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 Ministry of Health (MOH) outlined its key strategies to manage healthcare cost during the recent Committee of Supply (COS) debate. These are widely regarded as international best practices. To manage growth in cost of delivery, we implemented Health Technology Assessments to ensure that we fund and encourage the use of health technologies that are clinically- and cost-effective. With these efforts, we observed that drug spending growth in the public healthcare system has slowed from around 10% before financial year (FY) 2021 to 5% in FY2023. We have also implemented a value-driven care programme throughout our public healthcare clusters, tracking and benchmarking quality and cost outcomes across common conditions and identifying areas for improvement. These ensure that what we spend on healthcare is commensurate with good health outcomes for Singaporeans. Demand for healthcare will grow with an ageing population. Through Healthier SG and Age Well SG, we are investing in population health to keep Singaporeans healthier for longer. We are transforming care to anchor care in communities as far as possible, instead of over-relying on acute hospitals. We developed and publish fee benchmarks for close to 2,200 common procedures and conditions to guide fee setting in the private healthcare sector. We also publish hospital bill size information across all hospitals and ward types to enable patients to make comparisons. Through a Claims Management Office that we set up in 2022, we have stepped-up monitoring and enforcement against inappropriate MediShield Life claims that may drive up costs and healthcare insurance premiums. Finally, an important factor to manage costs is to ensure that we maintain financial discipline in how we pay for healthcare.”
“The first line and the most established way to prevent or slow progression of myopia is to use atropine eyedrops. Singaporeans being treated at Public Healthcare Institutions for myopia-control receive up to a 75% subsidy for atropine eye drops prescribed by clinicians. However, myopia-control glasses and contact lenses are predominantly prescribed in retail and community settings and are not subsidised.”
“There are currently no plans to expand the national subsidised screenings under Healthier SG to include sexually transmitted infections.”
“The public healthcare institutions set and adjust their fees to reflect the underlying cost, before applying subsidies. The Ministry of Health does not specifically track the five-year fee trends of tests for chlamydia, gonorrhoea, syphilis, human immunodeficiency virus as well as hepatitis A, B and C.”
“We have urged the insurance industry to take a hard look at their policy designs, to rein in the domino effect of over-coverage, escalating bills and higher premiums.”
“The Member may refer to the oral reply in response to Parliamentary Question Nos 31 and 32 for the Sitting on 4 February 2025 for more details on the Ministry of Health's and the Monetary Authority of Singapore's disclosure requirements that apply to both Integrated Shield Plans (IPs) and Riders. [Please refer to "Insurers' Responsibility in Informing and Giving Adequate Notice to Policyholders for Changes in Coverage and Claims", Official Report, 4 February 2025, Vol 95, Issue 150, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.] As for the other query concerning the impact of these changes on the affordability and access to healthcare, the Member may wish to refer to the written reply in response to Parliamentary Question No 10 for the Sitting on 28 February 2025. [Please refer to "Effect of Changes to Integrated Shield Plans by Insurers on Policyholders' Out-of-pocket Expenses and Access to Healthcare Services", Official Report, 28 February 2025, Vol 95, Issue 155, Written Answers to Questions section.] The Government's assurance to Singaporeans is the universal access to subsidised healthcare in public hospitals, which is supported by subsidies, MediShield Life, MediSave and MediFund, to ensure affordability. IPs and Riders are private commercial products that are sized for unsubsidised healthcare. Over-coverage, especially the low co-payment under Riders, have changed the dynamics between patients and doctors, resulting in over-servicing, over-consumption and escalating medical bills. Individuals should carefully assess whether the very high premiums of Riders are worth the coverage it offers for residual items like co-payment and deductibles.”
“I can appreciate where the Member is coming from. When you have so many appointments, the toll on the caregiver is quite immense and it all looks a bit inefficient. 6..30 pm But the Member also works in a hospital, there are so many specialties and sub-specialties, and when someone is senior, they start to have many different problems with many different organs. And therefore, while we can coordinate, they still require review by several specialists. We will try to streamline as much as we can, but I do not think there can be a major streamlining and cutting down of appointments. I would moderate expectations on that. Having said that, as I mentioned to Ms Ng Ling Ling, there are a range of things we are doing to moderate healthcare costs, and if we can do so and keep people healthy, we also will be able to reduce the burden of caregivers. I would say we are going far beyond measuring value now. Value-driven care (VDC), as I was telling one consultant, is old technology for health system. And today, I think health economists do recognise that with VDC, you can eliminate operational or clinical or disease level wastage. But with the ageing population we need to eliminate population level wastage. It means it is no longer just about how you treat this person in the most efficient way and cost effective way possible. It is about saying that this person should not be here in the first place. This is the level of efficiency that we are going to achieve now. It is many years of transformation ahead and we will work together.”
“I would say, the polyclinics are quite busy, but we can leverage private clinics more for preventive oral care. My hypothesis is that when you go to a private clinic because you have a decayed tooth, the dentist says you need a root canal. It is more expensive today. It requires quite a few trips to the clinic, and so, you would rather extract or, in the first place, let us not go to the dentists. So, there is a bit of that behaviour. That is why we are increasing the subsidy for such restorative treatment quite significantly. With this step and with some more education, including a national dental plan that we are now drawing up, we hope that more people are aware of the importance of oral health and understand that any restorative treatment, and for orange CHAS cardholder's preventive care treatment, they will all be better subsidised now. I think more people will come forward and we can better leverage and better use the capacity we have today in all the private dental clinics. So, I think this is an important step we are first taking and we are still reviewing and drawing up our national dental plan.”
