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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“Instead, we have biases deeply embedded in our social practices and our constructs. I think they probably had their roots in nomadic bands, where the men mainly hunted; the women mainly gathered. And then, these roots probably grew deeper in agrarian tribes, where the men mainly ploughed the fields and the women took care of domestic matters. The tribes decided to come together to form complex societies. And then, the key problem statement was: how do we, as different tribes, live peacefully together and not kill one another? The answer is to make everyone stakeholders of a stable and peaceful society. And that stake is the betterment of the family, of whom members are bonded by blood and DNA. It follows, therefore, that blood lines must be drawn to define the family. The basis to do so in most societies was the patriarchal structure. The expectations of sons carrying the family line, daughters marrying out, dowries flowing whichever way, sons having the greater share of inheritance – often, protected and reinforced the system. We cannot undo all these longstanding anthropological practices and history in one generation. But no matter how entrenched, that past is challenged by the present. I think there are at least three driving forces: one, education; and two, technology. And they combine in a powerful way to force a rethink of the status quo. Take education, for example. Young girls in Singapore grow up in an environment that their grandmothers would not have imagined when they were children. Education has become the great equaliser of most societies. With equal opportunities for education and development, women are now able to enter vocations and professions that were, historically, male-dominated.”
“One example was when our daughters were just toddlers. During Chinese New Year visits, relatives would glance at them and then turn to my wife and ask, "When are you having sons?" My wife will always reply, "I am happy with two daughters!" And I know our daughters heard those conversations. I wonder how they felt. Then, as a young girl, my elder one, when she first learnt of the concept of dowries, she had a shock. That was over dinner table. I do not know how it came up. And she started asking, "Why must the groom's family give the dowry?" We are talking in terms of Chinese tradition, "Why the four pieces of gold for the Teochews, why the roast pig for the Cantonese and Hakkas?" She had all these burning questions. My wife calmly answered, "Because in Chinese tradition, the girl marries out." That got her even more upset. She said, "So, this is like a transaction? I will be sold?" I tried to make things better by explaining, "The money can flow both ways. And in some cultures, it is the bride's side that provides the dowry in recognition that the husband will incur costs in taking care of the bride." [Laughter.] It was not a helpful intervention. I would say, if this was a supplementary question, it was a very badly answered supplementary question. We left it like that. All children, sons and daughters, are born into this world with no bias against men or women, like my own daughters. But through my daughters' eyes, during their formative years, I better understood the lived experience of social expectations and prejudices. And these are beyond Government policies and legislation. In fact, policies and legislation, especially those in Singapore, are meant to remove discrimination and promote equality.”
“Then, my parents moved into their own flat in Toa Payoh, next to a temple. That was the 1970s. The household composition did not change. I had an elder brother. So, my mother was the outlier, the only woman in the family. But what changed was her role in the family. She was a teacher, which meant she had to go to school very early in the morning, came home, marked the examination papers, marked the homework and then cooked, cleaned, looked after my brother and me; and also coached us in our homework. So, in her, I saw a very strong woman who, in her world, carved out a role for herself that was equal but different from my father. To me and my brother, she was our disciplinarian and also our anchor. Growing up, therefore, my family was mainly men, and women were the outliers. Then, I got married. My wife and I had our own children and the situation changed completely. Both our children are girls. I became the outlier. So, today, after my parents' passing, the people I love most in this world are all women. The dissonance I felt as a kid, slowly developed into a deeper understanding of the struggles and aspirations of women. I am not sure I totally get it, but I am trying to get it. You see, as a young father, I had thought that whatever discrimination and biases there were against women, it will be alright, my children will be alright, our daughters will be alright because these would, eventually, be scrubbed out by the norms of a modern society. After all, in Singapore, our daughters have a good education. They are growing up in a world where women can be CEOs, professionals, leaders of nations. And as parents, we will support them to fulfil their ambitions and their aspirations. But soon, I realised it was not so simple. And I saw it through the eyes of our daughters.”
“Mr Speaker, Sir, today, we debate an issue close to my heart. I will not just speak as a Member of the House or a Member of the front bench, but also as a son, a father and a husband. At the core of this debate are the relationships that all of us have with women in our lives, at our workplaces, in our country. And our duty to women should be equal to our duties to all fellow citizens and the choices open to women must be equal to those open to men. First, let me ask, what is the place of women in our lives? I will share a bit of my own circumstances. My grandfather and grandmother, they had nine sons, I have no aunties. Of whom, my father was the second eldest. They lived in a kampung in Lorong Chuan, now part of Aljunied GRC. I grew up watching the men in my family breed fishes, plant vegetables, rear livestock, repair cars, there was a workshop in our kampung. And the women cook, clean, look after the children. There was "men's work" and there was "women's work". Then, when my grandfather fell gravely ill, I saw it was my aunties, that means my uncles' wives, particularly my 阿姆, in Teochew, who took care of him. Then, when he died and during the last rites, I could see the men and the women had distinct roles and there were protocols during the last rites observed at the funeral. So, from young, I felt some dissonance because I was in Primary school then and, at that time in class, there was hardly any differentiation between boys and girls. If anything, the girls were often the better students while the boys were more playful and many of us were struggling to keep up. School lessons at that time already included stories like 花木兰, Marie Curie. And so, from a young age, we had both men and women as our role models.”
