Yeo Cheow Tong
Singapore
“Mdm Ho Geok Choo asked the Minister for Health in light of the recent report on fungal corneal infections (a) whether those who contracted the contact lens related fungal corneal infections will suffer permanent damage to their eyes; and (b) how long will his Ministry take to conclude its investigations into the causes of these contact le…”
“My Ministry performs a regulatory role and what we do is that we try to ensure that we have a conducive regulatory environment for the growth of this industry in Singapore. Let me tell him what we are doing in some areas.”
“Sir, on her two questions, whether we are satisfied that the school buses are collecting fares during the school holidays, as I mentioned just now, the school bus service is a contractual service between the parents and the service provider. It is therefore up to them to work out the terms and to abide by the terms.”
“Sir, on the first question, whether there is any abuse by owners of buses while using the 50% rebate, the answer is no, because LTA monitors very closely.”
“Sir, I have to repeat my answer. We are not responsible for regulating school buses and therefore will not be involved. SCHOOL BUSES (Installation of seat belts) 5. Assoc. Prof.”
“Ong Soh Khim asked the Minister for Community Development, Youth and Sports (a) if his Ministry will increase the cap of $10,000 per disabled person over their lifetime for the Assistive Technology Fund scheme; and (b) if not, whether there will be a flexibility to adjust the funding cap for this scheme based on the applicant's need, as j…”
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“The number of Medisave members with zero or near zero balances has remained fairly constant, at an average of about 6,400, representing about 0.3% of the total number of Medisave accounts. Ninety-nine percent of these depleted accounts were inactive at the time of usage, ie, no contributions had been made into these accounts for four or more months prior to the account being used. Over 70% of these account holders were below the age of 45 years. The members concerned had either already stopped working, or had become self-employed. A member who depletes his account has the following alternatives: (a) pay in cash the outstanding balance of the hospital bill; arrangements can also be made for the balance to be paid in instalments; (b) use the Medisave accounts of immediate family members; (c) overdraw on his Medisave account if the patient is in C or B2 wards of Government or restructured hospitals, provided the Medisave account is active. Only 27 members have made use of this facility from January to September this year. Patients who are genuinely unable to pay their hospital bills may apply for a waiver or partial remission of fees. TRANSFER OF RENTAL FLATS 2. Dr S. Vasoo asked the Minister for National Development whether the Housing and Development Board will relax the conditions for transfer of rental flats so that problems of families requiring child care help from relatives can be solved.”
“As to whether it is possible to ban all imports of cigarettes, this is a step that is not feasible at all. Cigarettes are unlike heroin or cocaine. Those are addictive drugs which have a tremendous impact on not just the takers but our society, because they inevitably lead to crime and other problems. But through our education programme, we will try to reduce the number of smokers and thereby as the numbers, shrink, the peer pressure and the public pressure on them will, in the end, result in our being able to achieve the norm of non-smoking in Singapore. At the end of the day, there will still be a few people who are die-hards and who will still smoke for various reasons. We cannot stop them, but we can make it very difficult for them to harm other people. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Yeo Cheow Tong]. Bill considered in Committee; reported without amendment; read a Third time and passed. RECLAMATION (TELOK AYER BASIN AND MARINA BAY) 5.20 pm”
“Control of advertisement is part of the multi-pronged approach that we are taking. But the main approach at the end of the day must be our public health education programme. Singaporeans are intelligent people and that is why as a result of the public health education programme, the prevalence of smoking has gone down so significantly in the last 12-15 years. We will continue to intensify our education programmes. We will continue to review ways to make it more effective, review ways for us to reach out more effectively to various sectors of the population. One of the key sectors that we are concentrating on is, of course, the younger people. Because if we can educate and discourage them from taking up smoking, then they will never become smokers. And that is the only way to go if we are trying to achieve our aim of making non-smoking a norm in Singapore. With that as an objective, we will be investigating, reviewing, and looking for new ways to pass on the message to our people of why they should not be smoking. Dr Lee also talked about the dumping of cigarettes with high nicotine and high tar content on Third World countries, and he stated that the Singapore Government had done nothing about this. Sir, he is wrong. Earlier in the year, we have already informed the tobacco companies that we are implementing limits to the nicotine and tar content of the cigarettes which they can import into Singapore. The limits that we have imposed are about the lowest in the world and that has made the cigarette companies quite unhappy. The ban on the import of cigarettes above those limits will come into being at the end of this year. We have given them enough lead time to prepare and to make sure that the cigarettes that meet our specifications are available.”
