Rahayu Mahzam
Singapore
“We engage the insurance providers quite regularly, but we are very mindful about where we intervene, especially because they need to be competitive and there is a commercial dimension to it, which we feel that we should respect. So, how we intervene is via the conditions that are put in place vis-a-vis the consumers.”
“So, that is not something they can worry about. There is already the S+3M framework that is already in place, so we know that MediShield Life is one, they have their MediSave and if all else fails, there is MediFund.”
“Should there be disputes over specific claims, policyholders can take it to the Financial Industry Disputes Resolution Centre (FIDReC), an independent and impartial institution that assists with insurance-related disputes.”
“It is just a symptom, so the underlying cost pressures still need to be addressed. The description that we had put earlier in the past is that it is a knot that we need to untangle; and that is something we are doing with a multi-pronged, with engagements with different parties and stakeholders.”
“I appreciate the Member's feedback. As I said earlier, this is something that we will continue to consider. But we do also have to appreciate that the information that we get is live, in terms of waiting times and all that.”
“But I do take the point and we are actually reviewing to see what is a meaningful way to put out this information so that the public can understand, so that we can all track properly whether the good health outcomes are a result of the efforts that we are making. I will take the feedback back and we will continue to review this.”
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“The latter will cover statements that a reasonable person would conclude are likely to harm the reputation of the victim and likely to cause any other additional harm to the victim. These two categories of harm differ slightly from the others in terms of the remedies victims may seek. I will touch more on this later. There have been suggestions to include two new categories, namely sexual grooming and the publication of online material that encourages or promotes suicide or acts of self-injury. These harms have not been included at this stage, because, firstly, these harms are already addressed through other measures in our broader online safety framework, through the Penal Code for sexual grooming, and the Broadcasting Act for online material that encourages or promotes suicide or acts of self-injury. Secondly, the OSRA Bill is designed in a way that seeks to stop online harm from occurring, such as through the removal of content. This is made possible because the online harm is identified through a single, discrete post, like the 13 categories of harms I described earlier. In contrast, sexual grooming often occurs over the course of communication or exposure to various pieces of content, where each individual piece of content may not be harmful in and of itself. Thirdly, OSRA is designed in way that relies on user reports. Recourse can only be provided in cases where the victim recognises that they are victims. Unfortunately, it is often the case that victims of sexual grooming or consumers of self-harm and/or suicide content, are not aware that they are victims. However, in such cases where these victims do come to the Commissioner for assistance, the Commissioner will work with the relevant agencies, including the Police, to provide the necessary assistance.”
“This category of harm will not be applicable to statements that tend to rally or call the public to undertake core political activities, such as calling for others to vote for a candidate in a Presidential or Parliamentary election. The ninth category is the non-consensual disclosure of private information. This harm is defined as the publication of any private information of a person without consent, and that a reasonable person would conclude was likely to cause that person harassment, alarm, distress or humiliation. The types of information that would be deemed as private would be context specific, and would depend on whether the information is already in the public domain. Whether the individual is of the view that the information is sensitive may also be taken into account by the Commissioner. The Minister for Digital Development and Information will also be able to prescribe certain types of information as "private information". The 10th and 11th categories are the incitement of enmity and the incitement of violence. Enmity refers to feelings of enmity, hatred or hostility against any group. Violence refers to unlawful force or unlawful violence. These harms are what we term "group harms", as they aim to tackle harmful online content that is likely to harm groups in Singapore. A group will be defined as a group of persons of any description and may include, for example, a group distinguished by race or religion. Lastly, the 12th and 13th categories are the publication of false material and the publication of statements harmful to reputation. The former will cover statements about a person that are false and that a reasonable person would conclude are likely to cause harm.”
“Like intimate image abuse, this will include images or recordings that may have been altered or generated by AI or other means and will cover depictions of both physical and sexual child abuse. Sixth, inauthentic material abuse. With the rapid development in AI technology and the advent of more powerful and easily accessible generative AI models, we have seen more deepfakes being used to cause harm to others. This harm is defined as the communication of inauthentic material that a reasonable person would conclude is likely to cause harassment, alarm, distress or humiliation because it is false or misleading. The material is regarded to be inauthentic where it is an image, video or soundbite that has been manipulated or generated through digital means to create a false or misleading depiction of the victim's words, actions or conduct, and is realistic enough such that a reasonable person would believe that the victim did say such words or engaged in such actions or conduct. This category includes not only expressed depictions but also implied depictions. Seventh, online impersonation, which is defined as online activity where one person pretends to be another without their consent and would lead a reasonable person to believe that the activity is conducted by the second person. However, parody, satire or commentary which no reasonable person would believe is made by the victim, is not online impersonation. The eighth category is online instigation of disproportionate harm. This harm seeks to address the issue of "mob behaviour" or cancel campaigns, where one individual calls for numerous others to pile on to another person, in response to the person's actions or speech, instigating disproportionate harm.”
“The Steering Committee was chaired by then-Minister for Law and Home Affairs, Mr K Shanmugam, and made up of Government agencies and experienced industry members. Let me now explain each harm in turn. First, online harassment, including sexual harassment. Online harassment is defined as the communication of online material that a reasonable person would conclude is threatening, abusive, insulting, sexual or indecent, and is likely to cause a person harassment, alarm, distress or humiliation. Second, doxxing, which will cover the publication of a person's identity information that a reasonable person would conclude is likely to have been intended to cause harassment, alarm, distress and humiliation. Third, online stalking, which will be defined as engaging in a course of online conduct that involves online acts or omissions associated with stalking, and that a reasonable person would conclude is likely to cause harassment, alarm, distress or humiliation to the other person. Fourth, intimate image abuse or the non-consensual sharing of intimate images, a harm that can result in a severe and lasting impact on victims. This is defined as the communication of online material that contains an intimate image or recording of a person, without their consent, that a reasonable person would conclude is likely to cause that person harassment, alarm, distress or humiliation. This includes images or recordings that may have been altered or generated by artificial intelligence (AI) or any other means. An offer to sell or distribute, and advertisements of an intimate image or recording, are also included. Fifth, image-based child abuse.”
