied Health Professions Council's (AHPC) Annual report 2022 on AHPC's website: AHPC | Announcements (healthprofessionals.gov.sg). The average waiting time for the first appointment with a Speech and Language Therapist in the public healthcare system for each year from 2018 to 2022 is five weeks.”
“The Ministry of Health (MOH) measures the carbon footprint of public healthcare institutions through their direct and indirect emissions of greenhouse gases arising from fuel combustion and electricity consumption. However, MOH does not collect data on the impact of medical gas emissions on our carbon footprint. There have been ongoing efforts in recent years to minimise desflurane use where medically appropriate. In 2019, the proportion of desflurane use ranged from 28% to 68% across the different institutions. This has decreased to a range of 5% to 42% in 2022.”
“Through the Health Promotion Board's (HPB's) Healthier Dining Programme, 60% of stalls across all hawker centres and coffee shops have at least one healthier option on their menus as of December 2022. This healthier option may be either a lower-calorie meal, or is prepared using wholegrain staples, healthier oils or lower sodium sauces and seasonings. To encourage hawkers to adopt healthier cooking, HPB has facilitated easy access to healthier ingredients through HPB's Healthier Ingredient Development Scheme. Examples of healthier ingredients are wholegrain rice, wholegrain noodles, lower saturated fat cooking oils and lower sodium salt, sauces and seasonings. HPB also generates consumer demand for healthier options through regular events and rewarding purchases of healthier options through the Eat, Drink, Shop Healthy Challenge on the Healthy 365 application.”
“Oral health therapists (OHTs) have a wide range of career options. As their training incorporates the skills of dental hygienists and dental therapists, they are qualified to work in any dental clinic in the private or public sectors. They may choose to practise in general settings, such as school dental services and polyclinics, or in specialist settings such as national specialty centres. OHTs may also choose to take up non-clinical roles such as in education and administration. The Ministry of Health (MOH) is working to broaden the clinical scope of practice of OHTs to meet the demands of an ageing population. A training roadmap on new expanded clinical roles for OHTs will be introduced later this year to ensure that OHTs are competently trained and upskilled to provide oral health services across all ages and in a variety of care settings, including in community and residential settings. MOH also plans to explore the expansion of OHT career pathways to include other formal career tracks, such as in research and administration. There may be some OHTs who wish to go on to dentistry. To that end, the Nanyang Polytechnic's Diploma in Oral Health Therapy has been accredited for entry into the Faculty of Dentistry at the National University of Singapore since 2022, where eligible graduates from the diploma course may apply for further degree studies to become a dentist.”
“The zero-tolerance policy will include a common definition of abuse and harassment across healthcare institutions, an effective reporting and escalation protocol, practices for a supportive culture of reporting, and clear consequences that are implemented and enforced. As was announced previously, the Ministry will work with public healthcare clusters to develop the details of the standardised zero-tolerance policy in the second half of this year. There is no intention to pass this into law. However, healthcare workers will continue to be protected under the Penal Code and the Protection from Harassment Act, and we will not hesitate to report egregious cases of abuse to the Police for investigation. Legislation aside, it is critical to build mutual trust and respect between healthcare workers, patients and their caregivers. The Ministry of Health Holdings will be launching a national public education campaign to promote respect for healthcare workers and to align expectations of healthcare workers' roles. We call on the public to support these efforts to ensure that healthcare works can carry out their duties effectively in a safe and conducive working environment.”
“The AstraZeneca COVID-19 vaccine has not been authorised for use in Singapore.”
“It is more instructive to look at MediSave balances at the point of death for Singaporeans who lived till at least 85 years old. Otherwise, it will give a misleading picture of excessive MediSave savings. The requested data for those who passed away aged 85 or older has been provided in the reply to Question No 7 for Oral Answer on the Order Paper for 27 February 2023. [Please refer to "Balance in MediSave Amounts Following Death of CPF Account Holders", Official Report, 27 February 2023, Vol 95, Issue 87, Oral Answers to Questions section.] Nevertheless, if we want to examine the data for Singaporeans who passed away at a younger age, the median MediSave account balance of Singaporeans who passed away at aged 65 or older between 2017 and 2021 is about $9,900. Among these, about four in 10 had $5,000 or less, three in 10 had between $5,000 and $20,000, and three in 10 had more than $20,000 left in their MediSave accounts at the point of death respectively. Please note that this includes many Singaporeans who passed away before the average life expectancy, and who naturally will not have sufficient time to draw down on their savings.”
“The prevalence of myopia among primary school students has been stable at about 29% for Primary 1 students and 51% for Primary 4 students over the last five years. The Health Promotion Board will continue their existing efforts, such as the National Myopia Prevention Programme. Required regular outdoor time for preschoolers will continue. Children at high risk of high myopia will continue to be fast tracked for specialist assessment for myopia control treatment.”
“We expect COVID-19 waves to occur from time to time, similar to other endemic diseases. For the past month, we have been going through another COVID-19 wave. Although COVID-19 cases have been rising, estimated infection numbers are a small fraction of previous infection waves. Average weekly hospitalised cases are not high and the number of intensive care unit cases remain low. Several new Omicron subvariants are currently circulating in Singapore, but there has not been evidence of increased severity among recent new subvariants. The Ministry of Health continues to closely monitor the situation. We urge those with acute respiratory infection symptoms to wear a mask if they must leave home and reduce their social interactions, especially with vulnerable persons. Vulnerable groups, such as those aged 60 and above, immunocompromised persons and those living in aged care facilities, are strongly encouraged to receive a booster dose one year after their last booster dose.”
“The "War on Diabetes" is a multi-year effort. With longer life expectancy and an ageing population, the prevalence of diabetes and number of diabetics can be expected to increase if nothing is done. Based on the National Population Health Survey, there was a slight decrease in the crude prevalence of diabetes in adults, from 8.8% in 2017, to 8.5% in 2022. After adjusting for ageing effect in the population, a reduction in the age-standardised prevalence of diabetes, from 7.8% in 2017, to 6.8% in 2022 was observed. These statistics suggest some progress in blunting a hitherto increasing trend. The Ministry of Health will continue our efforts in tackling diabetes and monitoring our progress.”