“If the office staff feel that their colleagues who are smoking are irritating them, then they should speak up and work out with the management of their offices on how to minimise the number of people who are smoking there or to give them certain opportunities to smoke in their own little office, for example. But that is something we should leave to the private sector to work out on their own. Mr Chiam made some statements about national servicemen picking up smoking while they are serving national service. If I recall, Mindef is quite aware of our national priorities to minimise the rate of smoking amongst young people and Mindef has taken a very active role in working with the Ministry on this programme. They have also cooperated in terms of educating the national servicemen on the dangers of smoking. With regard to section 3 (2), Mr Chiam has stated that there is a contradiction in accepting the contributions to charity of tobacco companies whilst we are discouraging them from advertising. Sir, we never turn down any contributions to charity from any company as long as they do not use that contribution to further their aims. There is nothing wrong with that. If they are prepared to sponsor a big event and not use that sponsorship to promote their products, I think there is nothing that should prevent us from accepting their contributions. Dr Lee Siew-Choh has come out with a whole array of points, many of which have only a peripheral relevance to smoking. He stated that people smoke because of the social pressures. Sir, there are many ways for people to defuse the tensions from pressures which are either induced by work or by other factors. Smoking may not be one of them. The main approach that we must take towards smoking is one of education.”
“Sir, our concern is to make sure that we minimise the access to advertisements in Singapore. For advertisements that come in through the air waves from radio stations, from TV stations in the neighbouring countries, there is nothing we can do about them. As regards imported publications, at the present moment the imported publications are sold largely to subscribers. So in terms of readership it is quite limited. But we will definitely be looking into what we can do to reduce their impact. With regard to the impact on tourists from our various programmes, the aim is not to convert tourists who are smokers to non-smokers. That is not our job. But our job is to make sure that the cigarette smoke of our tourists and local smokers does not have the opportunity to impact drastically on our local non-smokers. Therefore, air-conditioned restaurants where the smoke is being re-circulated have been placed under the extended restriction which will be effective on 1st November 1989 by the Ministry of the Environment. As to whether it is possible for such restaurants to be exempted if they have a separate ventilation system, I will convey the suggestion to my colleague, the Minister for the Environment. Sir, with regard to offices, the restriction on smoking in public areas is meant to cover places that are frequented by members of the public. These people go there for various businesses. But for the management and staff of offices, I think they have the ability to restrict smoking in their own areas if they want to. This is a choice which at the present moment we are quite happy to leave it to them.”
“Sir, first, I would like to thank all the hon. Members who have spoken up to fully support the amendments to the Act. Dr Wan Soon Bee, Member for Pasir Panjang GRC, has given a very accurate and thorough description of implications and consequences of smoking. Smoking has implications not just for the smoker himself but for the family, the friends, the people around him and definitely has a tremendous impact on the economy. That is why we are having such a strong programme to reduce the rate of smoking. Several Members, including Mr Chiam and Dr Lee Siew-Choh, have asked about whether the smoking rate has gone up. The rate of smoking has gone down significantly. The import of tobacco may not have gone down, but that is partly due to the fact that much of the cigarettes are bought by the tourists as well. Therefore, with the tremendous increase in tourist arrivals the sale of cigarettes would have gone up significantly at the airport. The key point is whether the rate of smoking amongst our citizens has gone down and that rate has gone down very, very significantly. I quoted the figure just now - 23% in 1977, today 13(r)%. The rate of smoking today in Singapore is probably amongst the lowest in the world, if not the lowest. It is far lower than in any of the other developed countries. Although, as Dr Lee said, the rate of smoking in the developed countries has gone down, they are still a long way from where we are today and the smoking rate is still in the range of 30-odd per cent in many of these countries. Dr Aline Wong is correct in saying that the advertisements in Singapore cannot be shut out completely because we have such an open economy. The same concern has been expressed by Mr Chew Heng Ching.”
“Sir, I have explained to the House several times that the accouchement fees for the high order births are higher because the point must be made that having children carries along with it some expenses, and that those families who opt for a larger number of children must be able to afford to bring up these children. BILL INTRODUCED SMOKING (PROHIBITION ON ADVERTISEMENTS) (AMENDMENT) BILL "to amend the Smoking (Prohibition on Advertisements) Act (Chapter 309) of the 1985 Revised Edition)", presented by the Acting Minister for Health (Mr Yeo Cheow Tong); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. IMMIGRATION (AMENDMENT NO. 2) BILL Order for Second Reading read. 1.30 pm”
“He is referring to the accouchement fee. Those are two different things.”
“Sir, our aim is to make sure that every child that is born in Singapore is a wanted child. This way the mother even while carrying the foetus will make sure that she has mother even while carrying the foetus will make sure that she has the proper nourishment and that she looks after her pregnancy properly, so that when the child is born he will be a healthy child. Furthermore, the family will then be able to give the proper support, nourishment, grooming, upbringing to ensure that the child grows up into a useful citizen of Singapore. So the main aim must be that we have children that are wanted children.”