“Mr Speaker, earlier, Minister Josephine Teo spoke about the genesis, the intent of the OSRA Bill and the need for more to be done to improve online safety. I will take Members through the Bill. Let me first give an overview of the structure of the Bill. The Bill is split into 15 Parts. Part 1 consists of standard provisions, such as the purpose and interpretation sections. Part 2 establishes the Office of the Commissioner of Online Safety, or the Commissioner. Part 3 defines the categories of harm that will fall under the scope of the Bill. Part 4 governs the statutory reporting mechanism; and Part 5, the types of directions that may be issued by the Commissioner. Part 6 covers the investigative powers of the Commissioner. Part 7 governs the oversight mechanisms that the Commissioner will be subject to. Part 8, on offences and enforcement. Part 9 consists of provisions relating to service of documents and powers to make regulations. Parts 10 to 13 establish the statutory torts and the damages that may be sought under the torts, which Minister Edwin Tong will speak on later. Part 14 deals with jurisdictional, procedural and miscellaneous matters, and Part 15 covers amendments made to other Acts. In my speech, I will be focusing on Parts 2 to 8 of the Bill, and will explain how the Bill will help to define what behaviours are unacceptable in the online world. Part 3 of the Bill will specify 13 categories of harm, with each category defined in legislation, to create a common understanding of the scope and definition of each type of harm. These definitions were developed in consultation with the public, platforms and were guided by a Steering Committee.”
“The Member's last question is in relation to sustainability of resources. Indeed, this is of concern. As the number of people living with dementia increases, this is something that we will have to be concerned about and the Government will have to continue to monitor and manage our healthcare expenditure to ensure long-term fiscal sustainability. But at the same time, ensuring that those who need help, people living with dementia and their caregivers, actually receive the support they need. So, we do different things to ensure that there is sufficient support, but we also look at preventive health. There is a need to continue with our population health efforts to ensure and manage the factors of dementia, such as high blood pressure. That is something that we will continue working on. 1.00 pm”
“Mr Speaker, I thank the Member for the questions. With regard to her first question on access to information and resources, the post diagnostic support community outreach team that I mentioned earlier, CREST-PDS, is designed in a way to catch caregivers and patients at the time that first diagnosis was made. It aims to provide timely support and support is given during a six-month period. The teams partner with selected hospitals and polyclinics to reach out to and support these clients. This programme provides the education on the condition, coordinates community resources, and facilitates early planning and management of the condition. As of December 2024, seven teams have been set up and it has reached out to over 800 persons living with dementia and their caregivers. So, I suppose as this programme continues to be rolled out, more and more caregivers and their dementia patients will benefit from this. Her second question was on respite care. At the moment, the caregivers who require subsidised respite care can tap on a few options. If they need respite care for say, a few hours, they can have the elderly put up at one of over 130 senior care centres that provide dementia day care services. Those caring for seniors with higher care needs can tap on respite care in nursing homes, for up to a month for a year. There are over 60 nursing homes offering nursing home respite care. Caregivers of homebound dementia seniors or homebound seniors can tap on the Home Personal Care Services (HPC) for respite. These can help the caregivers with the activities of daily living. In fact, there was an announcement recently about how the HPC has been enhanced. So, there is HPC+, which would be rolled out and be available to caregivers as well.”
“Mr Speaker, yes, we are tracking the different prevalence and trends. The limits as well as the chronic diseases that come under the CDMP are regularly revised and reviewed so that we can ensure that they remain adequate for those who need them. 1.01 pm”
“We do the review periodically, as and when we are looking into it, and when we have reviewed something, we will make the announcements. Recently, as the Member has highlighted, we announced the Flexi MediSave increase from $300 to $400, and we also increased the amount that you can tap on for outpatient scans, because we know those are big-ticket items, from 300 to 600 items. So, we will continue to review this. Members who wish to give feedback can also let us know. But as I said earlier, it is really about the balance. There is a need for us to make sure that there is sufficiency for a long run. We also need to understand that there are many different levers. There are many different avenues of support. There is the Community Health Assist Scheme (CHAS), there is the MediFund in situations where they need it. And we may need to look at what are the different ways in which you can help support the particular individual. But I am open to see if there are any further areas for which Members feel that there is a need of this. We do do this review fairly regularly.”
“On the question from the Leader of Opposition, I appreciate the sentiments, because I also do get those appeals from time to time. I would suggest that the Member can surface it to the Ministry. In fact, we do take a case-by-case approach to the situation, depending on the age. There have also been compassionate considerations, especially if the person is approaching end-of-life; there have been circumstances where there has been a bit more discretion exercised and leniency given. But we really have to look at the circumstances, the treatment, the costs as well as the balances in the MediSave.”
“So, these are things that reflect that we do review this periodically and will enhance it where appropriate.”
“But I would just want to stress that there has been no situation where if they cannot afford the treatment, they do not get the treatment, because that is usually prioritised. The last bit, the Member had asked about how do we ensure that those from low-income families are not prevented or discouraged from applying for exceptional withdrawal limits. I would say that no one is prevented or discouraged from applying for the exceptional limits. Each application will be looked at on its own merits to account for, among other things, their ability to afford it, how much their MediSave balances are, and whether there are other supports that are available. For example, as I said earlier, MediFund. So, they should not hesitate to ask for help if they need to. On a broader point, I just want to highlight that the first point is that MediSave is just one of the options for those who need support. There are other financial avenues available and I hope that patients are aware of that and would seek help from the medical social workers for that. The second point is, it is always tricky about MediSave. The intention, the whole objective of MediSave is to ensure that you have enough for the big catastrophic events that happens. And this typically happens later part in life. So, we need to find that balance of making sure that there is accessibility to its usage, but to also preserve it for healthcare needs in the future. To that point, we do review it periodically to make sure that there are sufficient enhancements and support given. As you know, recently we made the announcements about the extension of usage of MediSave for outpatient treatments, as well as, for outpatient scans – Flexi-MediSave and Outpatient scan.”