“On TCM first. TCM is a self-regulated field. So, the quality and the delivery of services has a big variation. So, I think we ought to be quite careful and always take an evidence-based approach. That is what we are doing now. Take certain treatments that we think has potential, has worked well in other countries, with evidence in existing literature, try it in our system, and if it works, we can then bring it into the mainstream. So, we are doing use case by use case, using an evidence-based approach. The Member mentioned MCs. Because it is a self-regulated system, it will be difficult for Civil Service or otherwise to pass a law to say that TCM MCs will be recognised. In any case, I think good human resource practice is to be able to tell your employees that when you are ill, call in sick. You do not have to produce an medical certificate and make an additional trip, either to TCM or to the polyclinic just to get the medical certificate. Actually, the Civil Service has already moved towards that. I think there are a few days in the year that you actually do not have to produce an medical certificate. You can call in sick and I think that is a better HR practice.”
“But because this is a lot more driven by policy, we adjust them instead every few years, taking into account general inflation. I think that is a much more practical approach.”
“Chair, before I answer Ms Hazel Poa's question, I forgot that I need to clarify two factual errors in my speech. First, when I was mentioning the attrition rate of junior doctors, I mentioned 7%. Actually, it is lower, at 3% to 6% over the past eight years. In fact, in the last two years, it was under 5%. When I was showing a chart, I mentioned that for long-term care, for those who were born in 1969 or earlier, they have an additional subsidy. I said the reason is because they are less covered by MediShield Life. I misspoke. It is that they are less covered by CareShield Life. As for Ms Hazel Poa's question, we are not adjusting the $500 to $700 yet. I know where she is coming from, because the Basic Retirement Sum and Basic Healthcare Sum are rising in tandem with inflation. Which is correct, because these are amounts of money that you want to save up for your old age and, therefore, when you spend, you must make sure what you set aside grows in tandem with inflation. However, when it comes to the claim limits of Flexi-MediSave or MediShield $500/$700, these are more policy-driven. Take, for example, today, we just announce that you can use MediSave to co-pay for dental root canal. Sometime ago, we say, we are subsidising Shingles vaccination and, whatever is the co-payment, you can use MediSave. Once we allow that, suddenly the demand for MediSave spending goes up. Therefore we review it and the increase from $300 to $400. So, if you look at what we have done, in 2021, it increased from $200 to $300; and now it increased from $300 to $400. Over five years, it has doubled from $200 to $400. So, if you have tracked inflation, actually, the increase will be much less.”
“But today, with all the step-down care, we begin to be able to discharge them. Today, the numbers of social stayers are far fewer, 50 to 80. So, from 300 down to 50, that is almost half a hospital freed up. 6.15 pm We do benchmarking now across the system to make sure that there is price transparency and patients have a basis of comparison, what is a more cost-effective healthcare. If you notice this, we have started doing some enforcement on doctors that have overcharged and overclaimed MediShield Life and MediSave. Finally, the most important two factors: one is financial discipline. I mentioned the UK NHS system. When you say healthcare is free at the point of care, actually it is not free. Someone else still has to pay for it. But to make it free for the patient means it is very expensive for the nation, because it will lead to a lot of excessive treatment and unnecessary servicing. So, that is why we have S+3Ms, including co-payment, to restrain the system. So, today we can deliver very good health outcomes at 5%, or, in fact, under 5% of gross domestic product. Actually, that is very good value for money. And finally, keep everybody healthy. Population health is critical. So, this is a summary of all the things that we are doing. I hope it is enough. But the Member is right. Healthcare costs cannot go on escalating like that. I am hoping that this is a post-COVID-19 phenomenon, where healthcare costs escalated because manpower costs had jumped post-COVID-19. Everyone, every country in the world realised that they need more manpower, they are hiring like mad and they have pushed up, globally, the cost of healthcare manpower. But I hope, at some point, this will stabilise. You will start to track general inflation rather than leads general inflation.”
“Thank you. There is a range of things we do to manage healthcare cost. For example, we now do central procurement and it gives us a bit more bargaining power, keeping prices low. We have a very disciplined system of what we call Health Technology Assessment (HTA), because there are so many new drugs today, so many new treatments. Some treatments may be 10 times more expensive than current treatment but promised to cure another 2% to 5% more of the patient population. So, you have to really sharpen your pencil and calculate, and see if it is worth it and is it cost-effective. So, HTA has been set up as a discipline within MOH to make sure that whatever we approve and subsidise is cost-effective. If it is not cost-effective, we start to have very frank discussions with drug suppliers, for example, to tell them that they need to lower their cost, then we can subsidise, which was the case for shingles vaccination and that resulted in a good outcome. Thirdly, as the Member mentioned, value-driven care actually is a major programme throughout our system. If the Member is interested, she can file a PQ and I will see what data we can share. But we are doing this across all institutions. We measure the KPIs against cost and then have a sense of how much we are spending to deliver the KPIs and the objectives that we want to achieve. Another major avenue to moderate cost is step-down care. When capacity is misused, it leads to a lot of wastage and resources. We used to have many what we call "social" stayers in our hospitals. When I first joined MOH, we had something like 300 to 500 of them – basically, people who no longer needed to stay in hospital but they had nowhere else to go. So, we keep them in hospitals and sometimes, families even admit them.”