“Sir, under this counselling programme that we have introduced, a woman who has been counselled will now be required to undergo the viewing of a videotape titled Abortion - Decide with Care. And the message there is reinforced with a pamphlet and is further reinforced by personal counselling by a counsellor that has been trained by the Ministry. Abortion is not allowed to be performed on the first visit. It can only be performed 24 hours after the counselling. Mr Chiam See Tong: It would appear that steps have been taken by the Government to give counsel to those who intend to abort, the purpose of which is to discourage them from going through with the abortion. So why is the Government so reluctant to amend the law? If it does not want to abolish abortion, why is it so reluctant to amend the law?”
“Up to June 1989, the National Skin Centre (NSC) had seen a total of 74.465 cases. Monthly patient attendance increased from 7,580 in December 1988 to 11,600 in June 1989. The present workload of NSC is about 92% of that in the old Middle Road Hospital (MRH). Subsidised patients, i.e. those referred by Government doctors, pay an average of $25 per attendance at the NSC, compared to $22 in MRH previously. This includes $15 for the consultation, and $10 for the laboratory investigation, treatment and an average of four weeks of medication. Those who cannot afford to pay have their fees waived. The number of subsidised attendances has remained fairly stable at about 6,500 per month. About 8% of them are treated free. Non-subsidised patients pay an average of $53 per attendance. Their numbers have increased steadily from 2,183 in December 1988 to 4,949 in June 1989. This shows that the charges are reasonable and the patients feel that they are getting value for money. table - Average Hospital Bill Size Per Patient Day, Comparative Average Bill Size (Cols. 481 - 482)”
“Procedural control will include proper and documented work procedures and clear definitions of types of access based on user's job functions and responsibilities. System access control will include use of authorised and predefined terminals, multiple levels of passwords for access and audit trail to enable trace back for subsequent external or internal audit review. Access to patient data will be further safeguarded by an appropriate form of personal authorization. The MediNet Steering Committee is expected to complete the studies and submit its recommendations by the end of this year. ORAL ANSWER TO QUESTION NOT REACHED BY 1.30 P.M. TREATMENT AND CHARGES AT THE NATIONAL SKIN CENTRE 1. Dr S. Vasoo asked the Acting Minister for Health if he will give the number of cases seen at the National Skin Centre since its operation and whether the charges are reasonable to encourage the use of its services.”
“MediNet is a proposed computer network linking public and the private sector participants in the health care delivery system. The objectives of MediNet are to reduce the cost and turnaround time for the preparation, transmission and processing of health care information, and to facilitate a better understanding of the utilisation of health services, and to enable faster access to health information. This would contribute to higher productivity, better patient care and help slow down cost increases. A MediNet Steering Committee, comprising representatives from government and private hospitals, various government agencies, professional and trade associations, has been formed to look into the feasibility, requirement specifications and other issues related to the implementation of a nationwide medical network, including confidentiality and data access rights to sensitive information. The kinds of information being considered for storage or processing by MediNet System will include Medisave claims data, health notifications for immunisations and communicable diseases, etc, patients' medical information, drug and surgical supplies data and general medical information databases which will facilitate healthcare planning, patient treatment and research. It is envisaged that the major users of the network will include government agencies eg. Ministry of Health, Ministry of the Environment, Ministry of Labour, CPF Board; government and private hospitals, clinics and pharmacies; medical and surgical suppliers; medical associations and research organisations eg. NUS and insurance companies. To safeguard confidentiality of data, there will be stringent procedural as well as system controls.”
“Sir, he makes a request when he arrives at the counter and tells the nurse, "Look, I cannot afford to pay." He will still receive the treatment. If he cannot afford, he pays what he has and we will investigate carefully. If it is true that he cannot afford, the remaining fees will be waived. But, of course, if we find that he can afford, the remnant will then be billed to him.”
“Sir, the policy of the Government is based on affordability, that is, those who can afford to pay for care in the private sector should then not be asking for subsidies. Those who can afford to see the practitioners in the private sector should be prepared to pay for the services at the non-subsidized rates. But, of course, if they are referred by the GPand they wish to receive the subsidized fees, they can make a request, and these requests are always looked into. Prime Minister: Carefully.”
“Sir, the availability of 'C' class beds is seen at the national level. That means for patients who can afford only the 'C' class beds, there are many empty 'C' class beds available in our other hospitals. They can opt for that. However, for those who are referred to NUH or SGH, depending on the complexity of the case and if they cannot afford to pay for the 'B2' rates, they are given waivers or partial remissions. In fact, in a previous sitting of Parliament I had given information as to the rate of remission or waivers in SGH as well as NUH.”