“The number of inpatient admissions associated with food-related anaphylaxis amongst patients aged 18 and below has increased from 49 in 2016 to 111 in 2020. Today, epinephrine injection drawn from vials or ampoules administered by physicians to patients who experience anaphylaxis is subsidised in public healthcare institutions. EpiPen is a brand of portable epinephrine auto-injector that individuals carry with them, in case of exposure to food or substances they are allergic to. It does not currently qualify for drug subsidies. Patients who face difficulty in affording treatment should approach the medical social workers at the public healthcare institutions for further specific assistance.”
“In any given week, even before COVID-19, there will be some healthcare workers who are rostered for extra duties, for example, to cover for colleagues who are sick or on vacation leave. During the COVID-19 global pandemic crisis, the pressure on our healthcare workers has increased tremendously. This was especially so over the last few months because, due to the Omicron variant, all our healthcare workers had put in an exceptional amount of extra effort and hours to take care of patients and keep our healthcare system running. MOH does not track such data as these are operational arrangements by the healthcare clusters and involve exigencies of service. As we now turn the corner from the current wave of COVID-19, our public healthcare clusters will do our best to allow staff the opportunity to rest and recharge and take vacation days and annual leave whenever possible.”
“This question has been addressed by the reply to Question Nos 46 to 49 on 4 April 2022. [Please refer to "Incidence of Long COVID amidst Recovered Singaporeans", Official Report, 4 April 2022, Vol 95, Issue 60, Written Answers to Questions for Oral Answer Not Reached by End of Question Time section.]”
“The pre-abortion counselling by a trained counsellor and a 48-hour time lapse after the counselling session is not required where termination of pregnancy is immediately necessary to save the life or prevent grave permanent injury to the physical or mental health of the woman. The requirements still apply to women whose babies have been diagnosed with foetal anomalies not compatible with life. In such situations, there may be options presented to the mother, such as proceeding with termination of pregnancy, or delivery upon confirmation of foetal demise, or delivery of a liveborn baby with planned palliative care to the point of neonatal or infant death. The trained counsellor would tailor the counselling session to the individual’s needs and focus on supporting the psychosocial, mental and emotional well-being of the woman. The 48-hour time lapse balances between avoiding undue delays where the situation may be life threatening to the woman and providing the woman sufficient time to prepare and consider her next steps to make an informed decision. Medical social workers and counsellors may also be activated, when needed, to support the distressed woman during this window.”
“Our general policy is that ElderShield (ESH) claimants who have been assessed to be permanently severely disabled would not need to be reassessed regularly, unless it is found that there has been a change in their condition. With the transfer of ESH administration from private insurers to the Government in November 2021, we are performing a once-off disability status refresh. Once ESH claimants are assessed to be permanently severely disabled during this disability status refresh, they would not be required to go for regular reassessment in the future. In view of the healthcare manpower crunch caused by the COVID-19 pandemic, the Ministry will extend the deadline for claimants to undergo their disability reassessments by three months. Claimants will continue receiving payouts during this period.”
“Some polyclinics can fill private prescriptions, but not all are able to do so due to limited capacity which may affect wait times and result in crowding. Prescriptions from private house-call providers can be filled at retail pharmacies. MOH will continue to review and improve the accessibility of care, including working with private healthcare providers, to facilitate accessibility to medications.”
“From September 2022, as part of the enhancement to MediShield Life, patients receiving cancer drug treatments can separately claim up to an additional $1,200 per year to cover other outpatient costs incurred, such as for scans, as part of the cancer drug treatment. This is above and beyond the claimable limits for cancer drug treatments. For patients undergoing radiotherapy, they can claim the cost of their scans and related services under the radiotherapy limits instead, which range from $300 to $1,800 per treatment. Scans that are done inpatient can continue to be claimed under the inpatient claim limits. Patients with Integrated Shield Plans (IPs), which cover seven in 10 Singapore Residents, may also claim the cost of their cancer scans from their IP where applicable. Singaporeans who face difficulties paying for cancer drug treatments and related services after subsidies, insurance and MediSave can apply for MediFund for further assistance.”
“As at end 2020, there are around 16,300 licensed nursing home beds. Based on our assessment of the needs, we plan to add around 5,000 nursing home beds by 2025. We increase nursing home capacity in three main ways. First, MOH develops purpose-built nursing homes and appoints operators through competitive Requests for Proposals. Second, MOH provides financial support to eligible operators who wish to increase their existing nursing home capacity through redevelopment. Third, the Government releases suitable land sites and state properties for interested operators to bid for and run nursing homes. We will continue to monitor nursing home utilisation rates regularly and adjust capacity plans accordingly to address evolving care needs.”
“There were 9,728 beds in the public hospitals as of end February 2022, with overall average monthly bed occupancy rate of 88.5%. There were 1,929 beds in the private hospitals as of end February 2022, with overall average monthly bed occupancy rate of 47%.”