“Through our S+3Ms framework, we will ensure no one is denied appropriate medical care because they cannot afford it. This Government understands that healthcare is a basic and essential public service that Singaporeans value. We have the experience, wherewithal, determination, ideas and policies to upkeep and strengthen this key tenet of our social compact. Our agenda for healthcare is transformative and long term and will take us well beyond this Budget year. I hope to have the continued strong support of this House, as we work together to overcome the mounting challenge of an ageing population, to cure sickness, to bring comfort to those in need and strengthen the health and happiness of all Singaporeans. [Applause.]”
“This gap is quite consistent with most developed countries, but we must try to narrow it. We need policies that improve population health. Individually, too, we can all practise better preventive care and take better care of our own health. Nationally, we need a major programme, hence Healthier SG. After one and a half years, we enrolled almost 1.2 million Singaporeans onto Healthier SG, about half of the eligible population. Three-quarters of our enrollees have also since completed their Health Plan consultation. Health screening, vaccination rates, they are all rising. Discernibly, more Singaporeans are exercising. We are happy with this good start. A lot of hard work lies ahead. We are inculcating more good habits amongst our population. We have cut down sugar consumption, including in the Members' Room. We are labelling packaged drinks. People are much more conscious. We are moving soon to sodium and saturated fats. We implemented Grow Well SG to improve health habits of our young. We are tackling the mental health challenge. And at some point, AI models will analyse our medical or even genetic data to predict 10 years ahead if we are likely to get a stroke, heart attack or cancer. And then, it will alert our Healthier SG doctor, who will, in turn, advise us what are the preventive steps to take. This is predictive preventive care – Healthier SG 2.0 – and we are not far away at all. Mr Chairman, we are determined to expand healthcare capacity. So, even though we are rapidly ageing, healthcare must be available when Singaporeans need it. We will develop our people, transform medical delivery and harness technology to continue to deliver high quality healthcare that Singaporeans deserve.”
“Something has to give. Indeed, in the UK, patients do not have to pay for public healthcare. But as a result, demand shoots up and they now have seven million public patients on the waiting list for elective treatments. Healthcare is affordable, but not so available. Dr Lim Wee Kiak asked what can we learn from other countries, including the National Health Service? I think what we can learn from the National Health Service is to try not to be in the position they are in now. Switzerland adopts novel medical technologies and ranks top in the world for quality. But about a quarter of the population chooses not to be treated, citing high cost. Hence, high quality healthcare in Switzerland, but not so affordable. 5.15 pm These countries offer an important lesson. If we are dogmatic and want to achieve one objective 100%, we pay a big price in the other objectives. But if we take a more practical approach, we can balance the trade-offs and try to maybe achieve all three at 80%. A key to achieving these lies in a healthy population. With better health, we can achieve all three at the same time without trade-offs. Mr Chairman, Dr Lim Wee Kiak talked about healthy longevity. A friend of mine, in his 70s and an avid golfer, once said that the perfect way for him to go is when he is 100 years old, playing golf, hits a beautiful shot, scores a hole-in-one, he is so happy, he collapses and dies. He may sound like he is joking, but I think he is dead serious. What he essentially described is the “holy grail” of healthcare where healthspan equals lifespan and you are healthy enough to do what you love until the last day. We are far from that scenario. Singapore, indeed, has one of the highest average lifespans in the world at 84, but our healthspan is only 74.”
“Many Singaporeans have actively participated, and more are starting to exercise more, which I find very encouraging. Today, I hope to convince more seniors to stay physically and mentally active. Besides doing exercise, seniors also need social circles to surround themselves with laughter. That is why we have established Active Ageing Centres across the country. We are providing these centres with more resources, to allow them to organise more activities and gatherings for seniors. In my constituency, I am a loyal promoter of Active Ageing Centres and have gained some insights through this. Inviting seniors to Active Ageing Centres is somewhat like making multiple visits to win someone over. When seniors first hear about Active Ageing Centres, they may ask out of curiosity, "What are these centres? Who built them?" Some might even ask volunteers, "Are you a property agent?" As we further explain the activities at Active Ageing Centres, seniors often become increasingly open to the idea of them. When we then tell them the centre has weekly communal meals and tell them, "Please come, it is on us", we then see the joy on their faces. In ancient times, martial arts masters would fight and kill each other to obtain martial arts secrets. But today, what we need are the secrets to good health, not martial arts. These health secrets are in fact readily available – eat healthily, get sufficient sleep, exercise regularly, go for regular health screenings and visit Active Ageing Centres when you can. These are the secrets for good health. (In English): Mr Chair, let me conclude. I spoke about our plans to achieve our three big objectives of public healthcare. The problem is that they are competing objectives, a trilemma. It is impossible to achieve all three fully.”
“Most of them have retired and live on their savings. When they need to use their savings to pay for medical expenses, they inevitably worry about not being able to afford them. Therefore, over the years, we have implemented many policies, including the Pioneer Generation and Merdeka Generation packages, as well as the Healthier SG and Age Well SG initiatives to reduce medical costs for our seniors. Last year, we adjusted the CHAS eligibility criteria, allowing more CHAS Orange cardholders qualify for CHAS Blue cards. I also just announced several new measures. First, we are increasing the withdrawal limit for the Flexi-MediSave scheme from $300 per year to $400. Second, we are increasing subsidies for certain dental services. Singaporeans can now also use their Flexi-MediSave to pay for root canal treatments and dental crowns. Third, we are increasing subsidies for long-term care services. From time to time, Singaporeans ask MOH to provide more subsidies. We understand this request and where reasonable and feasible, we will adopt these suggestions. But as the saying goes, there is no such thing as a free lunch. Whether it is more subsidies, more insurance payouts, or even free services, they all cost money. And these costs are ultimately borne by citizens through fees, insurance premiums or taxes. Through a multi-pronged approach of subsidies, insurance, MediSave and co-payment, we will continue to strive to reduce wastage of resources and avoid unnecessary treatment or overtreatment. By containing healthcare inflation, we can control the burden of cost for our people. For most people, the best way to ensure they can afford medical expenses is to maintain a healthy lifestyle and stay away from illnesses. Therefore, we launched the Healthier SG initiative.”