“I was not intending to speak but the Leader of the Opposition mentioned my name a few times. What the Leader of the Opposition said in his speech, I think it was a similar point that he made in the July 2021 debate, which was that if only MOM released the number early, you could have quelled all the xenophobia. I took that point. And my answer in July 2021, I think it is the same answer today. We take to heart the feedback that the Member gave. If we had released, perhaps, it would have quelled all the xenophobia and all the raw emotions. But as Minister Tan See Leng said, that data was graded confidential or maybe even secret, I am not sure. But it was not ready for release, because when you release ICTs of a particular country, others may compare, it can have other ramifications. So, it is not something that Ministry officials will readily say, "Let us release it for Parliament". But the situation became like that, CECA became a big issue with a lot of raw emotions and it got debated here. In the end, these Ministers had a serious discussion and said "Let us release it". And so, we take the Member's point, however it is not that straightforward a matter but nevertheless. I think what Minister Tan See Leng is also trying to say is that after all this, let us not blame this whole debate and raw emotions around CECA on MOM because they never released ICT data. It is not because of that, no. If we are honest with ourselves, it is not because of that. It could have quelled it, but I think many other factors took place resulting in those raw emotions, which is most unfortunate.”
“Based on the current design, our sense is "no", because now, we have isolated MediShield Life and IP with the CDL, with a limit. So, the rider itself is an outlet; and we can cover more drugs and higher limits, and it should be priced accordingly. So, we will observe. My sense is that based on today's design, the answer is "no". In the past, the answer is "yes", and it is not fair to the great majority who do not use non-cost-effective drugs.”
“But if consumer behaviour does not change and consumers continue to buy riders, notwithstanding high premiums, then, I think I agree with the Member, we may have a problem. In which case, as I had mentioned just now, together with MAS, we will be prepared to regulate IPs and riders. The Member mentioned the word "profiteering". I am not sure I would describe the insurance sector that way. I think they are competing. I am not sure they are profiteering from it. But because they compete, they try to fight for market share, they offer a wide coverage – sometimes, it is, in the long term, not very sustainable for their business. In healthcare, it is a very complex system. Regular market economics do not quite work and if need be, if we have to regulate, we will do so.”
“I thank the Member. Before I directly answer the question, let me explain what is happening now. In the past, as we know, MediShield Life provides the basic level of protection. Above that, there is IP; and above whatever IP does not provide, riders would provide. So, you look at the cake as three layers. In the past, what happens is, an IP has limitless claims. We call this "as-charged". But it requires some co-payment and riders to sit on top of IPs to cover part of the co-payment. But with the recent changes, that relationship has been flipped. Because an IP now has quite a strict coverage of four, five times of MediShield Life. So, IP has lower coverage; it also does not cover so many drugs because non-CDL drugs are no longer covered; IP coverage has shrunk. But now, the ballon is squeezed out into the rider space. Insurance companies now come in with riders with 18 times coverage – so, not "as-charged" but 18 times or a very high absolute number. I think there is an impact now where it is no longer "as-charged" but the entire IP plus rider is now capped, albeit a very high cap. I think we need to monitor this. The way consumers respond will be quite key. If consumers heed our advice, that if you just look at our CDL which is quite comprehensive and that IP coverage is actually quite adequate; and if they stick to just buying IP, then I think the problem can be addressed. When it comes to the riders, they should look at the price. Riders have to price in higher coverage plus more drug coverage, so they will be priced higher; and you cannot use MediSave – you can only use cash. So, if rider demand goes down and most people think IP is enough for them, I think we have addressed the problem.”
“Thank you. The first question is a good idea. I think MOH can work on this together with the Singapore Medical Council and the medical community, without involving the CCCS. Such price transparency itself will be quite useful. So, it is something that we will study and I had mentioned that in my reply. On the Member's second question, differential pricing across countries, this is widely practised by many global suppliers, including by pharmaceutical companies. I should first say that pharmaceutical companies are our close partners in healthcare. During the COVID-19 pandemic, they are the ones who provided us with vaccines and a way out of the COVID-19 pandemic crisis. So, they are our partners. But we also understand that they incur quite a lot of research costs which have to be recovered through drug costs when something is approved and able to be distributed. In so doing, they too, maximise their revenue by pricing the drugs in different markets differently. So, differential pricing is commonly done. Internationally, this is not considered something illegal; neither can MTI or CCCS do anything about it, because they do not have the extraterritorial power. But what we have done through the CDL, is that it gave us some negotiating leverage to talk to the pharmaceutical companies, to say, "Please lower the prices for the drugs that you supply to Singapore. If you do so, it crosses our cost-effectiveness threshold, it can be in the CDL, and therefore, it can be subsidised and enjoy MediShield Life claims." So far, we have been quite successful. I should reiterate a point raised in my former reply just now. Today, our CDL is actually quite extensive and, in fact, longer and more comprehensive than many similar listings in many developed countries around the world.”
“In the meantime, we urge individuals to consider the long-term cost of the insurance products they purchase against the level of protection they need. The fact is that our CDL is more extensive than similar listings in most developed countries, including South Korea, Australia and the United Kingdom. MAS also requires insurance intermediaries to properly assess if a health insurance product is suitable for a customer's needs and financial situation before recommending the product to the customer.”
“There are riders which can still cover non-CDL treatments, but with the policy changes effected by the CDL, the costs of these treatments will have to be reflected in the rider premiums, rather than loaded onto MediShield Life and IP premiums for the broad majority. In other words, the high cost of non-cost-effective drugs will not be socialised. Thirdly, the mark-up of cancer drugs by some healthcare providers may be quite significant. This is, again, encouraged by "as-charged" IPs and riders, which provided for effectively limitless claims. MOH had, in 2018, taken steps to moderate this by requiring all new riders to have a minimum co-payment of 5% and typically capped at $3,000 a year, for treatments from panel doctors. From 1 April 2023, we took another step to require IPs to set claim limits for cancer drug treatments, instead of having no limits at all. So, the IPs ceased to be "as-charged". For cancer drug treatments, most IPs provide coverage of up to five times that of the MediShield Life limit for treatments on the CDL. This is sufficient to cover cost-effective CDL treatments at up to 2.5 times that of unsubsidised PHI prices. A few Members have also raised concerns that the new CDL limits for riders – such as 18 times of the MediShield Life claim limits – continue to be high and can push up cancer drug prices. MOH shares the concern. We will review how to improve the transparency of cancer drug prices to help patients make informed decisions and encourage providers to calibrate their mark-ups. We are also monitoring cancer drug claims and coverage closely and will work with the Monetary Authority of Singapore (MAS) to take further steps to regulate IPs and riders if costs continue to escalate.”