“The time between the first and second Specialist Outpatient Clinic (SOC) appointments is dependent on many factors. These include a determination by the specialist on the severity of the condition, the clinical need for early monitoring, the need for intervening investigations before the next appointment and the types of treatment and procedures needed at the next appointment. Hence, MOH does not set a target wait time for patients’ second SOC appointment nor track the time between the first and second SOC appointments. However, if the patient’s condition requires an earlier review, the patient can contact the SOC for advice and the clinical team will work with the patient to determine whether an earlier appointment can be scheduled. During the COVID-19 pandemic, hospitals have put in place various measures to continue care for patients requiring SOC care. These measures include prioritising patients with higher medical needs for earlier SOC appointment, providing teleconsultation for suitable patients, providing home-delivery of medications so that patients can be assured of a sufficient supply, regular case reviews by the doctor-in-charge, contacting the patients to check on their progress and offering earlier teleconsultation or in-person consultation at the SOC, if needed.”
“The verification of positive Antigen Rapid Test (ART) results is necessary as part of official record-keeping to ensure that COVID-19 infection records are accurate. This can be done at primary care clinics, Combined Test Centres (CTCs), or Quick Test Centres (QTCs). MOH has also worked with approved telemedicine providers to provide remote supervised self-ART services, so as to offer more accessible options for members of the public who wish to have an official infection record.”
“All polyclinics and 20 Public Health Preparedness Clinics (PHPCs) are currently participating in a pilot programme to prescribe Paxlovid to clinically eligible patients in the community. The 20 PHPCs were selected by Primary Care Networks (PCN) based on their readiness to participate in the programme and are located across the island. We may extend this clinical service to more PHPCs after reviewing the experience and outcomes. Starting from 18 March 2022, eligible patients may be referred to the participating PHPCs or polyclinics for a consultation and prescription of Paxlovid, if appropriate. Paxlovid can be prescribed for any eligible COVID-19 patient who presents within five days of illness and meets the relevant clinical criteria. MOH has been monitoring the demand closely and maintaining a healthy stock of Paxlovid. For now, MOH will fully cover the drug cost of Paxlovid use in primary care settings, regardless of vaccination status, as it can reduce the likelihood of high-risk patients developing severe COVID-19 and requiring hospital admission. The charging policy for Paxlovid will be reviewed in due course.”
“MediSave is, currently, only extended to nationally recommended vaccinations and screenings which are already heavily subsidised or provided free, because they have been reviewed to be safe, cost-effective and appropriate for population-level screening for the selected groups, based on robust scientific evidence. This safeguards the use of MediSave and ensure that Singaporeans have sufficient savings for basic healthcare needs, especially in old age, and to keep MediSave contribution rates reasonable for all. For smoking cessation, individuals seeking support can enrol in the Health Promotion Board’s "I Quit Programme", which is free of charge. We will continue to ensure the affordability of appropriate preventive care.”
“The HCG quantum will be increased from early-2023, from $200 today to $400 per month for the lower-income, and $250 per month for other HCG beneficiaries. Other support measures include schemes like the Seniors’ Mobility and Enabling Fund to defray the cost of assistive devices and home healthcare items. For severely disabled Singaporeans, other schemes, such as CareShield Life, ElderShield and MediSave Care, may also provide monthly cash payouts.”
“In 2000, the ElderCare Fund was set up to support the financing of operating subsidies for intermediate and long-term care (ILTC) services through the annual interest income generated from the fund. Hence, since its formation, disbursements from the ElderCare Fund have been, primarily, allocated to finance nursing home subsidies. Where the same nursing home provider also provides other subsidised ILTC services, these are also supported. We wish to highlight that Table 1 on page 2 of the Elderly Care Endowment Scheme 2020/2021 Annual Report contained an erroneous "FY 2018" label, when it was meant to refer to disbursements made in Financial Year (FY) 2020, as reflected in the table title and preceding paragraph. We have clarified with Ms Carrie Tan that the question is on disbursements from the ElderCare Fund in FY 2020, instead of FY 2018. In FY 2020, the interest income from the ElderCare Fund was only sufficient to fund about 20% of the total operating subsidies for ILTC services. The home care services supported by the disbursements included home medical, home nursing, home personal care and home therapy services. The remaining 80% of operating subsidies for ILTC services were funded directly from the Government’s Budget. As the interest income from the ElderCare Fund is currently still insufficient to fully finance the annual operating subsidies for ILTC services, considering it for other uses beyond ILTC subsidies would be premature at this point. MOH recognises that informal caregivers play an important role in caring for our elderly. MOH has rolled out the Home Caregiving Grant (HCG), which can be used flexibly to defray the formal or informal caregiving costs for eligible individuals with permanent moderate disability.”
“For purposes of facilitating travel, it will be better to adopt internationally-recognised standards, such as that set by the World Health Organization, to define full vaccinations. Hence, our requirement is that the travellers must have completed a primary series of WHO EUL (Emergency Use Listing) vaccines, with the last dose of the primary series taken at least 14 days before arrival. This is also the definition used when we implemented the Vaccinated Travel Lanes. Travellers that meet the WHO definition for full vaccination will not need to undergo tests and Stay-Home Notices and can access various venues for 30 days. However, if the traveller is to stay in Singapore beyond 30 days and continue to enjoy vaccinated privileges, they must meet our domestic requirements to be considered fully vaccinated, which includes the three-dose requirement for Sinovac and Sinopharm, and the booster requirement. To allow travellers to meet our domestic vaccination requirements beyond the grace period, MOH will extend vaccinations and boosters through private healthcare providers, with full cost pricing.”