“Sir, the specialists in the hospitals are meant to be referral doctors, not family practitioners. Patients who are sick should first see their own general practitioners or the doctors in our polyclinics. If the acuity of the illness warrants it, the GPs or the doctors in the polyclinics will then refer these patients to the specialist departments in the hospitals or in the private sector. Such patients who are referred to the hospitals by our polyclinics will then be treated as subsidized patients. However, they will be referred to the department and they will be seen by the doctor on duty. If a patient insists on seeing a particular consultant, then the patient will have to make his own appointment as a non-subsidized patient.”
“Sir, the Member should remember what was stated in the last budget debate. I assured the House that 'C' class beds will always be available as long as there is a need for them. So in the older hospitals that are going to be rebuilt, the 'C' class beds in those new hospitals after redevelopment will still be available. In terms of the longer term policy, Sir, the policy of the Government is that those who can afford to pay should pay for the services that they are receiving. Whilst those who cannot afford should not be deprived of the medical care that they require. In terms of the level of subsidy for the 'B2' beds, the level of subsidy at the present moment is 69%. This will gradually be decreased as the average Singaporean's ability to pay improves with our improving economy. For the 'C' class patients, it will still remain highly subsidized so that 'C' class will be available and affordable to the low income group. Of course, we will still retain the policy of waiver of fees for the indigent.”
“Sir, patients who are referred by doctors, for example, general practitioners, have a choice of which hospital they wish to be referred to. For A&E cases, yes, we have catchment areas, and the reason is that it is in the best interest of those patients who are in an emergency to be taken to the nearest hospital rather than to the hospital of their choice. Of course, after admission, if they wish to be transferred, the patient is free to choose to do so. Mr Choo Wee Khiang: Sir, following the Acting Minister's reply, I would like to ask the Acting Minister precisely what is the long term pricing policy for 'B' wards, and indeed 'C' class wards? If I may add, after the restructuring of the other two hospitals, I would presume that there would not be any 'C' class wards left. I think that is the concern of most common people in Singapore.”
“Sir, the policy for private patients or non-subsidized patients is that over the next few years non-subsidized patients should be paying the full cost of their treatment in hospitals. A choice is made available to all Singaporeans whether they wish to opt for the better accommodation and the high level of services in the 'A' and 'B1' wards or, for those who cannot afford it, to go to the subsidized facilities, like 'B2' and 'C' class wards where the facilities are more basic, although the medical services are similar. As to whether we should standardize the fees for all the restructured hospitals, Sir, one of the objectives of the restructuring programme is to allow all the hospitals to be run autonomously so that each can then compete with the other in terms of value for money. It means that they will have to compete on the level of efficiency, compete on the level of quality of services provided and compete on pricing.”
“Sir, I have already said that just now, that if NUH were to actually charge the full cost it would be higher than $2,670. Mr Choo Wee Khiang (Marine Parade GRC): Sir, will the Minister enlighten the House as to the long term pricing policy for all the restructured hospitals, especially the 'B' classes? And also, would the Minister tell the House whether consideration will be given to standardize charges for all the restructured hospitals?”
“In NUH the full cost is slightly higher than the figure shown here because, as I stated earlier, NUH is still experiencing some losses. For NUH, the figure quoted is close to full cost, and for private hospitals it will be full cost plus the profit element.”
“Sir, patients in 'A' class wards who wish to enjoy the privacy of a single bedded ward, the better and more personalized level of services, will have to pay the full cost that is being incurred in the provision of such services. That means the cost of labour, cost of overheads, including the depreciation costs for the physical facilities that he is enjoying.”
“Sir, the fees at NUH are higher, but it does not mean that NUH is making profits from the higher fees. In fact, NUH in 1988 had a loss of $2.2 million after receiving a subvention of $21 million from the Government. This reflects the actual cost of providing a high level of services for patients. It also reflects the policy of the Government to charge the full cost to the 'A' and 'B1' class patients. In NUH the 'A' class patients are paying close to the full cost already. Also with NUH being a teaching hospital, the patients tend to be subjected to more extensive investigations, and that partly accounts for the higher per-day fee that is being experienced by the patients. Sir, the scale of SGH fees has always been higher than for the other Government hospitals. As I said, this reflects the newer facilities, better facilities, and also the much higher level of manning that is available in SGH. Let me give some examples. In SGH the number of doctors to admissions is 1:66 as compared to 1:81 in the Government hospitals. The nurse-to-bed ratio is also higher. In the other Government hospitals the nurse-to-bed ratio is 1:2. In GH, before the restructuring, the ratio was 1:1.4 beds, and because the restructuring programme allows SGH to recruit its own nurses, the nurse-to-bed ratio has now gone down to 1:1.1 beds in order to remedy the shortage of nurses that is being experienced. As regards informing the patients about the scale of charges, including itemization, the patients will definitely be told about this.”