“Mr Speaker, I thank the Member for the questions. I can appreciate concerns from her residents, but I would like to highlight that in respect of her first point, within the public healthcare institutions, there are medical social workers who are embedded in the system and are ready and available to give guidance to the patients when they face difficulties in paying their bills. I would also like to highlight that beyond just the usage of MediSave, having exceptional circumstances where they can withdraw within the limits, there are also other sources of support, including access to MediFund, discretionary support in the hospitals, in the public healthcare institutions. So, that is a key point to note. I would encourage the patients to go and seek support from the medical social worker, because they may be able to then look at the slew of support that is available for the patients. On the second question, I would like to stress that in our healthcare institutions, the priority is given to providing treatment as necessary. So, no patient would be in a situation where they would not be able to get the treatment they need if it is medically indicated because of their financial circumstances. That would be prioritised and that would be something that the healthcare workers and the doctors and the nurses will ensure happen. In the other part of the question, the Member asked about the timing needed. It really depends on the cases, because we do need to look at each case and the nuances and the reasons behind the application. And the complexity of the case may matter, in terms of the timing as to how we come up with the outcomes.”
“We encourage companies and agencies to adopt accessible digital design practices. And as individuals, we can help a neighbour or family member with picking up a new digital skill, model positive use of technology for our children and simply choosing kindness in our online interactions. Together, we can build a Smart Nation that genuinely serves everyone, not just those who are digitally-savvy, but all of us, with our different abilities and needs. The digital future is inevitable, but the kind of digital future we create is entirely up to us. Let us make it one we can all be proud of.”
“Just as it takes a village to raise a child, it takes a whole-of-society commitment to successfully support parents and youths in the digital age. We are committed to partnering with community and industry partners to make practical and accessible resources readily available for every parent. These resources will be tailored according to the various stages in the parenting journey, based on their child's developmental age range and their experiences with key digital milestones. For example, first exposure to screens, first phone. We want to support parents in cultivating healthy digital habits in their children from a young age. However, creating a positive online culture is not just about parents and children. Every single one of us contributes to shaping our shared digital space. I would like to encourage all of us to be kind in our digital interactions and cultivate habits of care that extend to the online space. Maybe before we share that post, we can pause and consider how our words might affect someone else. When we see cyberbullying happening, perhaps we could report it instead of scrolling past silently. These might feel like small gestures, but they will shape the digital culture we are all part of. As many in this House have alluded to, building a "we first" society starts with "me". The Government is committed to ensuring every Singaporean can be part of our digital future. Progress in building our Smart Nation must be shared by all and no one should be excluded or left behind. The vision of an inclusive digital society is a shared responsibility that requires us to all lean in. We would like to invite community partners to help support digital parenting in this ever-changing landscape.”
“We will be establishing an Online Safety Commission next year to provide timely and accessible assistance to victims who encounter online harms, such as cyberbullying and intimate image abuse. We will continue to review our legislation and build necessary regulatory safeguards. We are already studying approaches taken in jurisdictions, like the United Kingdom, European Union (EU) and Australia. In particular, we are looking at the implementation of age assurance measures in these places to guide our own efforts. We are engaging social media platforms, think tanks, technology vendors to understand the space. We want to put in place effective legislation that can protect our children from harmful and inappropriate content online. However, legislative levers alone cannot create the kind of safe and trusted online community we want to live in. For that to happen, we each must play our part to build a culture of respect and kindness in our shared digital space. I am encouraged by how families are stepping up. Parenting in the digital era comes with real challenge and I see parents putting in their best efforts. Based on our recent Digital Parenting Survey, we know that the majority of parents guide children's digital use, but many have expressed little or no confidence in doing so. Beyond stronger legislation, parents wanted access to relevant resources, such as online courses, guides and workshops, that can help them manage their child's digital activities. Today, we have the Guidance on Screen Use in Children to provide clear advice on the matter; a Positive Use Guide to guide healthy and positive uses of technology and social media; and the Parenting for Wellness initiative with resources to address matters, such as cyberbullying and managing screen use.”
“Accessible digital design is about more than just lines of code. It represents our shared commitment to building an equitable, thriving environment where everyone can take part confidently and with ease. Now, I would address something that has been weighing on many of our minds – keeping our online spaces safe and welcoming for everyone, especially for our children. In addition to the threat of misinformation and disinformation, we are seeing the troubling rise in online harms and negative online behaviour. According to MDDI's Online Safety Poll 2024, more than 70% of respondents indicated that they have encountered harmful online content such as cyberbullying. To better protect Singaporeans from online harms, we have been strengthening our regulatory tools. For instance, the Broadcasting Act was amended to allow us to enhance online safety of Online Communication Services (OCSs), which, at present, comprise social media services (SMS) and app distribution services (ADS), also known as the app stores. The amended Broadcasting Act grants the Infocomm Media Development Authority (IMDA) the legal powers to issue directions to disable access by Singapore users to egregious content found on OCSs, such as content depicting child sexual exploitation. Furthermore, the amendment also provides IMDA with the legal powers to issue Codes of Practice to require designated social media platforms and app stores to put in place systems and processes to mitigate the risks of exposure to harmful content for all Singapore users, especially for children. We are also stepping up efforts to improve support systems for those affected by online harms.”
“He uses the voiceover function to tell him what is on the screen but if a banking app is not properly labelled, the voiceover reads out unhelpful descriptions, like "button" or "image", that does not allow him to perform the task that he intends. A straightforward task like checking his bank balance or reviewing transactions becomes a frustrating guessing game. Beyond incorporating inclusive design features that serve users with special needs, a well-designed app enhances usability for all of us, regardless of age or ability. That is why we are working to improve this and as Government, we are taking the lead. We recently refreshed the Digital Service Standards, which serves as a set of guidelines for designing Government digital services. The new standards guide developers in aspects of digital accessibility so that digital Government services are compatible with assistive technology and are easier to use. We are also actively involving citizens in improving user experience of digital Government services and ensuring such services are accessible to all. A key part of this effort is our Tech Kaki community. Tech Kaki brings together citizens from all walks of life who share their experiences and insights to help us design better Government digital services. For example, the Health Promotion Board (HPB) engaged over 800 Tech Kaki members for feedback on their user experience and the useful insights shared led to refinements in the Healthy 365 app features. Such efforts contribute to ensuring the app is accessible to all Singaporeans, to support them in living healthily. Our hope is that whether it is applying for housing, booking a doctor's appointment, or seeking social support services, the experience should be smooth and reassuring for all users.”