“Hence, by the end of this year, we hope all public healthcare institutions will adopt generative AI systems that can automatically transcribe doctors' conversations with their patients and summarise them for doctors' review before they are entered into patients' healthcare records. By the end of this year, too, we hope all public health institutions will be able to use AI to automate and improve the accuracy of imaging scans, such as chest X-rays and mammograms. Mr Ang Wei Neng and Ms Ng Ling Ling asked about TCM. The quality of our system can also improve if we can successfully integrate aspects of TCM proven to be safe and effective to complement Western medicine as part of mainstream healthcare. Singapore is a multicultural country, open to learning from all parts of the world. If there is a jurisdiction outside of Greater China that can blend and integrate Western medicine and TCM, it should be us. We made a lot of progress in recent years. We now have our own TCM degree delivered by the Nanyang Technological University enhanced professional training, we streamlined examination requirements and we are strengthening the TCM accreditation framework. Today, certain acupuncture treatments are already incorporated in mainstream public hospital treatment. Later this year, SingHealth and the Academy of Chinese Medicine, Singapore will be co-organising a forum on the integration of TCM and western medicine. It will be attended by both TCM practitioners as well as Western doctors. I think it will be a great platform to explore further opportunities to identify further steps to synergise the strengths of both systems. Mr Chairman, my speech now in Chinese. (In Mandarin): [Please refer to Vernacular Speech.] For seniors, a major concern is medical expenses.”
“Technological breakthroughs, like AI and genomics, are ushering a scientific revolution in healthcare. Dr Lim Wee Kiak spoke about this. We are now working on new legislative protections to safeguard the use of genetic test information. These are important and sensitive personal data. In my view, these data should not be used to decide on issues, such as insurance underwriting, hiring people or granting of university places. But we will need broad public consultation for this legislation. Such a law is important to anchor the moral foundations of our society even as medical science breaks new grounds. With sufficient legal assurance, we will have the confidence to actively explore and experiment with the use of technology. Finding the right use cases is critical. We are not waiting for the legislation. We are starting now. In fact, we started some time ago. Many good applications are emerging. Singapore General Hospital is deploying an AI-powered app for parents to screen their babies for jaundice at home using their handphone with an app. The app is trained with Singapore's multi-ethnic data and is sensitive to different skin tones. At the National University Hospital, doctors use AI to recommend treatment for patients by tapping into a vast database of historical caseload. With this tool, some doctors quipped that a junior doctor can now perform almost at the level of a senior doctor, because the experience is granted to them through AI. In all these projects, the healthcare professionals remain in control of patient care and are enabled and enhanced by AI tools. Where an application is workable and is effective, we will expand it throughout the healthcare system.”
“From the moment they enter medical school, the subsidy we provide, the investment we made in our talent when they come into the system, going through housemanship, as a junior doctor, going through residency. We invested heavily and we continue to invest heavily in our doctors. But in championing the welfare of junior doctors, I urge Mr Faisal, too, to consider the interest of patients. Remember, healthcare is not like aviation. When pilots need to rest, passengers just have to wait for the next flight. All of us have experienced that in airports before. If we do that for doctors, patients will be left untreated and their lives can be in danger. So, for MOH, we constantly have to balance the welfare of healthcare workers as well as patients. If we suddenly limit the working hours of doctors, patients will suffer. There have been many efforts for us to better manage these tensions, which the Senior Minister of State Dr Janil Puthucheary will elaborate on. Transformation of our medical workforce is key to maintaining and improving quality of care. The profiles of our patients are changing – generally older, with multiple health conditions requiring simultaneous management and coordination. We are, therefore, re-organising the healthcare workforce. This means complementing specialists, who are very skilled in managing specific organ systems, with doctors with a broader breadth of expertise who can anchor, coordinate and manage cross-specialty issues for patients, which Dr Tan Wu Meng talked about. This will enable us to deliver more holistic and integrated care, and it will be a key priority in the coming few years. Besides the organisation of people, the ingenuity of our people matters just as much in driving quality.”
“Over Chinese New Year, I also announced salary enhancements for pharmacists, allied health professionals, administrative and ancillary staff later this year. About 37,000 staff will benefit. Doctors are another key area. We have increased the intake across our three medical schools from about 500 in 2020 to 550 in 2024. We have expanded the list of recognised overseas universities, so we can welcome more Singaporeans studying medicine overseas to return to Singapore to practice. Our healthcare workers, including junior doctors, they are dedicated and work very hard. Heavy workload is a phenomenon in all developed countries, which are ageing and experiencing rising patient load. Mr Faisal Manap spoke up about the difficulties that junior doctors are facing. I thank him for caring for our doctors. But let me state a few facts. One, the Employment Act does not cover professionals, managers and executives (PMEs), including doctors. The hours that you mentioned do not apply. I think many PMEs, including Members in this House, we work quite a number of hours, beyond what is specified in the Employment Act. Number two, I hope Members do not go away thinking that we are facing a major outflow of doctors. Our attrition, post-COVID-19, is about 7%. It is healthy. I wish it can be slightly lower, but actually, it is quite healthy. [Please refer to the clarification later in the debate.] Thirdly, salary adjustments for doctors were implemented 1 February 2024 only recently and we try to make sure we are competitive. I want to emphasise: MOH has cared for our people and invested in them heavily for decades.”