“With the Cancer Drug List, or CDL, announced in August 2021, drug companies have lowered their prices in order to include their drugs in the CDL so that they can get financing coverage, namely subsidy, plus MediShield, MediShield, MediShield Life and IP coverage. Since these changes, we have negotiated an average cost reduction of 30% for most drugs, and over 60% for some drugs. We can plough the money saved on procurement costs into more subsidies. Annual Government spending on cancer drug subsidies increased from about $12 million for about 50 drugs before the CDL announcement in August 2021, to around $80 million for more than 100 drugs from September 2022. Secondly, because of the high level of anxiety surrounding cancer, high-cost cancer treatments are often prescribed even where costs are not commensurate with the established clinical benefits. Overseas studies have found that about half of new cancer treatments were introduced without evidence of benefit to survival or quality of life. However, patients and their loved ones all hope for a cure. "As-charged" insurance policies, including IPs and riders, are policies where coverage can be effectively limitless and patients have limited co-payment; they further encourage this practice where non-cost-effective cancer treatments are prescribed. These are "as-charged" insurance policies. The CDL also addresses this issue. It sends a strong signal to patients and doctors to use clinically proven and cost-effective treatments, which are covered by subsidies and MediShield Life from 1 September 2022 and IPs from April 2023.”
“My response will also cover the matters raised in the questions by Mr Louis Chua1 and Mr Saktiandi Supaat2 which are scheduled for a subsequent Sitting. I would invite Members to seek clarifications, if need be. If their questions have been addressed, it may not be necessary for them to proceed with the questions for future Sittings. Let me first provide some facts that have been requested. The annual number of Singapore Citizens and Permanent Residents who received cancer drug treatment and services increased from 22,500 in 2017, to 31,500 in 2021, which is a 40% increase. Eighty-four percent received treatment in Public Healthcare Institutions, or PHIs, and 16% in private medical institutions. This proportion has remained stable over the past few years. A Member asked about the adequacy of the MediShield Life claim limit for cancer drug services. We have received similar feedback earlier and have recently increased the claim limit for cancer drug services from $1,200 to $3,600 per year. So, it has increased by three times. This is sufficient to cover the essential cancer drug services incurred by more than nine in 10 subsidised patients in our PHIs. Other Members raised concerns that generous insurance coverage, especially Integrated Shield Plans, or IPs, and IP plus riders provided by commercial insurance companies, will continue to contribute to the rapid escalation of cancer drug prices. I thank the Members for sharing the Ministry of Health's (MOH's) concern which gave rise to the recent policy changes. But first let me explain the key reasons for the rapid rise in cancer drug prices over the past years. Firstly, as a small market, Singapore lacks the negotiating power and can pay higher procurement prices.”
“Mr Speaker, may I have your permission to answer Question Nos 2 to 4 together, please?”
“And for all of us, carry ourselves well, ensure we are parties of integrity, honesty. And if anything goes wrong, handle it well, so that the people know where we stand.”
“I will also explain my side of the story one last time. As I mentioned, substantively, what matters to Singaporeans is that they want to see what is the difference in policies between the two parties. And, as I summarised just now, there are a lot of policies on which we are actually on the same page. I mentioned carbon tax, I mentioned preventive care, and there are others which are really shades of the same policies. But as the Opposition, you will always ask the Government to do a bit more. It is your job to do so and it is our job to think about it. For example, we just discussed worker safety. MOM is totally on top of this. But there are additional suggestions and MOM will think about it. But I think what matters most to Singaporeans in deciding between the parties are the fundamental differences. And here, I think there is one, when it comes to NIRC, because value systems and belief systems are involved. I talked about healthcare, that we got primary care; above that, we have secondary and tertiary care; below that, we have community care. I think just debating policy differences is just "primary care". If you want a full-fledged good political system that serves people, we got to go beyond that. The ruling party needs to do what is required – listening to people, explaining things well, including difficult policies, keeping yourself clean and honest, always think of the long term, correct mistakes, if it commits mistakes and constantly refresh itself. And for the Opposition party, do its homework, do not say "no data" as an excuse. Take a stand, even on sensitive issues, such as section 377A. Take a principled, consistent approach to your policies and explain how benefits are to be paid for.”
“I thank the Member for that clarification. We have always acknowledged the angst and the anxiety of Singaporeans on many issues, but we will see. Let us see how the debate moves on from henceforth. I just want to remind Mr Leong, and also, Ms Hazel Poa, how we raise issues matters a great deal. Many of us Members of Parliament, we tend to the ground in our constituencies. There are often neighbourly disputes. Sometimes, disputes between two units with occupants of different ethnicity. So, you can have problems like noise, or your flower pots along my corridor. You can approach it based on what the problem is – find a way to remove the flower pots. Or you can approach it with a certain racial undertone, the same problem, but different ways of approaching, different ways of describing it; and the latter can create sworn enemies out of neighbours. So, have a care. In Chinese, there is a saying: "人言可畏" – words can be very scary. So, be careful what we say. We need to preserve the harmony that is so hard-fought and hard-earned.”
“Finally, because all oppositions always ask the Government to do more, you also need to explain how benefits are to be financed. And then, applied to all political parties, we need to ensure our leaders and our representatives carry ourselves well, so that people know that we are people of integrity and honesty. That we have a heart for the people, we are doing this for the people. And then, there will be moments of truths. When bad things happen, members misbehave or something illegal gets uncovered within the party, how we handle them. These are moments of truths. They give people a deep evaluation of what is the core of this political party. So, this is what I feel all of us need to do, to ensure there is good politics that serve the people. We are opposing parties, we are contesting. A lot of words are said to each other, it is part and parcel of political contestation. But in many ways, we are also working together. At a time when the political landscape of Singapore is evolving, the people want a good, strong Government, but yet they want checks and balances in the Opposition. Every election, they are thinking through what is the equilibrium? And so, the situation is evolving. We are contesting, but we are also working together to find the equilibrium for Singapore. I share what I think we need to do to uphold good politics, because then, we will serve the people well.”