“Two years ago, he attended a one-day workshop at MakeIT, the library makerspace in Punggol Regional Library, to learn the basics of 3D printing. The workshop sparked his interest in 3D printing as he could see his ideas brought to life. Recently, he has expanded his skills to include Gen AI tools for advanced designs. Every week, Mr Ronnie returns to the library to create puzzles and toys for his grandchildren, hoping to kindle the same creative passion in them. At MakeIT, he also met people with similar interests and enjoyed exchanging ideas and tips with fellow members. Mr Ronnie's experience captures the spirit of our libraries as places to spark curiosity, equalise access to technologies and strengthen community through learning. Beyond libraries, learning also takes place at over 50 Digital Clubs that have been set up by People's Association Active Ageing Councils and SDO. These Digital Clubs promote peer learning and seniors are encouraged to learn from one another because, sometimes, the best teacher is the person sitting next to you who just recently figured something out and remembers how confusing it felt at first. To promote more of such learning communities, we will be collaborating with the Agency for Integrated Care to bring these clubs into Active Ageing Centres closer to where seniors normally gather. Having access to technology and knowing how to use it is important but there is another piece of the puzzle that is equally crucial. Digital services should feel intuitive and easy to use for all users. Take banking apps, for example. Most of us find them quite easy to use. But Mr Ng Choon Hwee, 70, who has a visual impairment, faces a very different experience.”
“In these programmes, they are also taught how to recognise suspicious links or offers online and build healthy digital habits. It is inspiring to watch them overcome their fears, adopt a positive attitude and embrace new digital technologies. We also understand that not everyone is ready or able to go fully digital and that is okay. This is why we have kept alternatives, like physical CDC vouchers. Residents who need assistance with Government digital transactions can continue to get in-person assistance at Government agencies' physical service touchpoints. They can also visit ServiceSG Centres for assistance with 600 frequently-used Government services and schemes. We encourage digital-first but will not be digital-only. We will continue to help citizens access Government services through whatever means they prefer. There is so much to learn about digital and we are trying to make it easier for everyone to be part of a learning community so that we can grow together. We are thinking about our children's future in this digital world and have introduced new AI for Fun modules to our existing Code for Fun programmes in primary and secondary schools in 2025. Students now get hands-on experience with AI technology, where they can learn to use generative AI for brainstorming and creating content, while understanding how to use it safely. And this learning journey extends beyond schools and beyond just teaching the young. Earlier this week, I spoke on how libraries serve as places where we can learn new knowledge and exchange ideas with people who have similar interests. The same goes for learning about digital. Take Mr Ronnie Meng, for example.”
“Let me share what we have been doing at MDDI and will continue to do to tackle these challenges. We have a long-standing commitment to support our seniors and low-income families in their digitalisation journey. For low-income families, we recognise that technology can feel like yet another financial pressure. That is why we have programmes that offer subsidies for Internet access and devices and over 20,000 households have benefited since 2023. During COVID-19, many activities moved online, leaving some seniors overwhelmed and at a loss with the abrupt changes. So, we set up the SG Digital Office (SDO) with digital ambassadors to support the digitally less savvy with essential digital skills such as accessing government services like Singpass and health services and communicating online. Since 2020, SDO has engaged over 40,0000 seniors and they will continue to walk alongside seniors on their digital journeys. Mdm Jeannie Chian, aged 67, from Bukit Batok East, used to feel left behind in our digital world where she saw younger people move easily through QR codes and mobile payments. She was scared that she would not be able to catch up. She also wanted to be independent. So, when she found out about the SDO's training programmes from a digital ambassador during a community event, she decided to give it a try. After attending the programmes, she gained the skills and today she can confidently use e-payments. Mdm Chian's experience reflects what we are seeing across Singapore. More and more of our seniors are going online. In 2024, 72% of seniors have the skill to find information online up from 53% in 2020. While it is also true that there are some seniors who are put off by the fear of being scammed online, the guidance at the SDO programmes help address the concerns.”
“Thank you, Mr Speaker. I stand in support of this Motion. The President's address reminds us that our success as a nation cannot be measured by economic growth alone. It is also about how we support every Singaporean, young or old, to contribute and to live with dignity. We all play a part in creating communities of care that demonstrate compassion and ability to build common ground despite our varied experiences. This commitment to create communities of care should endure, even as our lives in Singapore become more digitalised. We must be committed to making sure that going digital helps every Singaporean. No one should be left behind. Singaporeans should feel safe and respected in the digital space, and all of us, regardless of age, can look ahead with optimism and hope. Today, digital technology has already woven itself into almost every aspect of life. We access digital government services, use the Internet for school and work, shop online at our convenience and connect with loved ones through messaging apps and social media. This reality brings both opportunities and challenges and we know that the digital transformation is not easy. Seniors feel overwhelmed, trying to keep up with new digital functions and apps. Some families face financial pressures regarding devices and Internet plans. Parents worry about the impact of screen time and what their children might encounter online especially with cyberbullying becoming increasingly prevalent. Our young people feel anxious and stressed by the pressures and comparisons that social media can amplify in their daily lives. All of us, regardless of age, have probably been caught off guard by increasingly realistic fake content that is becoming harder to identify. These concerns are real and they matter to us.”
“I thank the Member for the feedback given. As far as I am aware, it is practised. But perhaps I could engage the Member to get some specific details of the case to understand where the gap is and why that was not communicated to the patient.”
“Subsidised patients who are transferred to another public healthcare institution to continue the care for their condition, can retain their subsidy status without the need for a polyclinic referral. This applies whether within the same cluster or between different clusters.”
“The Member had asked specifically about the benchmarks that I mentioned earlier. I do not have details at this juncture. We already have benchmarks on the professional fees. We are looking at how we can also create some benchmarks on the hospitals' costs, which would probably include some of the elements the Member mentioned.”