“This means that illnesses are effectively treated, patients’ preferences respected and innovative technologies leveraged to ensure patients can recover and get back to health quickly. The intangible aspects also matter. Kindness and care must fill our wards and clinics so patients do not feel alone in their journey of convalescence. When a patient nears end-of-life, we walk the last mile with them and ensure that they leave peacefully. What matters most to quality is actually our people. Our healthcare workers, they are the driving force behind good care. We saw that during COVID-19, and they deserve all our respect, appreciation and encouragement. 5.00 pm We are not doing badly in retaining and attracting talent. We are fortunate that Singaporeans want to join the healthcare sector. Our healthcare education programmes see healthy intakes. I always say, if you go to a primary school, for every 15 young students you see, one is likely to join healthcare. For every 20 students you see, one is likely to become a nurse. Regionally, we are an attractive place for foreign nurses. We worked with the Singapore Nursing Board to significantly reduce the processing time of registration applications from six months in the past to now, 30 days. We moved examinations online. With these moves, we become even more competitive. In 2023, we recruited about 4,500 new nurses. Last year, we continued this momentum with another 3,800 new nurses and introduced the Award for Nurses' Grace, Excellence and Loyalty (ANGEL) scheme. That was introduced in 2024 to encourage nurses to continue viewing their profession as an attractive long-term career.”
“So, they are not in any danger, but they just need a short stay in hospital. So, this acute medical ward caters to this kind of patients and immediately provided relief to the Emergency Department. During COVID-19, Singapore General Hospital had to convert this link bridge between two blocks into bed space for Emergency Department patients that overspilled. And no more space, we put them along the link bridge. Not many people knew that. Dr Tan Wu Meng knows that. The beds were recently removed and the bridge is now open to pedestrians again and one of the final harrowing memories of COVID-19 has now been removed from SGH. From 2025 to 2030, we plan to add another 13,600 beds to our system. This includes about 2,800 public acute and community hospital beds to be added to Singapore General Hospital, Changi General Hospital, Sengkang General Hospital and also Woodlands Health. It will also include beds in the redeveloped Alexandra Hospital and the new Eastern General Hospital, which will open progressively from 2028 and 2029 respectively. This will bring public hospital beds from 12,000 today to 15,000 in 2030. That is a 25% increase. We will also add around 10,600 more nursing home beds. That is a huge number. But that is the number that we have to deal with as our population ages. In the following decade from 2030 to 2040, the new Tengah General Hospital will open. Singapore General Hospital campus and the National University Hospital Kent Ridge campus would have undergone major redevelopment to further improve national healthcare infrastructure. The third and final objective is to ensure high quality.”
“Post-COVID-19, like many countries in the world, we saw many more seniors with complex conditions. A couple of years of isolation and neglect of chronic conditions have taken their toll. The average length of stay in hospitals jumped abruptly from six days to seven days post-pandemic. Sounds like one day, but it means a 15% increase in workload for hospitals. Worse still, COVID-19 delayed our infrastructure development. We have been doing major catch-up in infrastructure development. Expanding capacity, however, does not mean just building hospitals. We need smart capacity, across a spectrum of care needs and, especially, in the community. Only then will we be able to give the most appropriate care for different types of patients. Over the past five years, we have expanded capacity by over 6,300 beds, as shown on the slide. This includes 1,200 acute hospital beds with the opening of Woodlands Health and across other hospitals. This is the part in white. We rolled out Mobile Inpatient Care@Home and commissioned 200 beds. We opened new community hospitals and added 600 new beds and we also added 4,300 nursing home beds. And adding nursing home beds is a major move, because if a senior cannot find a nursing home bed, they will end up in the hospital. This capacity makes a huge difference. With Woodlands Health, the capacity crunch at Khoo Teck Puat Hospital has finally eased after many years. Bed occupancy has fallen from the typical 100% or more to now a healthier 85%. Average waiting times have thus fallen. Recently, the Singapore General Hospital opened an 80-bed acute medical ward to support its Emergency Department. It caters to patients who have suffered, say, a fracture or you met with an accident and you are in shock.”
“The enhancements for these schemes will be implemented progressively from January 2026. With these enhancements, over 80% of seniors, especially those being cared for at home, will pay less for their long-term care services. Let me illustrate with three examples. Example one is a lower-income family supporting a moderately disabled grandpa receiving home and community care. They pay about $600 a month today. In 2025, the interim rebates kick in, and their out-of-pocket payment will drop to about $500. In 2026, when the full enhancements are implemented, it will drop to $200. Thereafter, fees will continue to rise in tandem with inflation and income. Example two is a lower-income family who recently admitted their severely disabled grandma to a nursing home. The monthly out-of-pocket payment now is about $1,300. In 2025, when the rebates kick in, this will decrease to $1,150. In mid-2026, when the full enhancements are implemented, payments will further drop to about $1,000. Example three is a disabled grandma from a lower-income family who has been staying in nursing homes for a few years now. Instead of $1,300 a month, today they pay a discounted amount of about $900, because MOH caps their fee increases. The upcoming enhancements will formalise this temporary arrangement. We will continue working closely with providers to manage the fees that families have to pay, which should not change much this year. Over time, their fees should rise gradually in tandem with inflation and income. The entire package of long-term care enhancements will benefit more than 80,000 seniors, who can expect to receive support of up to $2.1 billion, from 2025 to 2030. Chair, let me move to the second objective of public healthcare, which is to ensure availability.”