“Between April 2020 and February 2022, enforcement actions were taken against 1,862 individuals and 286 enterprises as repeat offenders for non-compliance with safe management measures. Harsher enforcement actions, such as higher composition fines or prosecution actions, have been meted out against these repeat and recalcitrant offenders.”
“Patients are eligible for up to 75% subsidies when seeking outpatient treatment at the polyclinics and public specialist outpatient clinics (SOCs), with Pioneer and Merdeka Generation seniors eligible for an additional 50% and 25% off their subsidised bills respectively. In CY2020, the average post-subsidy annual bill size for outpatient treatment of mental health conditions under the Chronic Disease Management Programme (CDMP) in the polyclinics and public SOCs was around $110 and $270 respectively. Patients can tap on MediSave at up to $500 or $700 per year to pay for their post-subsidy outpatient treatment of CDMP mental health conditions, depending on the complexity of their condition. In 2021, nine in 10 of all patients who withdrew MediSave under the CDMP did not reach their annual $500 or $700 limits. Patients can tap on MediSave for their mental health treatment at polyclinics as well as more than 90 accredited GPs and private clinics currently. We welcome more clinics to be accredited and trained to make MediSave claims for mental illnesses. Clinics may apply through the Agency for Integrated Care.”
“For witnesses who are assisting in Police investigations for acts of violence, the Police may refer them to resources, such as mental health helplines, counselling services run by trained professionals or the Institute of Mental Health (IMH) for mental health support.”
“This will also address Written Question No 36 asked by Ms He Ting Ru for the Sitting on 4 April 2022. "Long COVID" is not a formal medical condition or diagnosis. It is a general reference to varied persistent symptoms experienced by some persons after a COVID-19 infection. Persistent symptoms can also occur after recovery from many other infectious diseases. Persons who had influenza or the common cold may, for example, continue to have fatigue or a prolonged cough. The underlying reasons for these persistent symptoms after COVID-19 vary widely, as do the symptoms, and are under active research internationally. MOH does not track the absolute number of all patients with persistent symptoms after COVID-19. Medical experts in Singapore expect a small proportion of patients from the recent Omicron surge to be affected by persistent symptoms. This is because such persistent symptoms are more commonly seen after severe COVID-19, and Omicron has led to fewer cases of severe infections, compared to previous variants of concern. Further, our population is also highly protected from severe COVID-19 through primary and booster vaccinations. Most of the persistent symptoms, such as cough and fatigue, resolve on their own with time. But individuals with more severe symptoms, such as shortness of breath or chest pain, may require further medical assessment and care, and MOH advises these patients to seek medical attention. There is no single response to these persistent symptoms, and treating physicians would be best placed to assess and advise patients on their management and recovery and on the resumption of work, school and daily activities. As necessary, these persons will be referred for further care and support services based on their condition and medical needs.”
“The Seniors’ Mobility and Enabling Fund (SMF) provides means-tested subsidies for consumables and assistive devices to help frail seniors. It now also covers replacement and customised devices. SMF provides two tiers of subsidies capped at $1,200 and $2,000 per year for consumables. Over the past three years, more than 80% of clients have not fully utilised their subsidy caps. The average utilisation is below the mid point of the subsidy cap. MOH will continue monitoring utilisation trends to ensure seniors’ needs are met. In addition, individuals can also apply for other financial support schemes, such as the Home Caregiving Grant (HCG), which provides monthly cash payouts for eligible individuals. Severely disabled Singaporeans may also be supported by schemes, such as CareShield Life or ElderShield and MediSave Care.”
“Thank you. The MTF Co-Chairs have repeatedly been asked when is the next milestone, when is the next date, when is the next KPI to be reached and then we will open up further. We have always tried to avoid that approach that many countries took, that when we reach vaccination at X%, let us open up; on this day, let us open up. Because the virus has, over and over again, proven that it is totally unpredictable. So, we would really rather not tie our hands that way but we always look at the entire situation, look into all the unforeseen circumstances, look at the hospital situation, cases, severe cases, vaccination rate, take everything into consideration and make a judgement call. And, so far, it has served us well. We tighten up when we have to, to keep everyone safe and we also ease up when we can and letting economic and social activities resume as normally as possible.”
“Thank you. I agree with Mr Lim Biow Chuan. At some point, the rules must be more relaxed. VDS will be stepped down. The cost need not be incurred by businesses, and those who choose not to be vaccinated take the responsibility. It is in my answer actually. I just do not think it is now because have a care for healthcare workers at this point – they are still very busy. But the Member is right that the vaccinated number is unlikely to go up further. We are at 97% – probably, the highest in the world. How to go up further? Maybe go up marginally, but what we can wait for is for cases to go down further, for hospital situation to be eased; then, we will be in a position to review this and make the right decision.”