“I thank the Member for the questions. I worry that as we are discussing these issues, we run the risk of conflating many different issues together. There are many different dimensions and contributions towards increasing healthcare costs, including also an ageing demography and an increased burden of chronic diseases. And at a larger level, there are a lot of things that MOH has to do to address the cost. This is also in the space of putting in Healthier SG, doing upstream efforts, making sure screening is in place, making sure our people are healthy. There is a whole slew of efforts that we are putting in place to arrest the increased healthcare cost. This particular situation that we are debating here today relates to a different dimension. It is about how people are consuming products. It is about how the insurance system works. It is about the design of the insurance product. And it is making sure that the different stakeholders in this ecosystem are aware that they all need to do their part. MOH will continue to facilitate this process and it is important for us to appreciate that it is not just about putting in regulations. It is not just about putting in the rules, because we do need to assess. Some of the suggestions that Members have raised here today are things we need to assess, because it may cause a reverse effect. There are measures and ways in which insurance companies will need to address some of their costs to remain sustainable. We need to make sure that those efforts then do not undermine the protection, fairness and transparency to the policyholders. So, that is something that we will continue to manage. We will take in the suggestions and we will continue to review it. But the issue is about making sure that everyone in the ecosystem plays a part.”
“We are also contemplating setting up more private hospital options, especially affordable ones, very much like Mount Alvernia, and we are exploring the possibility of new not-for-profit private hospital. These are some of the efforts that we are going to do, but even if we do this decision, it will take a few years. So, what I am trying to demonstrate is that there are many different dimensions that we are looking at in terms of trying to undo this knot, in terms of trying to reduce the claims. Because it is an ecosystem. It is not just about the rising costs. We have to appreciate that the rising claims or the rising premiums cost is as a result of increased claims, it is as a result of consumption and excessive one at that, and it is as a result of over-coverage. So, these are the things that we need to unpack. Therefore, some of the proposals or suggestions that the Member put up is, indeed, something that we consider. We already have levers; MAS, MOH have levers, in terms of oversight to ensure that the practices and the product design is something that is sustainable and ensures protection. There are avenues for the policyholders and claimants to make claims. FIDReC is one part of it, but there are dimensions of the holistic assessment of whether claims are necessary. It is something that they will have to take into account as well. We will continue with the education so that people have more choices. We will consider proposals of putting in more information so that people can make a judgement call and better decisions. But we need to do so meaningfully. These are things that we will continue to do to improve on this issue of rising healthcare costs as well as rising premiums.”
“To respond to the question by the Member, I just want to reiterate again the points that I made. Because the sentiment is really about wanting to make sure that our policyholders and patients, who are going through very difficult situations, are not shortchanged or disadvantaged because of unsavoury practices by the insurance providers. I just want to give that blanket assurance that that is indeed something that we need to look at and that there are already efforts in place for us to address that. What I do want to reiterate is that the manifestation of some of the issues that we are seeing today, in terms of escalating costs and premiums, is not necessarily completely resolved by just regulation alone. There are many different dimensions of it and I mentioned earlier that we are taking a multi-pronged approach to deal with this matter. Just allow me to recap and elaborate a little bit more. As explained, we take a multi-pronged approach. One of the approaches is about having that discussion with insurance providers to make sure that they review their insurance policy design product. Separately, we are also putting in benchmarks, fee benchmarks, to protect against overcharging and guide the pricing, because it is also about how much is charged versus how much they are going to claim. We also put in place measures to enforce against a small minority of doctors who actually make errant claims, because they are the ones who then put in the wrong claims, and end up ballooning the claims. So, there is a claims management office that sets up the claims rules and puts through a claims education process. We are also continuing to drive efforts to improve awareness of these claims practices.”
“So, that is another layer. They are made to inform their policyholders on it. There are also opportunities if there are, indeed, disagreements, the policyholders can reach out to FIDReC to have their disputes resolved.”
“I thank the Member for the question. Indeed, the commitment is about consumer protection and ensuring a sustainable system that can be meaningfully tapped on when policyholders or patients want to have options. So, I just want to make a distinction between the measures or regulatory efforts that goes towards the protection versus administrative matters that help insurers deal with this issue. I have explained earlier that pre-authorisation and also empanelment of doctors, is a way for insurers to manage their costs, manage the claims. With panels, how it works is that, usually there is an additional rider that the patient or policyholder can tap on, on top of the coverage. And because of that there is a need for the insurers to make sure that they are limiting their exposure of costs. And they put in then, a panel, and that panel has, at the backend, some arrangements of fees with the insurers. So, that is how the system works and in a way, it is a mechanism for the insurers to manage their costs. So, on MOH and MAS' part, we work closely to exercise regulatory oversight so that IP insurers protect the interests of policyholders and that their products are sustainable. And as I mentioned earlier, there are certain parameters which we look at. But IPs and riders are private products and insurers have to compete in a competitive market. Our general practice is to avoid intervening on aspects that are integral to market competition, such as premium, such as service quality. So, while we have an eye out to consumer protection, we do make sure that we allow for the insurers to also use certain mechanisms to get themselves out of the situation. To also allay the Member's concerns, there is a requirement for notification if they change their terms and conditions.”
“Right now, MOH and MAS work together, we have intervened in recent years to improve consumer fairness and protection. But we have also already, in place, regulatory measures to ensure that the insurance providers keep to certain key parameters. For IPs, for example, they tap on MediSave as part of the payment and so, we have levers to make sure that they comply with the different parameters that we require of them, in terms of riders, in terms of co-payments. Ultimately, at the end of the day, it is all about making sure that there is consumer protection. But it must be done in a fashion that is meaningful, that actually helps the situation rather than exacerbate it.”
“On the first question, I just want to assure the Member that we take a multi-pronged approach in trying to deal with this matter. Our conversations, discussions and engagements with insurers on their insurance product design is one, but we are also looking at different elements, including introducing fee benchmarks which we have done since 2018. We have introduced benchmarks for private professional fees and this guides the pricing and guards against overcharging. So, there are some levers here. We are now studying the possibility of going beyond professional fees, by introducing more benchmarks for hospital charges to guide fee setting by private hospitals. So, that is one measure in which we are trying to do. Separately, related to the Member's second point, it is also about consumer education. And that is also another aspect of the work that we are doing. I mentioned earlier that we are going to be embarking on the public education campaign. It is about explaining and providing information to policyholders about the different options they have, how they should calculate, what coverage they need versus how much they want to spend on now. Because, sometimes, it is just over-coverage and you are not actually going to be consuming it; it is not going to be good for you. So, education should also entail them appreciating what are some of the options they have so they do not get caught up in a particular situation which is not feasible for them. And so, basically it is about trying to ensure that consumer protection is something that is top of mind. Regulatory was one of the things that the Member asked about, regulatory measures. It is not that it is not without any regulatory measures.”