“Sir, the hospital bill size depends on a number of factors. These include whether it is a medical or surgical case, the acuity level of the patients, the type and extent of treatment and investigations carried out, the type of ward accommodation chosen, the rates of hospital charges and also the length of stay. The average bill size per patient per day for various classes of ward at Government, restructured and private hospitals is summarized in the table (Cols. 481 - 482) that has been handed out to Members. The table also provides some comparison of the average bill size of a typical medical as well as for some representative surgical cases in the Government, restructured and private hospitals for a patient admitted to A Class ward. table - Average Hospital Bill Size Per Patient Day, Comparative Average Bill Size (Cols. 481 - 482) The table shows that the fees for A and B1 wards in the Government and restructured hospitals are much lower than those in the private hospitals. The fee structure for SGH has been higher than for the other Government hospitals, reflecting the better and newer facilities and equipment and the larger number of medical and other staff available.”
“The Government's population policy encourages parents to have three children, and for those who can afford it, to have more. This is because having children and bringing them up is very expensive. The accouchement fees for the first, second and third child are heavily subsidised. However, the accouchement fees for the fourth and higher order births are not subsidised, and are therefore higher. This is consistent with the Government's current population policy. My Ministry therefore does not intend to reduce such accouchement fees in the future. table - EXAMPLES OF MANDATORY MINIMUM CANING PROVISIONS FOUND IN OUR STATUTES (Cols. 227 - 230)”
“Fees are also automatically waived for patients who are financial hardship cases and who have been issued with the Medical Fee Exemption Card by the Medical Social Work Departments of Government hospitals. LAVENDER MRT STATION/CRAWFORD HOUSING ESTATE (Building of footbridge) 17. Mr Loh Meng See asked the Minister for National Development whether there are plans to build a footbridge over the Rochore Canal linking the Lavender Mass Rapid Transit station to the Crawford Housing Estate. The Senior Minister of State for National Development (Dr Lee Boon Yang)(for the Minister for National Development): Mr Speaker, Sir, a pedestrian footbridge over the Rochore Canal linking the Lavender MRT Station to the Crawford Housing Estate will be built by PWD. It will be completed early next year. CHUA CHU KANG (Resettlement compensation) 18. Dr Low Seow Chay asked the Minister for National Development (a) why the resettlement compensation for some farmers are held up for such a long time; (b) whether there are any changes in the compensation rate and the guidelines on awarding farmer's rate compensation to unlicenses farmers; and (c) what is the number of resettlement cases in Chua Chu Kang Constituency as at the latest convenient date and when the full resettlement compensation will be released to them.”
“Mr Speaker, Sir, the Singapore General Hospital was administered as a restructured hospital as from 1st April 1989. For the month of April 1989, 15 inpatients representing 0.2% of all B2 class inpatients and 103 outpatients representing 0.6% of the B2 outpatients were granted remission of medical treatment fees. In addition, about 90 inpatients and 255 outpatients had their fees automatically waived as they were on the Public Assistance Scheme or had been issued with the Medical Fee Exemption Cards. The hospital assists patients who have difficulty in paying for their medical treatment by allowing: (a) patients to pay by instalments; (b) the use of Medisave by the patient's immediate family members (ie, spouse, parents, children, or grandchildren); (c) the use of future Medisave contributions provided the patient is admitted to a B2 class ward; (d) the use of siblings' Medisave provided the patient is admitted to a B2 class ward and is solely dependent on his/her siblings. If the patient is still unable to pay for his medical treatment with the above assistance, he or she is referred to the hospital's Medical Social Work Department for a review of the socio-economic and financial circumstances of the patient and his/her family. If the patient satisfies the hospital's criteria for remission of fees, the Medical Social Worker wil recommend his/her application to the hospital management for approval. In addition to the above, patients on the Public Assistance Scheme and residents of the Ministry of Community Development welfare homes and approved voluntary welfare organizations issued with Medical Fee Exemption Cards will have their medical fees automatically waived.”
“Sir, let me clarify. There is a shortage of nurses in the Government hospitals and in the Government service. Therefore, we have to vet very carefully the conflicting demands. It is up to HNF to put up the case and if we find the requirements have a higher priority than the other competing requirements, then we would try to allocate whatever scarce resources we have to help them.”