“If I may just offer my view – for the ruling party, it means being able to recruit good people, with strong integrity, strong Government, competent. In particular, we need to be able to listen to people more, empathise, understand pain points and be able to address them. And where we have to implement policies that are not so popular, that will even cause a bit of pain, but for the long-term good of the people, we need to explain sincerely, honestly, why we need to do this. We need to put in place institutions, systems, checks and balances within our system; it is part and parcel of institution building. Then, for the Opposition, the main thing you need to do is to present alternatives, so that people have a basis of decision, have a basis to compare. And, in doing so, first, you got to do homework, put forward proposals that are credible. There is so much data out there, there should be no excuses that there is not enough data. In any case, if you need specific data, you can always submit a written question to ask for specific data. And then, when there are sensitive issues, like section 377A, take a stand and not hedge. Because it is important to take a clear stand, so that the people have a measure of what the party truly stands for. Third, when it comes to alternate proposals, take principled, consistent approaches, have consistent considerations. It cannot be that in 2015, you proposed zero population growth for foreigners; and then, when there are not enough workers – now what? It cannot be that in 2019, the housing paper said cut back and do not build too many houses, but now that we are short, you say build more and the contexts are different. So, you need consistency in your considerations in your policy proposals.”
“I thank the Member for that clarification. So, the difference between us is the 2%-points in GST and how you make up for it. In your proposal, amongst other things, it is to shift the NIRC – which, as we explained, I think we have a fundamental disagreement on that. But may I say this, Speaker, that we can debate the issues, we can point out where are the shades of differences, where are the areas where the PAP Government says, "we do this" and the WP Opposition says, "let us do a bit more"; and where are the areas with fundamental differences. In the end, for this whole system to work, for this House to be a constructive Chamber for debate, for us to serve the people well, we have also to decide between us, that we have to uphold good politics. What is it that the people really want? What is it that Singaporeans really want? From the ruling party's point of view, we say "Singapore is a vulnerable small place, we will have significant challenges. We need a strong, competent Government – clean, with integrity and able to deliver the goods; and we will have checks and balances, but we need the agility and the strength, in order to serve Singapore well. For the Opposition in WP, you will tell the people, "You need a checker against the ruling party. You need a co-driver. There has to be checks. There should be checks and balances." What is best for Singaporeans? I say the answer to many Singaporeans is probably both. They want a strong, competent Government, but they also believe that power cannot be absolute. There should be checks and balances. And so, it is our duty, if we want to serve the people well, to make sure we have good politics between us. What does that mean?”
“Sir, Speaker, I had a question and I wonder if the hon Member would like to clarify.”
“On Mr Leon Perera's first point, as I said in my speech, yes, there have been many ideas raised by the WP, as well as other Members. But on GST and the Budget, I still do not know – and this could be due to my ignorance because I am not in finance – I still do not know if the WP supports the GST system. And in your alternate budget, whether you are contemplating not having the GST system, because I do recall WP has always been against the GST system. And if that is the case, I would say that that your alternative does not make sense. It is not a viable nor serious alternative because without that source of revenue, it is not possible to do more. But if your position is: you accept the GST system, but stay at 7%, and not go to 9%, then I think I may have a different view; and I will explain.”
“Let me address the second issue of balancing. And, of course, Deputy Prime Minister Wong is the Finance Minister, but I am expressing my view. I think the balance is best struck when it is 50-50, with equal apportionment. If I may, Speaker, there is a Hokkien song, "Jit Lang Jit Pua, Kam Qing Buay Suah" (一人一半，感情不散). If you divide things in half, you preserve the relationship, you preserve the peace. And the song did not go "Jit Lang Luck Chup Bak Xian, Jit Lang Sze Chup Bak Xian, Kam Qing Buay Suah" (一人60%，一人40%，感情不散). No, it does not say you have 60%, you have 40%, you preserve the peace. [Laughter.] There is wisdom to half-half. There is – I do not know if Members remember when we were young – we learnt the story of the fox dividing the meat amongst two parties and the fox deliberately tear it 60-40. The one who gets the 40% of the meat protested to say the other piece is bigger. So, the fox took a bite of the 60%, he deliberately took a bigger bite and then the situation got reversed. The other one who got a smaller piece said that the other piece is bigger and so the fox kept taking bites, until in the end you have nothing left. I remember that lesson, not because it is an interesting story – because at a formative age, that was to me a lesson in values. It was not a lesson in reducing the growth of meat consumption for the long term but it is about how we preserve peace and sometimes, 50-50 is the best and the most wise way of doing so. That is our position. It is a matter of values, principles, for future generations that are not born, we should honour "half-half" and it is in our Constitution now. We do not want to change it too easily.”
“But perhaps the state of being a "super-aged" society can ultimately and overall be a good thing too – where people live long fruitful lives; where there is health, longevity; where there is warmth and care in every community, and we look out for each other. And perhaps one day, after we tackle the challenges of a "super-aged "society with our Singapore spirit, we can reach the stage where society treats age as nothing but a number and 65 need not be that artificial line that divides the two sides of the dependency ratio. One may be advanced in age, but still feel young and even if the body feels old, the heart remains young. Thank you, Sir. [Applause.]”
“A recent New York Times article caught my eye, reported that the reality of the state of happiness in Finland is actually more complex. The report says the Finnish people are happy about their strong social safety net, but they also worry a lot about their security and domestic political situation. The report went on to say this, "the happiest people in the world aren’t that happy…more like content." It went on to say that there is a way of life in Finland called "sisu", which roughly translates to "grim determination in the face of hardship" that apparently brings you happiness. You can understand how "sisu" came about, given Finland's harsh climate living conditions and a strong sense of insecurity due to a long common border with a big and historically unfriendly neighbour, Russia. When you have such a long yet inaccurate English description struggling to translate a specific concept, you know this must be some kind of unique characteristic embedded in the DNA of a particular people and in this case the Finns. For Singapore, what is it? They have "sisu". I do not think we want to say "kiasu". [Laughter.] But for Singapore, a small island along the equator, in the middle of Southeast Asia with a diverse population at the intersection of the world, I think we have a different trait, a quiet unity, optimism and stout heartedness that we can together, overcome all challenges. Sir, it is ironic that the challenge of ageing came out of good things – people living longer due to medical advances and better quality of life, fertility rate coming down as aspirations changed and women get more educated.”