“I will answer the Member's questions in a straightforward way. Is it equitable? Actually, not quite. So many of us are doing so much to protect that 3.5%. Is it, therefore, to protect public health outcomes? The answer is yes. As I have explained, hospitals are not out of the woods. I just visited Ng Teng Fong General Hospital this morning. They are very busy. We can see cases coming down. We feel, generally, safer. We are prepared to gather together without safe distancing, take off our masks when we are outdoors. In the hospitals, it is still a crisis situation. Every day, we have hundreds of people coming to the emergency department. Many of them with chronic illnesses, some infected, but they do not know about it. But that is the outcome of two over years of focusing on COVID-19. The business-as-usual (BAU) workload has built up. Chronic cases have become more serious. So, hospitals are now busy. Healthcare workers need all our support. So, while we understand it is not exactly an equitable situation when you look at businesses, you do not want, at this point, to add workload to our healthcare workers. So, I will say the fair thing to do – we are just coming down the slope of the transmission wave. Let us go through it a bit more, make sure our hospitals are in a better position, healthcare workers have a breather. Then, I think we consider whether we can remove the VDS.”
“Like Influenza, which kills tens of thousands of people every year, we will need to continue to take precaution and adopt appropriate SMMs in order to manage the risk and damage from COVID-19. We are still some way to treating COVID-19 as an endemic disease, because the virus is still circulating around the world and evolving. The virus continues to spread widely in other countries, especially among those whose people are not well vaccinated, leading to significant evolutionary pressure. There is, therefore, still a risk of it mutating into something more dangerous, into a variant of concern. So, while we have eased up the SMMs and reopened our borders, the pandemic crisis is not over. We will have to continue to monitor the local and global situation, do our part to keep our country safe and continue to work together to tackle whatever challenges that may come our way.”
“5% of our adult population that is not fully vaccinated and they account for over one-fifth of cases that require ICU care or die. While the patient load at our public hospitals has eased, hospitals are still very busy. With the recent easing of SMMs and the resumption of visitors to hospitals starting today, workload will go up for our healthcare workers. The more cautious and correct course of action now is to keep VDS and not to risk having more non-fully vaccinated patients getting infected and needing hospital care and adding workload to our healthcare workers. Make no mistake. Individuals who choose not to be vaccinated impose a cost, sometimes a significant one, on our hospitals in terms of workload, businesses in operating SafeEntry checks and enforcement agencies in conducting checks. When we are sure that the situation in hospitals is stable and improving, we will review the VDS and consider if we can reduce the number of settings or remove it completely. Then, it will be a matter of individual responsibility of these non-fully vaccinated individuals to take precautions to avoid high transmission settings, or better still, change their mind and get vaccinated. Finally, Assoc Prof Jamus Lim asked if COVID-19 can be treated like Influenza at some point, as an endemic disease. This is the objective set out by MTF last year and we are making good progress, as a country. I should clarify, however, what "endemicity" means. It does not mean we treat COVID-19 as if it is not there. It is, in fact, the opposite, because endemicity means the disease is constantly there, circulating at a rate that is more predictable and not likely to disrupt normal lives.”
“On TraceTogether, and in response to Ms Hazel Poa and Assoc Prof Jamus Lim, MOH no longer relies on TraceTogether for contact tracing for the general public. Cases who self-tested positive and go on to Protocol 2 do not upload their TraceTogether data, and we rely on them to do the responsible thing to inform their contacts to self-monitor. So, there is really no need to compare the data between self-reporting and TraceTogether because, having vaccinated the vast majority of our population and being determined to live with COVID-19, we have passed that stage of the pandemic where we contact trace every case. Having said that, agencies that look after more vulnerable sectors, such as schools or preschools, continue to use TraceTogether for contact tracing. Further, the aggregated statistics generated by TraceTogether and SafeEntry can give us a good idea of the settings that are more susceptible to transmission of the COVID-19 virus. So, on the whole, the costs and benefits of TraceTogether change as we make further progress in living with COVID-19. MTF will, therefore, review its relevance and application to stand it down when it is no longer needed, while maintaining the capability to restart it should we encounter a more dangerous variant of concern. For SafeEntry and VDS, I will address them together because they are closely related. Today, SafeEntry is the most convenient way to check the vaccination status of an individual entering premises. If we decide to do away with VDS, then there is no need for SafeEntry. As of now, VDS is still needed. Even as we know that the Omicron variant is less severe than Delta, unvaccinated or non-fully vaccinated persons are still a lot more likely to fall very ill if they are infected. As of now, we have about 3.”
“Mr Liang Eng Hwa asked if we will review the safe management measures (SMMs), given that we have passed the peak of the Omicron wave. As the Member is aware, the relaxed rules came into effect on 29 March 2022, which is why we are all seated together today, and we have also transitioned to a Vaccinated Travel Framework on 1 April 2022. It is a decisive but calibrated move. We did not declare a Freedom Day nor did we declare the pandemic to be over, as some countries did. Taking a cautious step-by-step approach has served us well throughout the pandemic and we will continue to do so. That said, we were able to make this decisive move as we observed that the number of daily cases had been steadily declining in recent weeks. More importantly, the number of severe cases needing to be hospitalised had also declined. It is in this context that the Multi-MinistryTask Force (MTF) assessed the further easing of our SMMs and resumption of many normal activities to be appropriate. These relaxations will likely cause an uptick in daily cases, which we should be able to ride through without any major changes to our public health posture. Once cases subside further, we will consider further easing of the SMMs. This can include reviewing distancing rules between tables in F&B settings that Mr Liang Eng Hwa specifically raised, and I want to assure Mr Liang that I am aware that one metre versus 80 centimetres makes a huge difference to F&B establishments. It also makes a huge difference in terms of transmission. So, we have to weigh the costs and benefits. We will also review TraceTogether, SafeEntry, as well as Vaccination-Differentiated Safe Management Measures (VDS) which various Members have asked about. Let me go through the three measures in turn.”