“The number of obese children has increased significantly over the last 10 years. In 1976, in the Primary I intake only an average of about 1.3% of the students suffered from obesity problems. In the latest survey carried out last year, the percentage was 11%. So there is a very significant increase over a period of just 12 years. This increase is largely attributed to the increased affluence among Singaporeans. Parents have more money to spend, they have fewer children, therefore they tend to indulge in spending more money on their children. This is not only being done, but amongst other things they are providing their children with more pocket money so that they can buy more things. Children tend to spend a lot on food, especially food which has a high level of sugar and which tends to be very fattening. Children are also less inclined to be involved in highly active activities. They tend to bemore oriented towards sedentary activities. Our programme is to encourage parents to ensure that they control the diet of their children. We are also working with MOE to see how this can be done in the schools. With regard to the level of activity of children, we have been working with MOE to modify the content of the physical education programme in schools to make them into one which is more aerobic and which should keep the children more active during their physical education period. I understand the Ministry of Education is introducing in stages this new physical education programme and they are also training teachers and acquiring the necessary equipment in the primary schools. I am hopeful that with all these programmes we should be able to cap the rise in the number of obese children and hopefully with the supportive activities, in fact, get them to trim down.”
“Although the Ministry now controls all the hospitals the day-to-day running of the hospitals is still left to the Medical Director of the Hospitals. The Ministry provides the crucial policy decisions and we do some supportive work in terms of the finance systems, manpower, planning and all that. With the restructured hospitals, the policy decisions will still have to be vetted by the Ministry and we ensure that they comply with the Government objectives. We will also be vetting to ensure that the hospitals remain efficient. They are really today very efficient. As I have explained earlier on, with a very low percentage of the GDP being used in the medical care area, we have been able to achieve a very high level of medical care. We will be monitoring to make sure that this remains so. Dr Koh Lam Son has asked for the Ministry and the Government to monitor the work and to regulate the work of the GPs in the private sector. Sir, our private sector GPs have been doing a tremendous job. They are now accounting for over 70% of the patient load in the primary health care area and they are doing it at a fairly low cost to the patients. They have achieved it without regulation from the Government and I do not see why the Government should intervene and run the risk of making it even more expensive. He has asked for visits by nurses as is being done by doctors in other countries. Sir, that is the role being performed by the HNF at the moment and this will continue. He has asked for the GPs to be allowed to fulfil the role of educating school children in health matters. I will ask my Ministry to consult the Ministry of Education on this subject. In terms of obesity, he is correct in raising concern about the obesity level of our children today.”
“My Ministry is also providing one medical officer to each of these Centres in order to strengthen the services provided. The HNF is also upgrading and expanding its rehabilitation, counselling and day care programmes at these Centres. In addition, my Ministry, together with the HNF, will work together for the further expansion of the health screening programmes for the elderly which will be provided free at all the Senior Citizens Health Care Centres. The polyclinics will also continue to provide medical treatment for the elderly at half the fees charged to the general public. Sir, another facility which will greatly benefit the elderly will be the first community hospital at Ang Mo Kio. Building work will begin in August this year. It will cater for elderly patients and others with simple illnesses who do not require the expensive and sophisticated treatment offered by the acute hospitals. Sir, my Ministry will also be working very closely with the private sector to upgrade the level of health care provided by the family physician. We are currently working with the College of General Practitioners on a vocational training programme for all young doctors wishing to specialize in family medicine. A special two to three year training programme in paediatrics, general surgery, emergency medicine and other specialities has been planned for these doctors before they take up private practice as family physicians. This way, we can upgrade the standard of primary health care in both the government and private sectors. Sir, the other point brought up by Dr Aline Wong is: what is the Ministry of Health's role after the hospitals are restructured? Sir, the role will be no different from what it is today.”
“Thank you, Mr Chairman. Sir, I had earlier informed the House that my Ministry places a strong emphasis on preventive and primary health care. We are reorganizing and further upgrading the primary health service to meet the challenges of the next two decades. Over the next five years we will be phasing out the old and inefficient outpatient dispensaries and polyclinics and replacing them with eight new polyclinics in the HDB new towns. By the early 1990s we will then have a total of 16 modern polyclinics or health centres strategically situated throughout the island to provide primary health care service. Sir, one of these services will be a general health screening programme for adults. It will include taking comprehensive medical history and examination, and tests on the blood, urine and stools. It will also include a chest X-ray and an ECG examination of the heart. This comprehensive medical examination will cost only $60, and will be available at various new polyclinics later this year. We are also laying the foundation for community health services for the elderly by working very closely with the Home Nursing Foundation or HNF. My Ministry will be providing accommodation in all new polyclinics for Senior Citizen Health Care Centres to be run by the HNF. The plan is to have a total of such 10 centres based in the new polyclinics situated in the new HDB towns. Currently, my Ministry is providing 38 nurses to HNF to run the Senior Citizens Health Care Centres and to provide nursing care for the bedridden or semi-ambulant who require home nursing. These nurses visit the homes of such patients three to four times a week and we will increase the number of nurses should the need arise.”