“To achieve this, the current formula is deliberately designed to divide the NIRC equally – half for current generation to spend and the other half adds to the savings for the future. The half-half apportionment is a formula that is simple, is fair, and I think, is wise. It is very tempting, even seductive, to say let us shift half-half to 60-40. But we debated and enshrined the fiscal rules in our Constitution not that long ago. We should not at the first sign of need, push for changes in the rules, just to take the easy way out. We should hold on to the equal apportionment principle for as long as possible. This is good stewardship and it is the PAP's position and that is why there is a fundamental difference here. Sir, I mentioned earlier that ageing is the unique challenge of this generation. But previous generations had their unique challenges too, be it the plague, the industrial revolution, the World Wars, unravelling of the global monetary system, threat of nuclear holocaust, Cold War. Specific to Singapore, this and earlier generations had to weather the threat of communism, racial riots, becoming an independent nation, severe recessions, COVID-19 and we overcame them all. It is the overcoming and not the problems and challenges, that defines a generation. I had earlier said that ageing is a part of the human condition. As someone who is one Zodiac cycle away from becoming an "aged", and as the Health Minister, I consider ageing a stage of life to be greeted like an old friend and certainly not a pathology. Sir, I spoke about Finland's positive economic performance earlier, even though it is a "super-aged" society. Another interesting fact about Finland is that the World Happiness Report ranked the Finns as the happiest people in the world, six years in a row.”
“Whatever the Government proposes, ask for more. So, here is one difference between our two Parties. I do not think it is a major one and it is again part and parcel of political contestation. But a fundamental difference arises when it comes to WP's ideas for the Budget. Why is that so? Because to do more, one has to spend more, and one has to say where the money is coming from. However, the WP never supported the Goods and Services Tax (GST) system. So, an alternate budget without the GST simply cannot work and is not a viable alternative. The sums just do not add up. You cannot give up a major source of revenue and yet want to spend more in so many areas. I am new to this subject. I may have misunderstood WP's position. Perhaps, it has changed its long-held position and now accepts that GST is needed, but merely objects to the increase from 7% to 9%. Then to make up for the loss of two percentage point of GST revenue, the WP has proposed, amongst other things, changes to the Net Investment Returns Contribution (NIRC) formula. So, instead of drawing half of NIRC for Government spending, WP proposes to draw a higher amount or a higher percentage at 60%. The PAP Government will not agree to it and this is a fundamental difference too because it has to do with our beliefs and our values. We debated this issue in the Budget Debate last year and Deputy Prime Minister Wong had explained the Government's position. Let me try to explain again but now using a little bit of my own words. Our view is that the reserves belong to all generations of Singaporeans, current and future, even though they are not born, they cannot vote and their voices have yet to be heard. As responsible stewards, we will nevertheless safeguard their welfare and interests.”
“All of us, including Mr Leong and the Progress Singapore Party (PSP), and everyone in the House, we know that race issues can be played up, especially in multi-racial Singapore. We can debate, we can spar, but we should not pit one group against another, over and over again, always looking to tear at the seams of our society and if we keep doing that, it will sow disunity and divide our society. In multi-racial, diverse Singapore, our harmony is hard earned. Let us not take it for granted. In fact, let us be very careful to preserve it. Mr Leon Perera had asserted that the Government tries to push a single "dominant narrative", without regard to the alternatives raised by the Workers' Party (WP). I think it cannot be true. If not, we would not be having such extensive debates on so many issues in this House and hearing out each other. Further, every political party will have its own dominant narrative based on its manifesto, based on its values. PAP has it. WP has it. It is part and parcel of political contestation. Many Members, including WP Members of Parliament, have raised many ideas in this House. You have. We welcome them and where appropriate, we take those ideas in while formulating or reviewing our policies. And where we have a different view, we will explain why. I would say that many of the ideas raised in the House, including by the WP, are not fundamentally at odds with existing policies. They build upon the policies that we already have and make them better, cover more areas. Sometimes they are shades of the same policy and we need not exaggerate their differences. In the case of preventive healthcare or carbon tax, WP's proposals are actually similar to the Government's policies. Very often, WP, as Opposition, wants more of what is already being done.”
“Running up to the debate, there was much demonising of CECA, that it allowed unfettered entry of Indian nationals into Singapore. The discourse took on a worrying racial undertone. As a former FTA negotiator, I asked to deliver a Ministerial Statement in this House. And that was July 2021. I acknowledged the concern amongst Singaporeans on jobs and livelihoods. I explained to the House how an FTA works – in particular, the chapter on movement of natural persons – and how CECA preserves our right to immigration policies and setting work pass conditions for foreign nationals who want to work in Singapore. I also had a fairly long exchange with Mr Leong. But when Mr Leong filed a Motion on foreign talent policy in September 2021, two months later after the Ministerial Statement debate, he continued to refer to CECA as a cause for widespread anxiety among Singaporeans on jobs and livelihoods and did little to reduce the raw emotions and misimpressions on CECA that had been stoked. It was as if my Ministerial Statement and explanation in July 2021 did not take place. I recall during that Motion debate, he eventually conceded that some people would think that his statements on CECA had racial undertones, against the Indian community. In January 2022, Mr Leong made an allegation that teachers in Ministry of Education (MOE) were treating vaccinated and non-vaccinated students differently. I was Multi-Ministry Taskforce (MTF) chair and I got quite worried whether our vaccine-differentiated safe-management measures (SMMs) had somehow inadvertently been imposed on young children. Because this was a serious allegation, Minister Chan Chun Sing stood up and asked for details. Mr Leong then clarified that his information source was a Telegram chat and there were no details.”