“It is also not fair to the providers, most of which are charities. It is time for us to improve our subsidy framework and significantly expand our structural support for seniors and their families. The next slide illustrates the changes we are making. The left side is nursing homes, the right chart is for home and community care subsidies. The X-axis on each slide is the per capita household income bands, while the Y-axis is the subsidy percentages. The white boxes show the current subsidy percentages, the blue and orange boxes are the additional subsidies. So, you see everything moving up. In short, we will, as indicated in blue, increase subsidies by five to 15 percentage points for almost all eligible households; expand eligibility for maximum subsidy of 75% to 80% from about two in 10 to about three in 10 households. So, you see the leftmost two columns of each chart are now of the same height. So, the maximum subsidy is now expanded to a larger group. Provide additional subsidies of five to 15 percentage points, as indicated in orange, for those born in or before 1969 as seniors in these cohorts are not well covered by MediShield Life; and expand eligibility to cover from six in 10 today to about seven in 10 households, so more can benefit. [Please refer to the clarification later in the debate.] The increases in subsidies will be effective from July 2026. It is more than a year from now. So, between now and then, we will provide interim rebates, which will keep the fees low for Singaporeans using long-term care services. Similar enhancements will apply to community dialysis services too. We will also increase the Home Caregiving Grant and expand the coverage of the Seniors’ Mobility and Enabling Fund, as announced by the Prime Minister in the Budget Statement.”
“Both the enhancements and fee benchmarks will be implemented around the fourth quarter of 2025. Use of Flexi-MediSave will be effective sometime in the middle of 2026. The final area is long-term care services. The Prime Minister mentioned this in the Budget Statement, so let me elaborate. Long-term care is for seniors who have become frail, disabled and dependent on others to carry out daily activities, such as eating, showering or changing. They are cared for in two main settings; one is nursing homes, or, at home, with support from community and home care services. Mr Xie Yao Quan asked if there could be fee caps for these services. In fact, both services today are heavily subsidised by the Government, with co-payment by users. With an ageing population, our annual national long-term care operating expenditure has almost doubled over the last five years, from $1.7 billion to about $3 billion today, and it continues to rise. This is because as one gets older, our care needs intensify. There is also considerable upward pressure on fees. This is mainly driven by manpower costs, especially post-COVID, where salaries of healthcare workers globally were reset to a much higher level. To ensure affordability, MOH has been increasing funding to support nursing home providers, while also quietly imposing caps on fee increases for existing residents. We did not announce this but, quietly, we have been doing that to keep fees low. So, nursing home providers also absorb part of the higher costs for these existing residents. As for seniors newly admitted to nursing homes over roughly the past one year, they have been paying higher fees and this can be a financial burden to their families. This arrangement is not sustainable.”
“This means the dentist will remove the decayed parts of the tooth, including the nerves in the roots of the tooth, and then fill it up, and then cap it with a protective artificial crown. The tooth is, therefore, saved. It adds to your 20 teeth; 20 teeth include those that you save. They said no, because extraction was cheaper and it involves fewer trips to the dentist. But this is penny-wise and pound-foolish. We will have fewer and fewer teeth as we grow old if we take this approach. This diminishes our ability to chew effectively and in our old age, affects our nutritional intake. We will, therefore, increase the CHAS dental subsidy limits for restorative procedures, such as root canal, for Pioneer and Merdeka Generation as well as CHAS Blue and Orange cardholders. We will also allow Flexi-MediSave to be used for costlier treatments like root canals and permanent crowns at CHAS dental clinics and public healthcare institutions. The next slide shows the net impact for a typical Merdeka Generation cardholder, someone with a tooth decay but decides to save it. For this senior, a molar root canal after subsidy costs about $700 at a CHAS clinic, that is the leftmost column, which he must pay by cash today. After the subsidy enhancement, the out-of-pocket payment will be about halved, to $370. He can also use up to $400 in Flexi-MediSave, so there may not be any cash payment required, and that is the rightmost column. When subsidy goes up, we must prevent some providers from raising prices sharply and creaming off the subsidy. We will, therefore, have to strengthen governance to prevent abuse, by introducing fee benchmarks for common dental procedures. So, MOH will follow up with this.”
“This scheme provides seniors aged 60 and above the flexibility to use their MediSave for outpatient treatments at polyclinics, public Specialist Outpatient Clinics, as well as Community Health Assist Scheme (CHAS) clinics. This limit was last raised in 2021, from $200 to $300. Since then, outpatient medical needs have grown further. We will therefore increase the withdrawal limit to $400 per year, from the fourth quarter of 2025. Dental health is another area where affordability is becoming a concern. Several MPs have raised this and asked if oral health can be part of Healthier SG. Actually, preventive dental care predates Healthier SG. All of us remember in primary school, the dreaded moment the dental nurse comes in and calls your name, that was preventive care, long ago. There has been a longstanding collaboration between the MOE schools and MOH to protect the teeth of the young. However, in adulthood, oral health deteriorates. Generally, a person needs at least 20 natural teeth to chew effectively. Unfortunately, only about half of our older population have them. We will take further steps, therefore, to encourage preventive oral care and hopefully, preserve more teeth. Currently, only Pioneer Generation, Merdeka Generation and CHAS Blue cardholders enjoy subsidies at private dental clinics for preventive procedures, such as scaling, polishing and filling. We will extend subsidies for these dental procedures to CHAS Orange cardholders. 4.45 pm I have met many residents, and these includes my own Citizens’ Consultative Committee Chairmen, who suffered from tooth decay and then decided to extract their tooth. I asked them, "Why don't you save the tooth?" It can be done via a root canal procedure, which is quite common now.”