“Mr Speaker, Sir, may I address Question Nos 19 and 20 in today's Order Paper and also Parliamentary Questions for oral answer filed by Mr Leong Mun Wai, Assoc Prof Jamus Lim and Ms Hazel Poa1 for the Sitting on 5 April, please?”
“The Ministry of Health (MOH) has taken various measures to ensure that ART kits are widely available. We conducted two nation-wide distributions of free ART kits to households in August and October 2021. Persons who test positive and their registered close contacts can collect free kits from ART vending machines located island-wide. We also issued over 200,000 ART kits to all Social Service Offices (SSOs) and 47 Family Service Centres (FSC) since October 2021, to be made available for their beneficiaries. We have also already facilitated more ART kit brands that meet our quality standards to be approved by the Health Sciences Authority (HSA) and made available for sale locally. The average ART kit retail price has thus been reduced from $12 to under $5. As we go through the Omicron wave, the demand for ART kits is high, and globally, supply is tight. Fortunately, we have secured supply early, and is generally able to meet demand so far. Another nation-wide distribution of ART kits will be welcomed by many, but will not be the best use of our stock at this stage.”
“Given that primary care is the first line of care, we have observed a 140% increase in daily average attendances due to Acute Respiratory Infection (ARI) at the Public Health Preparedness Clinics (PHPCs) and polyclinics from 9,100 in January 2022 to 21,810 in February 2022. However, as the Omicron wave wanes, which it will, the cases will fall. To support the primary care sector, MOH provides grants, enables test centres to certify infections, and has been encouraging those who experience mild or no symptoms to recover at home.”
“Mr Leong also mentioned incentive. I think I have answered that in my speech, which is we will have a consultation, we will put in the package, we will describe the package in the White Paper to be tabled in this House later. I think I have answered all his questions.”
“Thank you. Mr Leong said three questions, but I counted quite a number. I will just try to address them. First, he said PSP recommend "cutting" healthcare costs. It is not the right description of what we are doing here. We are trying to make people healthier. By making people healthier, it is less likely they will get chronic diseases and, so, healthcare costs can be moderated. It will still increase due to ageing, but we can moderate the increase. But we are not "cutting" healthcare cost per se. When treatments, operations, surgeries are required, they will be given. As for the middle class, how will Healthier SG take care of their current issues, where if they have a catastrophic illness, it will wipe out a lot of their cash? We are all responsible for our own health and in some sense, our own finances too. We are helping, not just the middle class, but everyone else, it has to be universal. We want to help every Singaporean take care of their own health, through Healthier SG. Outcomes delivered by our healthcare system, is not a new concept. I mentioned about setting outcome KPIs, but they have always been there. I mentioned some of them, today we have the highest life expectancy at birth for men and women, across 204 countries. That is a major outcome, delivered over the decades. And we will continue to focus Healthier SG on delivering right outcomes. But now, because of the design of that programme, we have to look at specific outcomes that we are driving at. How many percent taking up enrolment, taking up healthcare plan, how many percent have one single doctor, what is the subscription of doctors into this plan, how many doctors are in our national IT system, because those are essential. So, some of these outcomes, drivers have to be captured as well.”
“The short answer to the first question is yes. Choice will be preserved. And I mentioned in my speech: there are residents who for various reasons, see a doctor that is not near their home and in fact, out of the cluster that they come under. So, choice will be preserved as a principle. Second question: during our consultation, we will not prejudge what we want to include, or what we want to exclude. If the Member feels that out-of-pocket expenses for consultation is an issue, by all means, let us know. I assure you it will not be the first time we hear that feedback and certainly will have to consider. We want a package that is compelling, attractive and that we can afford.”
“Think through the funding process, communicate and talk to the clusters, build up the PCN structure, so that we have a basis to work on now. That 10 years of hard work enabled us to implement Healthier SG today. So, I think we need to get that perspective correct. As for the COVID-19 Healthcare Award (CHA), the intention is and has always been, to also distribute to outsourced workers who are full-time, working in the healthcare institutions. It has always been the intention, but the details took a while draw up. And so, shortly after this, it will be announced and they will get to know when and how much they are getting.”
“Healthier SG has been something we had been talking about for the last few months. When I came to MOH in May last year, my first speech was about preventive care. And I spoke to the healthcare community and the leaders of both private and public healthcare institutions, from then on, we have been talking about Healthier SG and consulting many people. What I announced today, in the healthcare sector, it is not a secret – except the name "Healthier SG" which we came up with a few weeks ago. But the capitation model, IT system, preventive care, enrolment process are some things we have been talking about. So, I am not surprised that Mr Leon Perera filed an Adjournment Motion talking about this topic, because it is a very live topic within the healthcare sector. And I thank him for that contribution. 5.15 pm But when he mentioned the outcomes going the other way, I think that argument is counter-factual. Imagine if we had not had HPB, imagine if we had not had "Step Challenge", imagine if we had not had the Primary Care Network (PCN), Public Health Preparedness Clinics (PHPCs) – I think that the outcome today would be far worse. Because we know what drove unhealthy populations are lifestyle, food, devices, sedentary lifestyle, all kinds of things that we are also guilty of. Fortunately, we have all these interventions. But in the last 10 years, could we have, as he mentioned, thought deeply about it and come out with Healthier SG? I think the ideas would have been there, execution would not be ready. It took 10 years, more than 10 years of work from my predecessors: set in place the structure, three clusters; put in place the basic IT system, without the IT system you cannot implement this.”