“I described how the pension systems in the Western developed countries are contributing to significant national debts, which burden future generations. So, inherent in the pension crisis is the Government's inability to look after both the current and future generations of their people. We consciously avoided those problems and, in fact, have built up a national nest-egg in our reserves. We are drawing income from it and want our future generations to continue to benefit from it. Sir, since we are on the topic of governance, let me respond to the points made by Mr Leong Mun Wai – but he is not here today but Ms Hazel Poa is here – and also Mr Leon Perera on Tuesday. Mr Leong Mun Wai alleged that the Progressive Singapore Party (PSP)'s concerns and questions were often dismissed by the People's Action Party (PAP) Government and there were occasions where the PSP was painted as, I quote, "xenophobic, nativist and racist". The Government has always acknowledged the concerns raised by various Members of the House, including by the PSP Members. This includes Singaporeans' anxieties about jobs and competition in a globalised and fast-changing economy, affordability and accessibility of HDB flats and so on. We have always acknowledged those problems. And it is raised by all Members of the House, regardless of their party. And we are working hard to adjust policies and make deliberate efforts to address these issues. But I hope Mr Leong Mun Wai will also acknowledge the serious concern we have in the way he raises and debates issues. I was personally involved in a couple of these issues. This House would recall that we had a debate on Comprehensive Economic Cooperation Agreement (CECA), our Free Trade Agreement (FTA) with India. That was July 2021.”
“In particular, with community support, there are great opportunities for seniors to age healthily in communities. And this is the next area where big changes need to take place. Hence, beyond Healthier SG, the next major area of priority for the Ministry of Health (MOH), is to build up community care, to get us all to do what is right for our health, to support ageing in communities. I am glad that quite a number of Members has spoken about this. It will be a continuation of Healthier SG and as a national programme as ambitious and extensive as Healthier SG. Forward Singapore has been described as a refresh of our social compact. A social compact is usually understood as an unwritten contract between the individual and the state, the responsibility of the individual to contribute to the larger good and the obligation of the state to provide assurances and opportunities to its citizens. So, under Healthier SG, how does this concept apply? The Government will provide the support and structure for individuals to take care of their own health. But then, beyond the relationship between individual and the state, the community is at the core of the healthcare social compact. Finally, the fifth area. There is also the significant factor of good governance. Preparing for ageing, be it in the areas of urban planning, economic development, retirement adequacy or healthcare reforms, requires anticipatory policy-making, which is the hallmark of the Singapore Government. We have made preparations for an aged society in these areas well ahead of time. We have had more than a decade of head start before the problem caught up with us. Good governance also involves responsible stewardship.”
“In healthcare, this means slowing down the onset of severe diseases and making people healthier. If this cannot be done, the sheer disease burden driven by ageing will overload the healthcare system. Worse, it can cripple the finances of governments. Hence, building on the foundation established over many years, we developed Healthier SG, our preventive care strategy which we will launch in July this year. Healthier SG delivers preventive care by building up primary care, family physicians in community and polyclinics and it becomes the foundational layer of healthcare. But at this level, family physicians in primary care, they cannot work alone. For the minority of more serious cases, they need to escalate the care upwards, to secondary and tertiary care in our hospitals. But then, for the great majority of less serious cases or even healthy residents, they need to devolve the care downwards to community and family care. The communities we live in, the families we hold dear to, are places that create and sustain health. Studies show that 60% of health is determined by social factors, within communities and families. It is about having a good family environment, hygienic living conditions, nutritious food, education for children, good employment opportunities and public amenities like parks, libraries and sports facilities. And where health interventions are needed, they are more social than medical and often verge on common sense – sleep well, eat well, have rewarding relationships, exercise, do not smoke, undergo periodic health screening and vaccinations. However, it is the common-sensical easy things that always get put off because there are no immediate consequences and therefore, they fall prey to inertia. Community support can help us overcome those inertia.”
“So, those who live longer may see their CPF savings run out before they pass on. Hence, in 2009, we introduced the CPF LIFE scheme. Singaporeans turning 65 in 2023 who meet a stipulated level of savings in their CPF accounts are automatically enrolled in CPF LIFE. When they retire, CPF LIFE uses risk pooling to provide a steady stream of monthly payouts for as long as they live. Another challenge is that some segments of society do not save enough in their CPF accounts. Hence, in 2007, we introduced Workfare, to top up the salaries of lower-income workers so that they can save more for retirement. In 2016, we implemented the Silver Support Scheme, which provides cash support for seniors who have accumulated less retirement savings in their working years. The scheme was further enhanced two years ago. MOM will continue to look at ways and means to improve retirement adequacy of Singaporeans. The fourth area is to reform the healthcare system, what I feel is probably the most important. Like pension systems, most health systems in the world are designed when life expectancy was much lower. These systems focused on hospital care, which is the most costly part of the whole healthcare ecosystem. But so long as the population is young, the system works fine. But as life expectancy rose, so did the disease burden. The old designs start to break down. It is like you have been training very hard for a sprint and then, you realise your race is a marathon. The situation is also like an overflowing kitchen sink. We can keep mopping and soaking up the water on the floor, but the work is endless and the effort increasingly trying. At some point, we need to figure out how to turn down the tap.”
“It is already a super-aged society, as more than 20% of its population is 65 and above. Yet, pre-COVID-19, it had been growing at around 2%-4% a year. It had produced several world-class companies. It had a vibrant startup sector. Singapore will become older, but we can remain economically dynamic and vibrant, as long as we continue to remake our economy and prepare our people for it. Let me move to the third major aspect in preparing for a "super-aged" society and that is, retirement adequacy. I mentioned the pension crisis earlier. Many pension systems were designed when life expectancy was much shorter, between 50 and 70 years old. Now, with people getting older and fertility rate falling, pension systems have become unsustainable. Some governments have had to borrow to plug the funding gap. The accumulated national debt is then passed to the next generation to shoulder. In Singapore, we are fortunate to have the Central Provident Fund (CPF) system. For many Western developed countries, the starting point is "defined benefits". This means there is a national pension pot. Everyone pays into the same big pot while you are working and after retirement, every retiree dips into the pot to draw their defined pension benefits. The starting point of our CPF system is "defined contribution", where workers save up in their personal accounts, employers and the Government contribute into the accounts too, and workers draw down from their own personal accounts when they retire, until the funds run out. With the CPF system, we avoided the major problems faced by pension systems around the world. The CPF system, however, is not without its challenges. One challenge is that life expectancy differs from person to person.”