“If you feel that the treatment or you accept the reason that the treatment is aggressive or it is not covered, then you may need to consider whether you want to choose an alternative treatment. Or if you feel that actually that is a treatment that is purely covered, you can go ahead and you will then have to make the claim subsequently. There can still be disputes, of course, as with other similar grounds. But there is very little leverage. There is going to be back and forth, but there is lesser leverage for the insurers to reject. Because if it is truly something that is circumscribed by the contract, then there is no running away from having to pay out according to the terms of the contract.”
“I thank the Member for your question. I just want to clarify though that we are discussing this matter in the context of the IPs. As you can appreciate, the IP is a term insurance, very much like typical insurance policies. It is a term insurance which only goes towards coverage for the duration of the term. So, if your residents are in a situation where they are within that period of their term and they then meet the requirements and the criteria for their claims, I do not see why they would be affected by anything. Because they lie in the bed they make, the contract that they have signed within that contractual period. When we talk about pre-authorisation, as I explained earlier, it is a slightly different animal. It is not part of the term's conditions. It is an administrative process. It allows for treatments that are pre-planned, hospitalisation or surgery that is coming up for policyholders to get confirmation to see whether this treatment is something that their insurers would pay for. What we hear, what we understand is that, typically if there are rejections, it is possibly because there is an exclusion in the original contract, so you could not have gotten it covered anyway, or the fees are too high, the treatment plan may be too aggressive, meaning you have not considered other treatment plans. But it still does not take away from the fact that if you do then consume a treatment and it falls within your contract, you can still claim from your insurer. It is just that there was no pre-authorisation. As for the recourse, so if let us say, you submit a pre-authorisation claim and it is rejected, or in that recent case, suspended, it just means that you need to consider your options.”
“And if we cap premium increases, products will become unviable, which will hurt policyholders. So, we need to loosen and untie this knot, step by step. Every stakeholder needs to do its part and MOH will facilitate the process. We have urged the insurance industry to relook their overly-generous policy design, such as minimal rider co-payment. Insurers will need to balance between providing assurance and protection, and encouraging prudent consumption and servicing. We will do more to educate consumers on choosing the appropriate health insurance coverage for their needs. We are in fact launching a public education campaign soon. To rein in private sector cost increases, MOH has developed and published over 2,800 doctor fee benchmarks, which providers and insurers reference to set fees and review reimbursements respectively. We will study what more can be done to guide fee setting by private hospitals. MOH will also continue to work through the Multilateral Healthcare Insurance Committee, which brings together key stakeholders from healthcare providers, medical professionals, insurers and consumer representatives, to address these issues collaboratively.”
“Members also asked about the practice of pre-authorisation. Pre-authorisation is an administrative arrangement – not a contractual benefit – offered by insurers. It enables insurers to review and approve medical treatments and associated fees, to make sure that they are medically necessary and covered by the policy, before they occur. This arrangement also gives patients the assurance about what will be covered. Today, five of the seven IP insurers provide pre-authorisation. Regardless of pre-authorisation, IP policyholders enjoy their full contractual benefits and can still make claims for their treatments according to the terms and conditions of their policy. Panels are another means that insurers use to manage claim costs, by ensuring that doctors on the panel adhere to fee ranges set by the insurer. Seeing a panel doctor typically allows policyholders to enjoy more favourable co-payment terms. All policyholders remain entitled to their full contractual benefits, even if they seek care from a non-panel doctor. Most insurers have at least 600 private specialists on their panels. MOH monitors insurers’ practices and works with them to ensure adequate panel coverage at the overall and speciality level. With Extended Panels, most IP insurers also allow policyholders to access doctors on other IP insurers’ panels, subject to review. The trends we see – escalating costs, premiums, tightening claims management practices – are consequences and symptoms of the knot that insurers, doctors, hospitals and policyholders are caught in. Regulation will not loosen this knot; it will make it worse. If we restrict insurers’ claims management practices, we will likely see even larger premium increases.”
“So, in response to the Member’s question, Mr Fadli Fawzi is right that features such as "as charged" expands coverage and contributes towards weakening the discipline of insurance claims. There are other features too, such as covering deductibles and co-payment, which also need to be looked at. But private healthcare insurance is in its current unsustainable state not because of collusion or anti-competitive behaviour. That usually leads to supernormal profits by market players at the expense of consumers. Here, insurers are either making losses or barely breaking even on their health portfolios. The situation is due to excessive competition that has gone wrong – another type of market failure. Mr Yip Hon Weng and Ms Mariam Jaafar asked if there could be new laws for stronger regulatory oversight. We already have a Competition Act to proscribe collusion and anti-competitive behaviour. If we strengthen regulatory oversight, it should be to correct the market failures arising from unsustainable and self-harming competition that have taken place today. Regulations to prevent insurers from correcting the current problem will likely exacerbate the situation, make private insurance even more unsustainable, with no market correction mechanism. Should there be disputes over specific claims, policyholders can take it to the Financial Industry Disputes Resolution Centre (FIDReC), an independent and impartial institution that assists with insurance-related disputes. The Monetary Authority of Singapore (MAS) will also take action against insurers if they do not pay claims in accordance with policy terms and conditions or have unfair claims handling practices. MOH will continue to work with MAS to exercise regulatory oversight over IP insurers and products.”