“I have spoken about these objectives in earlier COS speeches, but let me talk about our plans in the coming few years, for each of these objectives. First, affordability amidst rising costs and inflation. Dr Lim Wee Kiak, Mr Yip Hon Weng, Ms Mariam Jaafar and Ms Hazel Poa asked about this. We therefore have the S+3Ms framework – Government Subsidies, MediShield Life, MediSave and MediFund – to cushion patients from healthcare cost increases. Today, seven in 10 patients in subsidised hospital wards pay nothing out-of-pocket, zero; while eight in 10 pay less than $100. We constantly review and enhance the S+3Ms framework, to adapt to emerging clinical practices and also, new circumstances. Last year, we updated the income thresholds to allow up to 1.1 million Singapore residents to qualify for higher subsidies. A few months ago, we announced significant adjustments to MediShield Life, to better protect Singaporeans against major hospitalisation episodes, and then defray costly outpatient treatments like dialysis. Most recently, we announced subsidies and MediSave withdrawals for vaccinations against Shingles. Today, I will talk about further adjustments that we are making. One, I start with MediSave withdrawal limits for outpatient scans. Over the years, Magnetic Resonance Imaging (MRI) and Computed Tomograph (CT) scans have become more commonly used for diagnosis of certain conditions, such as cancer, as they are more detailed and accurate than X-rays. But they are also more costly. To ensure these remain affordable, we will double the MediSave withdrawal limit for such outpatient scans, from $300 to $600 per year, starting in 2026. Next is Flexi-MediSave. A few Members of Parliament (MPs) have asked about this.”
“Thank you. When I first joined this Chamber 10 years ago, in 2015, the Government's annual health budget was about $9 billion. I was then-Minister for Education; my Ministry was in second place, at $12 billion. The Ministry of Health (MOH) was very far behind at $9 billion. This year's healthcare budget is $21 billion, moved to second behind the Ministry of Defence (MINDEF). By 2030, it is estimated to be over $30 billion – at least another $10 billion increase. In comparison, a two-percentage point increase in GST gives us about $5 billion more in revenue today. We need the additional GST revenue, paid for mostly by those who are better off, foreigners and tourists, to continue to support universal and affordable healthcare for Singaporeans. The support given in healthcare is practically all structural, instead of vouchers. We can argue about the perfect timing for raising tax revenues. However, if we do not raise the revenue in time while the population ages and healthcare expenditure escalates, we will not be debating budget marksmanship then. There will not even be a balanced Budget target board to aim for, as our fiscal position will be deep in the red. That said, we cannot let the healthcare expenditure curve escalate uncontrollably. It is a bill all of us, ultimately, have to pay, as taxpayers, as patients or as insurance policy holders. But it is very difficult to rein in escalating healthcare expenditure, especially when it is a matter of life and death for ourselves or for our loved ones. Further, all round the world, people have high expectations of the public healthcare system. Our three biggest wishes are for healthcare to be available when we need it, of high quality and affordable.”
“Mr Chairman, the most active exchange during this Budget debate has been over fiscal policies – saving as a nation or budget marksmanship, temporary vouchers versus structural support, increasing the Goods and Services Tax (GST) earlier or later. As Health Minister, I feel that I have a duty to somewhat weigh in. Chairman, in the course of my speech, may I display a few slides on the LCD screens please?”
“Influenza vaccination services in retail pharmacies were introduced as part of a sandbox on 28 October 2024. We will conduct a review of its effectiveness and safety after six months of data, taking into consideration information from site audits, user feedback, the management of any vaccine adverse reactions or reportable events and the overall uptake. A decision on whether it will be extended will be taken later in the year.”
“Influenza circulates globally year-round and there is no way to prevent cross border spread without extreme economic costs to Singapore. We urge Singaporeans to take preventive measures, such as being vaccinated against influenza, practising good personal hygiene, avoiding crowded places and wearing a mask and seeking medical attention promptly when unwell.”
“A breakdown of the utilisation of the lifetime limit is in the table below.”
“The Ministry of Health (MOH) and MOH Holdings (MOHH) are setting up hostel-type accommodations to house foreign healthcare workers who are new to Singapore and employed by the public healthcare institutions. This eases their entry into Singapore. MOHH will have capacity to house about 2,000 occupants across five sites by end-March.”
“The average attrition rates of various specialists ranged from 1% to 7% over the past few years. However, for specialties that have fewer doctors, each resignation can translate to a significant percentage and are, hence, subject to higher year to year variability in attrition rates. We continue to plan long term and maintain a healthy training pipeline of new specialists across all fields to meet healthcare needs. Moving forward, as Singapore ages, the more critical need in clinical manpower is less likely to be for specialists, but doctors with broader skills that can coordinate and integrate care across specialists. Hence, we have been training more Family Physicians to anchor primary and community care, and Hospital Clinicians to anchor hospital-based care.”
“Subsidies will be available to all Singaporeans and Permanent Residents who meet the eligibility criteria for shingles vaccination under the National Adult Immunisation Schedule. These criteria are based on an individual's susceptibility to shingles infection or increased risk of complications. Individuals who are not eligible for subsidies are less susceptible to shingles infection. Nevertheless, they can still benefit from the reduced price that the Ministry of Health has negotiated with the vaccine manufacturer, if they receive the vaccine at CHAS general practitioner clinics or public healthcare institutions.”