“We will need more foreign manpower to complement the local core, which will remain the majority. For Employment Passes, MOM will continue to calibrate its policies, to bolster our local talent pool with an international pool. The Complementarity Assessment Framework (COMPASS) evaluation system is more sophisticated, sensitive to both economic needs and the social impact of foreign manpower. Four, our economy will continue to upgrade and evolve, to rely more on brain than brawn, to enable machines, computers and AI to augment the ability of the human worker and indeed, drive growth through productivity improvements. That is why we are driving research and development through the National Research Foundation, implementing Industry Transformation Maps (ITMs) and growing high technology and high value sectors, such as biomedical, financial services and information technology (IT). Governments around the world have two common manpower worries. We are concerned that technology will replace human workers and then, if that happens and on a large scale, there will be too many workers and too few jobs. We are also concerned about the imminent shortage of manpower due to an ageing population and so there will be too few workers and too many jobs unfilled. So, instead of losing sleep over contradictory worries, one perhaps may be the solution for the other. The confluence of both major trends, AI and technology and ageing, can be an opportunity to elevate our economy. But education, training and a personal responsibility to evolve our attitude towards our career with age, that will be key to unlocking this potential and this possibility. Sir, Finland has a per capita GDP of over US$53,000, lower than Singapore, but high.”
“I think it is worth noting here that raising our retirement and re-employment ages does not affect the retirement savings that people have built up in their CPF accounts, and it is unlike in France and many other developed Western countries. Hence, the main impact of raising these ages is that workers are protected from being dismissed due to their age by their employers. Workers can choose to retire early should they want to. Hence, raising the retirement age in Singapore is an unmitigated good to workers. Employers must certainly do their part, for instance, through job redesign and reskilling, and learn to benefit from tapping the silver workforce. Two, and equally important is female participation in the labour force. With universal education and greater opportunities, labour force participation rate for women increased from about 51% to 63% over the last 20 years. This House debated the White Paper on Women's Development last year. Our work to ensure equal opportunities between men and women must continue, so that our wives and daughters can fulfil their full potential. The Workforce Singapore has launched the herCareer initiative to support women to come back to work. By 2024, we will give this a further push by introducing the Tripartite Guidelines on Flexible Work Arrangements. Three, we complemented our local workforce with foreign workforce. The quality of the Singapore workforce is world-class, but there are just not enough Singaporeans. So, in many labour-intensive industries, we will continue to need foreign manpower. Some of these, like construction, are sectors which locals are less likely to join. Others, like healthcare, need more manpower to take care of more seniors.”
“Now, at this age, I am seeing the junctions being replaced by traffic circles again in order to slow down traffic, to cater to a more senior population. At the flat level, HDB has selected more than 300,000 flats built up to 1986, for the Home Improvement Programme (HIP). It has been a massive effort and HDB is now moving on to select newer flats built in the following 10 years. HDB has also announced earlier this month that the Enhancement for Active Seniors (EASE) programme will be expanded to include more features, such as customised ramps and wheelchair lifters. So, you can see that our living environment is bending its form to suit today's society's shape. All these are deliberate efforts to help us prepare for an older society. The second area is that we need to adapt our economy to an ageing population. The most imminent impact is on the labour force. The growth rate of our resident labour force has already slowed down. Between 2002 and 2012, it grew by 30%; but in the next decade, it only grew by 15%. But the fact is that we still managed to continue to grow the workforce, despite the onset of ageing in the past two decades. This is due to a few reasons. One, more Singaporeans are able to stay economically active for longer. The labour force participation rate for resident seniors aged 65 and above has almost tripled over the last two decades, and it is about 32% now. We should continue to support the aspirations of older workers to continue working and contributing. We have also been gradually raising the retirement and re-employment ages, from 60 and 65 in the past, to now 63 and 68. The Ministry of Manpower (MOM) aims to raise them to 65 and 70 by 2030.”
“Stallholders from the former Commonwealth Drive Food Centre have moved into a new two-storey Margaret Drive hawker centre located in the development. I was told that the chicken rice stall is still there; it is preserved. Another BTO project integrates a block of Community Care Apartments for Seniors and is strategically located next to the soon-to-be redeveloped Alexandra Hospital. As we redevelop and rejuvenate older towns, we continue to encourage inter-generational mixing in younger towns, such as Sembawang – my constituency. HDB has incorporated a range of flat types, including studio and 2-room Flexi apartments, into new BTO developments in places like Sembawang, and they cater to singles and seniors, and as a result, we have a more inclusive town. We have the Proximity Housing Grant, priority schemes for parents and children to live with or near each other, and larger 3-Gen flats which further encourage inter-generational mixing in all our housing estates. These are changes at the town level. At the neighbourhood level, the physical environment is becoming more friendly and liveable to all ages, all over Singapore. Wherever possible, Active Ageing Centres, three-generational playgrounds and childcare centres are located side by side. Such facilities are a mainstay now in HDB estates. There are visibly more congregation and rest points, exercise parks, lifts at pedestrian overhead bridges to allow barrier-free access and roads redesigned to slow down traffic through implementation of more Green Man+ and Silver Zones. When I was growing up, living in HDB estates, I could see the traffic circles disappearing, replaced by traffic lights junctions because they are more efficient in carrying heavier traffic.”
“We fortunately do not face the challenge of population dispersion like Japan. We do not have many rural areas – the furthest is Lim Chu Kang, maybe. We also have a significant advantage in that 80% of our population live in public housing and HDB can play an active central planning and development role in ensuring inclusive communities. A few years ago, Senior Parliamentary Secretary Eric Chua hosted me for a constituency visit to Queenstown. It is one of our oldest towns, with more than 20% of its population aged 65 and older. So, Queenstown at that time is almost a "super-aged" town – 1%-point short. But Queenstown is like a time machine that gives us a glimpse of what the future will look like in every town in Singapore. By 2030, most towns in Singapore will be like Queenstown, in terms of the residents' age profile. Last week, I made another visit to Queenstown. I can see that the place is transforming. It is now labelled a Health District, an initiative that I launched with Minister Desmond Lee some time ago. As a Health District, many agencies came together to implement various initiatives to improve the health and well-being of Queenstown residents. This includes integrated planning, evidence-based design of the living space, and then many community initiatives, including physical activities, befriending programmes and healthcare services, to support seniors. What left the deepest impression on me was HDB's effort in planning ahead. To ensure inter-generational mixing, HDB is redeveloping the old areas, launching new BTO projects to inject a younger population into the town. A BTO project now occupies what used to be the former Queenstown town centre.”