“For Class C children. I think our policy is that even for the low-income group, we give free services only for those who really cannot afford to pay. Having children definitely will result in increased cost to the parents. That is why we are encouraging only those parents who can afford to have more children, to proceed to have three, four or more. So the message is, first, to be able to afford more children and then have them. For those people with one or two children, I think, being young and having Medisave accounts, they should have no problems paying for the various subsidized fees that are presently applicable to the Class C patients. So I do not see any need to provide free paediatric treatment for children in the Class C wards.”
“Sir, as I have mentioned this morning, we are in the process of planning a children's wing and so I am in no position to provide the details. Sir, Mr Choo has asked whether we are going to corporatize the children's wing. The new Kandang Kerbau Hospital will be corporatized. And since the children's wing forms part of the new hospital, obviously it will also be under the autonomous management of the new hospital. He has asked for free paediatric treament for all children.”
“We have existing day-release employment scheme in which patients work in open employment during the day with companies and return to the View Road Hospital at night. This programme was started in 1984, and we now have 31 patients who are participating in this scheme. For 1988, 34 placements for employment were made for the patients and we are still trying to encourage more employers to participate in this scheme. With regard to day-care centres, we now have two day-care centres at the Mandalay Day Care Centre which is situated in Woodbridge Hospital and the Alexandra Day Care Centre. These two day care centres provide rehabilitation and sheltered work for the discharged psychiatric patients. The training activities include clerical, hairdressing, embroidery, toy making and various other industrial work. Altogether, 21 firms have supplied contract work to these two centres and we again would like to encourage more companies to assist by providing work to these two centres. Sir, with regard to Woodbridge Hospital redevelopment, the piling work will begin shortly, and there are no plans at the present moment to make Woodbridge a restructured hospital.”
“But we will consider and see how we can perhaps make the polyclinics available to other doctors who are prepared to run it. The main measure that we are using now to discourage the non-emergency cases from utilizing the A&E clinics and thereby depriving those who require emergency treatment is to give the lowest priority to those non-emergency cases which can afford to wait. So even if an emergency case comes in much later, we will make sure that the emergency case is treated immediately and the non-emergency cases, even though they may be waiting for an hour, would be pushed further back until we have cleared all the emergency cases. I think that is a fair measure. Mr Heng Chiang Meng has asked quite a few questions on the psychiatric services. Sir, we are taking all possible steps to treat the mentally ill and those who require psychiatric care on an outpatient basis, rather than institutionalizing them in Woodbridge Hospital. We now have several outpatient clinics and we will extend the services to other polyclinics that are being opened up in the coming years. With regard to the child psychiatric services, Sir, we will be extending the child psychiatric sessions to the new polyclinics that are being opened in Tampines and Yishun. We will also extend the age range of the children who are being treated in those clinics. Children, up to 12 at the present moment, will include children ages 13 up to 20. To cope with the expected increase in workload, we will increase the staffing strength of these clinics and units over the next three years with the addition of three specialists, a psychologist and a medical social worker. Sir, he asked about the aftercare programme.”
“Sir, towards the end of 1985, my Ministry launched a campaign to educate Singaporeans on the proper use and the function of the A&E Department in the hospitals. The monthly A&E attendance prior to the campaign was about 37,000 per month for the years 1984 and 1985. And this monthly figure fell almost immediately after the campaign, to only 29,000. So the campaign was very effective. However, I think the message has started to wear off and the numbers have been increasing gradually. Today, we are back to a very high level of 34,000 a month. And the non-emergency cases formed about 34% of all attendances. This compares with only 20% after the campaign period. The non-emergency cases are fairly spread out, even spread out between office hours and after office hours. So there is no change. During office hours when clinics or GPs, outpatient clinics are opened, we are also getting about 30-odd% of non-emergency cases. Sir, we feel that there is a very high demand for the A&E services largely because it is a very comprehensive service and one which is being offered at an extremely low cost. It therefore attracts non-emergency cases even when such patients could easily go to a neighbourhood GP or clinic. With regard to the availability of doctors after office hours, we carried out a survey and we found that about two-thirds of all the private clinics do open after office hours. These two-thirds spanned over all GPs, and since most of the doctors in the central business district do not work after office hours, it means that the percentage of those operating in HDB estates after office hours is very high. Mr Yeo has asked whether we are prepared to open the polyclinics after office hours. We have no plan at the present moment to do that.”