“My response will also address oral Question Nos 73 to 75 from the Order Paper on 22 September 2025. Allow me to begin by putting the issue into perspective. The Ministry of Health (MOH) has previously explained the current state of private healthcare and insurance: insurers, private hospitals and providers have got themselves tied up in a knot, resulting in escalating private hospital bills, rising premiums and more safeguards introduced to the claims process. The concerns raised by Members point back to this deeper issue. A significant root factor is the design of private health insurance. Insurers know that policyholders are worried about unexpected large hospital bills, so they offer plans with generous coverage and benefits through Integrated Shield Plans (IPs) and riders, covering almost to the last dollar with little co-payment. But when someone else – in this case, insurers – pays for almost the entire bill, the dynamic between patients and providers changes. There is tendency for over-servicing and unnecessary treatments. This is backed by data. The likelihood of a patient with a private hospital rider making a claim is 1.4 times that of a patient without a rider. The size of the claim is also on average about 1.4 times that of a patient without a rider. Rising private hospital claims put a strain on insurance. For IP portfolios to be sustainable, insurers raise premiums to cover claims. Policyholders have seen sharp increases in premiums for private hospital plans, namely IPs and riders. They also introduce more safeguards to manage claim costs, which helps insurers moderate premium growth to some extent.”
“NLB had also considered retaining and revamping Geylang East Library at its current location. However, it will cost more than two times per square metre to revamp it in its current location as compared to relocating it to Tanjong Katong Complex. This translates into a budgetary difference of $22 million. We recognise that whenever public libraries are relocated, they will become closer to some residents and farther for others. We are thus committed to ensuring that the new locations remain accessible. For residents who live near the existing Geylang East Library, the new location is a short bus ride away. Notwithstanding this, NLB has engaged Geylang East residents to better understand their needs. We take public feedback seriously. NLB is working to identify a potential suitable space nearby to provide some form of library presence, such as a reading corner or a pop-up library. We will also work with relevant grassroots organisations to help residents access NLB's digital resources or delivery services, ensuring continued reading and learning opportunities. This year marks NLB's 30th anniversary. Our mission is to inspire Singaporeans to read, learn and discover and this mission is stronger than ever. At the National Day Rally, Prime Minister Wong said that Singapore must be a "we first" society. This aligns with how we envision our libraries, as trusted spaces where people from all walks of life come together as one community to read, learn and discover together. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)]”
“The recently launched SG60 Heart&Soul Experience draws extensively from the National Archives' rich repositories of photographs, videos and oral histories, enabling Singaporeans to connect to stories of the past, even as we look towards the future. Our libraries must remain accessible and be conveniently located in key community hubs where Singaporeans live, work and play. This has guided the formulation of the Libraries of the Future Masterplan, a 15-year masterplan to systematically revamp and upgrade the older public libraries from 2017 to 2030. As part of this plan, NLB's strategy has been to move standalone libraries to places which enjoy easy access to transportation hubs and networks. This includes shopping malls and integrated hubs. We understand that some Members are concerned about the relocation of the libraries and its impact on the community. The decision to relocate any library is not taken lightly. Before deciding to relocate a particular library or to revamp it in-situ, NLB considers various factors, such as land use plans, the number of residents it can best serve, the library's age and the number of years since the last major renovation. Ultimately, NLB makes the decision based on how it can best serve and reach more patrons with its services and collections. The upcoming relocation of Geylang East Library to Tanjong Katong Complex, as mentioned by the Member, reflects this approach. In the last decade, from 2015 to 2024, Geylang East Library has experienced declining visitorship from 670,000 to less than 470,000, about a 31% drop. We hope the relocation will help to improve the visitorship for the library, just as it did for the libraries at Harbourfront and Tampines, which saw a 58% and 71% increase in visitorship respectively over three years.”
“To ensure that these services are developed to meet the diverse needs of PwDs, NLB had engaged over 500 PwDs and their caregivers to understand how its libraries could better serve their needs. As a key social equaliser, NLB continues to support lower-income families through the kidsREAD programme, which promotes reading among young children since 2004. NLB launched kidsREAD@Home last year to bring volunteers directly to public rental flats to conduct reading sessions for children, after a pilot in 2023. To date, almost 200 children have benefited from kidsREAD@Home. Finally, our libraries serve as anchors for the community. They are places where Singaporeans foster connections and encourage one another to learn and discover. Libraries are spaces where people can discover their interests and connect with like-minded individuals. Our libraries are home to 130 volunteer-led learning communities that cover a diverse range of interests. Some examples include Learning I.T. for Seniors, which is conducted in English and Mandarin, and the Ilham Pustaka Malay Reading Club, which is co-facilitated by established local authors. Through these avenues of peer learning, library patrons can exchange knowledge on various interests, generate support for new passion projects and strengthen community networks. Beyond fostering present-day connections, our archives also connect us with our past. The National Library and National Archives are the memory institutions of Singapore, preserving our documentary heritage and sharing stories of our past that help us have a richer understanding of what it means to be Singaporean.”
“As libraries empower people to embrace new technologies, libraries will also equip citizens with the skills to go online safely and responsibly. Some of you would be familiar with NLB's S.U.R.E. campaign, which stands for Source, Understand, Research, Evaluate, and how it provides everyone with a simple and intuitive framework to assess the reliability of information. This is supported by a range of programmes and resources on topics such as generative artificial intelligence, online scams and digital safety. Another area in which libraries have curated resources on is parenting in a digital age. This is a challenging experience for many parents. Those of us who are parents today did not grow up with digital technologies and are naturally not confident in our ability to guide our children's digital habits. To support digital parenting, NLB has curated relevant resources, such as videos via its LearnX platform, for parents to help their children develop and practise healthy digital habits. NLB will do more in this area and is conducting parenting programmes and workshops at libraries to help parents and children practise healthy digital habits together. Next, our libraries play an important role in bringing learning and knowledge to those with less means in our community. In particular, NLB has been re-inventing itself and its spaces for persons with disabilities (PwDs). In 2023, NLB launched a suite of services for PwDs at the Punggol Library. This includes Calm Pods, which offer a private and calming sensorial experience to those who might need it, and the Borrow-N-Go tunnel, which enables users to go through the wide passageway and have their books automatically checked out.”