“The country has enacted new laws only recently to raise its official retirement age, and hence also its pension age, from 62 to 64 – just two years. But that alone has led to massive public protests. Finally, ageing is driving the ballooning of healthcare spending, especially in OECD countries. The UK National Health Service is facing a crushing patient load. It is described as facing the "scissors of doom": one blade represents patient load and disease prevalence and that is going up; the other blade represents resources and manpower and that is going down. In Singapore, we have been thinking about the problem of ageing for a long time. We first started thinking about changes to the retirement and CPF system with the Howe Yoon Chong Committee 40 years ago. The Government set up the Committee on Ageing Issues almost 20 years ago and formalised it into the Ministerial Committee on Ageing in 2007. So far, the Ministerial Committee has coordinated and launched two comprehensive action plans. If you are wondering, the Minister for Health is the Minister-in-charge of the Ministerial Committee. Because of this strong foundation, we are in a position to cushion the impact of ageing and perhaps even reap dividends from it. Sir, today, I will speak on how we are preparing for an ageing society. If we continue pressing on along this journey we started, we will have a bright, dynamic, vibrant and happy future. While Singapore will inexorably become a "super-aged" country, it can also remain a superb country. My speech will cover five key areas of impact. Together, they are the enablers for Singaporeans to live a meaningful and happy life, whatever their age. Let me start with the first area which is in urban development.”
“First, it causes population dispersion as young people gravitate to cities to seek better jobs and opportunities, leaving rural areas old and depopulated. This is happening in Japan. It is projected that by 2040, close to 900 municipalities, which is nearly half of Japan's total, could disappear. To counter this demographic polarisation, Japan is taking some aggressive measures. They are giving cash incentives to young people to say, "Move out of the cities, come back to the rural areas". They are also merging towns. Second impact: when people get older, the way they consume, they save, they learn and the way they work change. And this has significant economic consequences. One immediate concern is the shrinking workforce. China has confronted this issue for some years already, but it came to further prominence when China reported a fall in their population by 850,000 in 2022. So, that is the first time China's population shrank in the last 60 years. Notwithstanding, with a large population, China is in no danger of running out of workers. It still has eight million or more graduates every year. But the demographic shift has probably prompted China to rethink its economic development path, away from growth in labour intensive, export-driven industries, to higher quality, higher productivity activities. Third, ageing has cast a big question mark over the sustainability of social welfare systems. Many pension systems around the world are becoming no longer viable. Because there are more and more older people drawing from the central pension pool, and fewer and fewer young people contributing into it. France has projected a pension system deficit of 10 billion Euros a year.”
“Thank you, Speaker. This is just in case I have one paragraph left and the time runs out. I rise in support of the Motion. Every generation needs to confront their unique challenges. For this generation, it has to grapple with climate change, geopolitical tensions and uncertainties the Prime Minister talked about yesterday, rapid technological advancements that can disrupt jobs and industries. What about domestically? I think the biggest social transformation for this generation will be ageing, which is the topic of my speech today. Ageing is unlike other elements of health – it is human condition which we can neither prevent nor cure. The United Nations (UN) defines a country as "ageing" if the share of its population aged 65 years or older crosses 7%. So, magic number 7% means you are ageing. It is considered "aged" if the share exceeds 14%, and once that share reaches 21%, it is considered "super-aged". That is the UN definition. So, let us look at some countries. France took 115 years to transit from "ageing" to "aged", and it became "aged" in 1980. Sweden took 85 years and then became "aged" in 1975. The US took 69 years to become "aged" in 2013. Singapore? We took 19 years and became "aged" in 2017. One hundred and fifteen years, 85 years, 69 years – and we, 19 years. And then the gap for Singapore between "aged" and "super-aged" is estimated at only nine years, which means we will attain "super-aged" status in 2026. Today, we are one of the fastest ageing countries in the world. We are not alone. Many countries, such as Japan, South Korea, Germany and UK are already where we will be in 2030. The impact of being a "super-aged" society is profound. Just let me cite a few.”
“For instance, with precision medicine, we can consider individual variations in genetic, environmental, and lifestyle factors when predicting the health risks of individuals, and determine the most effective prevention and treatment strategies for them. At the same time, there will likely be a proliferation of experimental treatments, such as genetic therapies. We need to support and embrace technological advances but remain aware of the risks and pitfalls. Experimental treatments tend to work only on a small minority, so mass deployment of new treatments must be subject to evidence-based clinical development and evaluation of cost and medical effectiveness. Even as new medical technology becomes established, it will likely be costly and deployed only in specific circumstances. This would require a rethink of our healthcare financing policies, especially the role of medical insurance and MediShield Life. We may also need new legislation to safeguard moral and ethical standards in the practice of new medical technology such as precision medicine. MOH will undertake this long-term effort in partnership with researchers, physicians, economists, bioethicists, regulatory bodies, and the public, to reap the benefits of these new solutions.”
“We are therefore updating the Healthcare Services Act, to make regulations services-centric, instead of focusing on the premise where care is delivered. Similarly, we need to review our healthcare financing policies to make them more premise-neutral, and ensure support is available regardless of where care is sought. For our seniors we need to make ageing in community the default, because it is the best way for them to stay socially engaged and active, and hence healthy. As part of the Forward Singapore exercise, we are studying the specific measures to enable this. Broadly, our built environment must be made more senior-friendly, with new housing options such as Community Care Apartments, and existing common spaces such as void decks, parks, and coffee shops transformed into conducive environments for seniors. Our network of Active Ageing Centres will need to be expanded, and their operations remodelled, so that they can become nodes for seniors to make friends, volunteer, participate in active ageing programmes, and receive support for maintaining good health. As seniors approach end-of-life, we will seek to fulfil the wishes of the great majority to pass on in the comfort of their homes, surrounded by their loved ones. We will therefore strengthen support for palliative care by enhancing clinical protocols in hospitals to enable more seamless care transitions, upskilling healthcare workers, and engaging Singaporeans in conversations on their preferences. We will also enhance financial support for palliative care and ensure sufficient capacity across all settings to meet growing needs. We are in a period of major breakthroughs in medical science, especially in areas like precision medicine, gene editing, and artificial intelligence.”