“Thank you for reminding us. We will do so. I should inform Members that, in Singapore, for our young children below 12, we have one of the best oral health in the world and that is because of a very strong collaboration between MOH and MOE schools. When we were in Primary schools, we all dreaded the dental nurse coming into the classroom and reading out our names, because that means we would be going to the dentist. But because of that, preventive care was done and executed very well for children. As we get older, bad habits set in and then dental hygiene and dental health deteriorate. So, actually, the dental programme is a very good story about how effective preventive health or preventive care can be.”
“Yes, we will have to measure the outcomes of success. I mentioned earlier that we are moving to capitation and, along with the funding model, there will have to be a set of KPIs and these will have to be outcome-based. I have mentioned some of them, such as prevalence of chronic illnesses, as well as the driving factors that lead to these outcomes, such as re-admission and various clinical effectiveness, cost effectiveness of treatments. I can tell you, as of now in MOH, we have developed such a long list of KPIs. We need to whittle it down to a more manageable set and, in time, I think we can share them. As to the Member's second question whether GPs are encouraged to work together, the answer is yes, because a third of our GPs are now already in PCNs or primary care networks and that is a very important resource and very important starting point to bring them into Healthier SG.”
“Let me talk about S+3M and I will invite Senior Minister of State Janil Puthucheary to talk about new hospitals and manpower. The Member is right to describe that it is a bedrock and it is also very robust, designed and evolved over the years. I took Members through the process of subsidy; insurance; remaining, use your own savings in MediSave which is also contributed by your employers; and then, for those with low income, MediFund. There is longevity in this framework. But having said that, even today, as Members read out your cuts, there are several suggestions: how to activate them better to help make things easier for the population to take care of their health. We will take them in, we will continue to review and, as you can see, over the years, the rules are always being refreshed, improved and strengthened to better support Singaporeans.”
“We want to extend these interventions to the broad population, which will benefit most those with lower incomes who do not have the time, resources or wherewithal to do this. I have been lucky to have a highly-trained and well-meaning doctor friend who nagged me and helped me. We hope everyone in Singapore will have such a friend, too – a family doctor to advise and nag us to do what is right for our long-term health and for our family. We want to make it easier and affordable for everyone to stay healthy. We will have a fuller debate on Healthier SG in the House later this year when we present the White Paper. I seek the support of Members to translate Healthier SG into a healthier Singapore population. [Applause.]”
“However, it is important to understand that spending on health is quite different from spending on, say, education, which is always forward-looking, moulding the future of Singapore. Healthcare spending is critical, it is essential but mostly about treatment – trying to restore a sick person back to where he was in the past and, often, imperfectly. Sometimes, we hear comments, including in this House, that healthcare spending is an investment in our people. If we are honest with ourselves, we know it is not the same as education. It is driven by deteriorating health that can be prevented. It is often about paying for unwise lifestyle choices of our past. But there is a component in our healthcare spending that is forward-looking and about investing in our future and, that is, preventive care. Healthier SG will grow that component. What we are saying here is that as healthcare spending inevitably grows in the coming years, let us have the discipline to always set aside enough to invest in keeping our people healthy for the future. Our multi-layered safety net in healthcare, embodied in the S+3M policy, will always be universal. That is, we will not have a situation which happens in other countries, where a patient comes to a hospital and gets turned away because he is unable to pay, because he is not covered by insurance. We will not let that happen. That universality will now expand in coverage, beyond medical treatment, to preventive care and population health. The more well-off and better-informed are already taking better care of themselves, with coaches, therapists, personal doctors and diet plans.”
“Over the next few months, MOH will conduct public consultation to gather views and inputs and come up with an attractive and affordable package. Within the package, perhaps, preventive health screening can be free, or at a nominal cost. Perhaps, more Medisave can be used to pay for medication. Perhaps, if you stay healthy according to your family doctor’s care plan, there could be MediShield Life premium discount. This is like car insurance. If your car is accident-free and no repair is needed, then your insurance premium will be reduced. After designing the package, we will draft a Healthier SG White Paper and table it in Parliament for debate. With the strategy direction in place and with the support and cooperation of hospitals, family doctors and the public, we can all lead healthier and more fulfilling lives, and the elderly can enjoy their twilight years happily. 5.00 pm (In English): Mr Chairman, a central issue of the Budget this year has been the increase of GST, because we need to meet the rising healthcare expenditure of an ageing population. Healthcare expenditure will increase because we are committed to make healthcare affordable to those who are sick by heavily subsidising healthcare bills. After subsidy, there is still a remaining sum that needs to be paid. We can cover most of them through MediShield Life. And then there is still a smaller remaining sum, which the patient can pay through his MediSave. And if there is still a small sum that the patient cannot afford, he can apply for MediFund. So, subsidy, then MediShield, MediSave and MediFund – that is, essentially, the S+3M framework – a multi-layered safety net for healthcare and it will continue.”