“Library visitorship and physical loans in 2024 have remained strong, with 20.8 million visitors to our network of libraries, the National Library and the National Archives. Our patrons have also checked out 24 million physical items in 2024, showing that Singaporeans continue to value the physical library experience. At the same time, digital consumption of information continues to be on the rise, with library members borrowing 14.8 million digital items in 2024. Beyond championing a culture of reading, NLB is transforming into a national platform for lifelong learning, working with like-minded partners to provide learning opportunities for everyone. While our libraries have traditionally been successful at engaging children, we have increased our offerings for adults. NLB has partnered with SkillsFuture Singapore to help working adults embrace lifelong learning through THRIVE@libraries, our marquee learning festival. Moreover, learning engagement has been extended to seniors through programmes like Time of Your Life Celebration. To support our Smart Nation ambitions, NLB has invested in initiatives to give citizens opportunities to explore emerging technologies. One such initiative is StoryGen, which taps on generative artificial intelligence's image generation capabilities to bring stories to life for library patrons. As new technologies emerge, NLB is committed to ensure that these learning opportunities remain accessible for all. Citizens can count on the public libraries to be a place for them to learn as well as experience new technologies and find out for themselves how exciting these developments can be and how they may apply to everyday life. New technologies come with associated risks.”
“Mr Speaker, I thank the Member for the opportunity to speak on the future of libraries. The Member has raised several queries which I will address in my response to this Motion. Digital disruption has impacted libraries worldwide as reading habits shift amidst a rise in digital content consumption. NLB's latest National Reading Habits Survey confirms this trend. While e-book reading has held steady, physical book reading among adults dropped to 75% in 2024, compared to 89% in 2018. And 81% of adults indicated that they like to consume information via videos, compared to 62% who indicated that they like to consume information via hardcopy sources. To remain relevant, libraries will need to adapt and reinvent how they deliver content and services to its citizens. Given the shifts in the information landscape, NLB is aware that inaction will undermine the fundamental role libraries and archives play as custodians of knowledge. In today's digital age, libraries play an even more critical role as community institutions whose physical presence fosters a sense of rootedness in community amongst patrons. We will continue to develop our libraries and strengthen its mandate as a key community node to foster learning and reading in this digital age. NLB has seized the opportunity to re-imagine how libraries should look in the digital age. Today, let me share three key roles of libraries and how NLB will continue to fulfil them to support the reading, learning and discovery needs of our citizens in the digital age. First, libraries serve as catalysts for reading and lifelong learning, a key goal that NLB has always championed. We want Singaporeans to discover, or rediscover, their love for reading, be it turning the pages of a physical book or scrolling through an e-book.”
“As I mentioned, we will continue to assess this situation. But the Member may want to consider for those situations where the mother comes in, what they can do is to apply for LTVP+ and if she satisfies that requirement, she will then be entitled to Singapore Citizen rates. In the meantime, we will continue to assess and to see where we can continue supporting the mothers who have difficulties with the delivery costs.”
“If it is outside the episode of delivery, LTVP+ foreign spouses of Singapore Citizens are also eligible for healthcare benefits, such as subsidies for in-patient services at the restructured hospitals and this is at the same level as PRs. So, in that sense, they are also covered for some of their other expenses. In any case, if there are any difficulties, the foreign spouses may also seek help from medical social workers. So, actually, a large part of the concerns that the Member has are already addressed with the existing policies. But we will continue to look at all gaps. We always review our financing policies regularly to see if there are emerging trends or needs that we need to address.”
“I thank the Member for her interest. Firstly, on the numbers, I will leave MHA to respond to her queries. But based on the indications that we have in respect of delivery episodes in 2024, actually, in terms of the other Pass types – LTVP and others – the numbers are really a smaller percentage; I would say less than 10%. So, the majority of those who are foreign spouses, they are PRs or LTVP+ holders. I would just highlight a couple of things to address the other questions that the Member has raised. I understand. The concern is really the Singapore child and you are helping a Singaporean with this situation. As I have mentioned earlier, firstly, the majority of the foreign spouses that we see are PRs or LTVP+ holders, which means that they are entitled to Singapore Citizen rates for the whole delivery episode. It means that from the time they are admitted for delivery to the discharge of the mother after birth, it is fully covered at Singaporean rates. In that sense, the issue of the Singaporean child not being supported, does not exist because for any mother who is delivering a Singaporean child and if they are a PR or LTVP+ holder, the whole episode of delivery is covered. Also, it can be applied retrospectively. So, if the mother is in the process of applying for her LTVP+ and it has not yet been approved, and she then got admitted but there is a process or an application pending, she can actually apply for the rates to be applicable to her as well. This is also something that addresses those concerns. There are two other points I wanted to make.”
“However, making healthcare insurance mandatory for all long-staying foreigners will have to be carefully considered, as this may in turn pose a financial burden on their Singapore Citizen family members. We will continue to study the feasibility of this.”
“Ms Sylvia Lim asked about maternity hospitalisation subsidies accorded to foreign mothers giving birth to Singapore Citizens. The majority of foreign spouses with Singapore Citizen children are Permanent Residents (PRs) or holders of Long-Term Visit Pass-Plus (LTVP+). Therefore, they are eligible for healthcare subsidies in public healthcare institutions. In particular, mothers with permanent residency or LTVP+ who are married to Singapore Citizens receive the same level of subsidies as Singapore Citizens for all items and treatments incurred for the entire delivery episode, from admission for childbirth to discharge after delivery. On Mr Gan’s question about help and subsidies for non-Singaporean relatives and spouses, the Ministry and our public healthcare institutions do receive appeals regarding financing for healthcare costs incurred by foreign spouses or relatives of Singapore Citizens. We assess them on a case-by-case basis based on individual circumstances and do not specifically track the number of appeals. Ultimately, as healthcare subsidies are borne by all Singaporeans, any extension of these benefits to foreigners must be assessed carefully. Foreigners facing financial difficulties with their healthcare bills may approach our medical social workers for assistance. Healthcare insurance is another way to help protect families with foreigner members on LTVP or Dependant’s Pass from large hospital bills. Today, such individuals may buy plans offered by Integrated Shield Plan insurers and pay premiums in cash or using their Singapore Citizen/PR family members’ MediSave. They may also be covered by employer medical benefits.”
“Mr Speaker, may I seek your permission to answer Question Nos 1 and 2 together, please?”