“Pre-implantation Genetic Screening (PGS) is still a pilot and it is premature to consider subsidies until we have properly evaluated the programme for both clinical and cost effectiveness. In the meantime, we have provided pilot funding to the programme so that PGS is more affordable for eligible patients.”
“The Ministry of Health (MOH) implemented anonymous Human Immunodeficiency Virus (HIV) testing to encourage at-risk individuals to come forward for HIV testing. This was necessary as at-risk individuals might be deterred by the requirement to notify MOH of the case details of a positive result under the Infectious Diseases Act (IDA). Personal identifiers are not required for the notification of other sexually transmitted infections under IDA, namely, syphilis, gonorrhoea and chlamydia.”
“Under Project Silver Screen, seniors found to have functional abnormalities in their vision, hearing and oral health are referred for further investigations at community-based services operated by the healthcare clusters, such as community eye and hearing clinics. Seniors among this group with more complex conditions that cannot be managed within the community are referred to specialists at the public healthcare clusters. Between October 2023 and September 2024, about 39,000 seniors participated in Project Silver Screen. Of which, about 5,000 were referred to specialists.”
“Over the five years from 2018 to 2022, about 500 women each year attempted to have a second child through Assisted Reproductive Technology (ART) after having used ART co-funding previously to conceive their first child. More recent data is not available. These women had a mean number of three unused co-funded ART cycles, or a median of four unused cycles, after the first child.”
“We have urged the insurance industry to take a hard look at their policy designs, which we believe are fueling healthcare costs and also detrimental to their business. MOH will continue to publish information on IP premiums and coverage to facilitate consumers in making informed decisions on private insurance plans. The public needs to constantly examine if the premiums paid are worth the healthcare expenses they cover.”
“The Government's main assurance to Singaporeans is the universal provision of subsidised healthcare in public hospitals, supported by subsidies, MediShield Life, our national health insurance scheme, MediSave and MediFund. On the other hand, Integrated Shield Plans (IPs) are private commercial products. IPs are subject to the Ministry of Health's (MOH) requirements on key parameters, such as the co-payment and deductible. Private insurers update their IPs regularly, such as the premiums, claim limits and scope of coverage, in accordance with the policy contractual terms, and based on their commercial and actuarial considerations. In making these changes, MOH expects insurers to ensure that their policyholders' interests and well-being are safeguarded. The Member may refer to the oral reply in response to Parliamentary Questions 31 and 32 for the Sitting on 4 February 2025 for more details. [Please refer to "Insurers' Responsibility in Informing and Giving Adequate Notice to Policyholders for Changes in Coverage and Claims", Official Report, 4 February 2025, Vol 95, Issue 150, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.] Insurers have recently been raising IP and especially Rider premiums. MOH has publicly expressed our concerns on these commercial products before, that due to their comprehensive coverage, they have changed the dynamics between patients and doctors. As such, individuals with IPs and Riders are significantly more likely to make claims, with significantly bigger bills. This has contributed to claim amounts rising sharply, which, in turn, drive up premiums.”
“In 2024, the median wait times for referrals from primary care providers to public hospital Specialist Outpatient Clinics (SOC) were 35 days for subsidised patients and 12 days for unsubsidised patients. That said, these are median wait times. Patient referrals, whether subsidised or unsubsidised, are first and foremost prioritised based on the urgency of their medical conditions. Cases assessed as urgent will be given earlier SOC appointments regardless of their subsidy status.”
“As shared in an earlier answer in 2022, the average nurse-to-patient ratio for general wards in the public acute hospitals remains unchanged at around one nurse for every four or five patients. [Please refer to "Nurse-to-patient Ratio and Efforts to Reduce Nurses' Administrative Workload", Official Report, 2 August 2022, Vol 95, Issue 66, Oral Answers to Questions section.] In the Intensive Care Units (ICU), the ratio is higher at about one to two nurses for every ICU patient, depending on the complexity of each case.”
“Public hospitals typically verify patients’ identities by checking against a photo identification document, for example, their physical National Registration Identity Card (NRIC) or in Singpass. In medical emergencies, such as when patients are brought into the emergency department unconscious, the patients will be temporarily registered using a system-generated unique identifier number. This is necessary to ensure that medical care can be immediately provided, as any delay may harm the patients. Later, when the patients are able to produce their photo identification, for example, their family members bring their NRICs to the hospital, their records will be updated in the public hospitals’ systems.”
“The incident arose when a patient who was brought into the hospital by an ambulance did not have his National Registration Identity Card with him, lied about his identity, in order to conceal a criminal offence committed earlier. This resulted in a wrong data entry, which the hospital has to rectify later. In the rectification process, no payment was made to any information technology (IT) vendors. Everything was done by existing IT personnel, but it was a tedious process. The hospital was asked by the Police to estimate the cost, and the estimate of the cost of in-house manpower needed was $10,000. Lying about one's identity is a very serious matter. It endangers the patient and the clinical team and also incurs unnecessary costs and man effort.”
“The uptake for influenza and pneumococcal vaccinations recommended in the National Adult Immunisation Schedule (NAIS) have been on a steady rise in recent years. For pneumococcal vaccination, the uptake among residents aged 65 and above increased from 22% in 2020 to 61% in 2024. The uptake for influenza vaccination in the same age group also increased from 18% to 42% over the same period. There is already substantial financing support for vaccines in NAIS. Influenza and pneumococcal vaccinations are free for eligible Healthier SG enrollees, and other Singaporeans receive subsidies between 50% and 87.5%. MediSave may also be used to further reduce out-of-pocket costs at Community Health Assist Scheme (CHAS) general practitioner clinics and polyclinics.”