“Apart from this, the healthcare system will also be under more pressure, so will Government healthcare spending. Fortunately, many chronic diseases can be prevented. We know the saying "prevention is better than cure". TCM practitioners also often say that "illness is best treated at an early stage". But this requires lifestyle and diet changes, even before you fall sick. The Chinese idiom of “preparing for rainy days before the torrential rain” is most appropriate to use on healthcare. Therefore, our top priority is to help you stay healthy, instead of going to the doctor only after you fall sick. In any healthcare system, prevention and treatment are equally important. But with an ageing population, we need to recalibrate and tilt the balance towards preventive healthcare. Hence, we are going to launch the Healthier SG strategy. This is a national strategy that focus on preventive health – a strategy that will provide health check-ins for Singaporeans and improve their lifestyle and habits. We will encourage middle-aged Singaporeans to sign up with their family doctor. After that, the family doctor will work with public hospitals to assist you in disease prevention and stay healthy. The doctor will also help you do health screening on a regular and scheduled basis and get you vaccinated. They will work with community partners, including the People's Association and SportSG, to help you improve your eating habits and diet, quit smoking and do more exercises. But preventive care means that you see a doctor, go for regular check-ins and even health coaching when you are feeling fine. This is not the habit of Singaporeans. We tend to think "why do we see a doctor for no reason?". To encourage people to do so, we need some incentives.”
“We want to work towards a scenario that no matter where you are receiving care, for example, at the GP or dental clinics, polyclinics, hospitals, SOCs, nursing homes, eldercare centres, the same data can be retrieved to support your care. That is why MOH has been enhancing and rolling out the National Electronic Health Record (NEHR) system. We then need to ensure that such data sharing is secured and users take greater responsibility for data access. We would need new legislation to govern this and we intend to put in place a Health Information Bill in the next couple of years. Mr Chairman, let me now say a few words in Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] Chairman, in the next few years, we will be putting in place a major healthcare reform. We will focus on preventive health care for two reasons. First, ageing population. As we get older, we will inevitably have more illnesses. Second, Singaporeans are actually becoming more and more unhealthy. What we should do more, we do not do enough and vice versa, what we should do less, it is not sufficiently less. Not enough physical activity, not enough exercises on a daily basis, over-use of electronic gadgets, consuming too much sugar, salt and oil. Hence, there are more people with chronic diseases. If we do not change our lifestyle and habits, we will suffer more illnesses in the next 10 years. If you are sick, your quality of life will be compromised. After retirement, you may have plans to try something new, or spend time with your family, but should you become sick, you will be unable to achieve your aspirations. Once we fall ill, we have to rely more on our families, children and grandchildren for simple daily living or medical expenses, and this will add to their burden.”
“For example, once we roll out Healthier SG, I expect preventive care efforts to be implemented in communities and these efforts can be led by nurse clinicians and pharmacists, not necessarily by doctors. So, I foresee Healthier SG opening up many new job roles for our healthcare workers. Finance is another major support system. We have been funding our healthcare clusters, largely by their workload, such as the number of treatments, number of surgeries and operations. We will change this to a capitation model, where healthcare clusters get a pre-determined fee for every resident living in the region that they are looking after. Under the new system, the absolute budgets of each healthcare cluster will not be affected. In fact, the budgets will go up a little bit. What will change is the basis of calculating the budgets. Appropriate surgeries, procedures and treatments will always be provided when required. But with this shift in the basis of funding, there will be a natural incentive for hospitals to try to keep residents healthy through preventive care. Complementing this new basis of funding is a set of KPIs, a set of health outcomes. Some salient indicators are quality of care, uptake of healthy lifestyles and habits, prevalence of chronic illnesses, cost effectiveness of treatments and so on. The last critical support structure is IT. Family doctors in the frontline of Healthier SG will need good system and data support. They must have access to patients’ medical records. They must have the IT tools to track their patients' conditions and progress over time. They must also be able to share their records with other healthcare providers.”
“We have taken a geographical approach to enrol residents because this will cater to the needs of the great majority because, today, about nine in 10 residents will visit a family doctor or hospital near their homes. Nevertheless, individuals will have choice. You can choose whether to enrol or not. You can choose who to enrol with, even doctors who are far away from your home. There are a variety of reasons why some Singaporeans may decide to do that, because the clinic may be nearer to your workplace, near your parents’ place, or is a friend that you have known for many years. Finally, the last component. We need the necessary support structures to make Healthier SG work and this is actually no small matter. Manpower is a big part of this. Ms Mariam Jaafar asked for our workforce transformation plans. So, let me share briefly. We need to build up and optimise our primary and community care workforce further. Today, a fifth of doctors and nurses are in primary and community care. By 2030, we will need to increase this to at least a quarter. But besides growing the number, we will further build up the competencies and skills of our healthcare workforce. For doctors, family medicine should feature even more strongly in the curriculum of our medical schools. We now encourage new graduates not to become a specialist and do your residency straightaway but get exposed more broadly in medicine and build up confidence in dealing with chronic illnesses. Postgraduate training in family medicine will be strengthened, too. For nurses and other healthcare professionals, the potential for skills upgrading is even greater. We need to broaden interdisciplinary training and empower them to practise at the highest level of their licences.”