“Sir, Encik Abbas has expressed his concern about the shortage of health therapists, and he has asked what we are doing to train them. Sir, we are taking various steps to train more health therapists. At the present moment, the Ministry has 26 vacancies in the areas of physiotherapy and occupational therapy. The first step we are taking is to award more scholarships for the training of these people. Six scholarships were awarded last year which is a vast improvement compared to the two that were awarded in 1987. We hope to be able to attract more applicants this year, and if we are able to, we would be happy to award at least 10 to 15 scholarships this year. Sir, the staffing position of therapists will also improve with the return of the scholars who are presently under training abroad. Four will be returning end of this year and another five will be returning next year, making a total of nine. He has also asked whether we are considering a revision of the salaries. Sir, we have proposed to the Ministry of Finance on this but unfortunately we were not successful. We will try again. Mr Choo Wee Khiang has stated that in view of our economic growth and the increased standard of living in Singapore, C class beds should no longer be basic beds, but we should improve on them. Sir, the needy and the underprivileged will be catered for and we will provide them with the full medical care. But the facilities that we will be providing will be basic level. For those who feel that they are entitled to a better level of accommodation, they should then contribute a little bit more towards that higher level of comfort. Mr Yeo Toon Chia has talked about the A&E services.”
“Sir, I will ask my officers to look into it.”
“I think I am almost finished, Sir. Mr Heng Chiang Meng, most of his points I have already addressed in my earlier answer. I will just talk about the Human Organ Transplant Act. He suggested that we should give priority to those who have opted in. We only have priority for those people who have not opted out, that means, by default they have opted in under the Human Organ Transplant Act. But I think what he means is that for those who have opted in under the earlier legislation we should perhaps give them an even higher priority. I will ask my officers to look into it but I doubt whether that will be any more effective than our earlier efforts to encourage people to opt in actively. With regard to the National Kidney Foundation, we are already providing help to NKF. We are providing them with the premises for them to carry out their dialysis operations and these centres which we are offering them are being charged at a nominal rate of $1 per month. So far, NKF has accepted the following premises: our Kim Keat Road Maternal and Child Health Clinic which we have vacated, Holland Road and Serangoon Road OPDs which we have vacated. We will continue to offer them our vacated premises and space will also be offered to NKF in the new community hospital when it is built. We also provide professional expertise to NKF. Our doctors serve as the Medical Director and advisors to the organization. We also provide training of NKF nurses and the NKF patients who are undergoing dialysis. We also make available to NKF the consumable items at cost and these items are a lot cheaper than if NKF had to buy them from the private sector because we have the advantage of bulk purchasing.”
“Sir, several sites are being considered at the present moment. I will keep the House informed when we have decided on the actual site. URINE DETECTORS IN HDB LIFTS (Progress report) 9. Encik Zulkifli bin Mohammed asked the Minister for National Development (a) in how many lifts and in which Housing and Development Board estates have urine detectors been installed since April 1988; (b) what is the progress of the pilot project to date; and (c) whether any decision has been made to install the urine detectors on a wider scale.”
“Sir, my Ministry will build a children's wing as part of the redeveloped Kandang Kerbau Hospital, with about 400 beds for children and the newborn. The pediatric and neonatal units from Tan Tock Seng Hospital, Toa Payoh Hospital and Alexandra Hospital will be transferred to this new facility when it is ready. Planning for the hospital has commenced and building is targetted for completion by early 1994.”
“Sir, I beg to report that the Committee of Supply has made further progress on the Main and Development Estimates for the financial year 1989/90 and ask leave to sit again tomorrow.”
“Sir, my Ministry plans to build a new polyclinic in Bukit Batok New Town. It will be located at Bukit Batok West Avenue 3, and is scheduled to be completed in 1991. BILL INTRODUCED COMPANIES (AMENDMENT) BILL "to amend the Companies Act (Chapter 50 of the 1988 Revised Edition)", presented by the Minister of State for Finance (BG George Yong-Boon Yeo); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed. MAIN AND DEVELOPMENT ESTIMATES OF SINGAPORE FOR THE FINANCIAL YEAR 1ST APRIL, 1989 TO 31ST MARCH, 1990 Order read for consideration in Committee of Supply [6th Allotted Day]. [Mr Speaker in the Chair] 12.44 pm Head I (cont.) - Resumption of Debate on Question [21st March, 1989], That the sum to be allocated for Head I be reduced by $10 in respect of Code IC 1500 of the Main Estimates." - [Dr Hong Hai.] Question again proposed.”
“Sir, a total of 1,595 children were treated at the Child Psychiatric Clinic in 1988. In addition to the Child Psychiatric Clinic at the Institute of Health, child psychiatric sessions were started at the newly-opened Jurong Polyclinic in October 1988. We will extend the child psychiatric sessions to other new polyclinics that will be built in Tampines and Yishun in 1990 and 1991, respectively. The services are also being expanded to include older children between the ages of 13 and 20 years. To cope with the increased workload, we will increase the staffing strength over the next three years with the addition of three specialists, a Psychologist and a Medical Social Worker. MAIN AND DEVELOPMENT ESTIMATES OF SINGAPORE FOR THE FINANCIAL YEAR 1ST APRIL, 1989 TO 31ST MARCH, 1990 Order read for consideration in Committee of Supply [5th Allotted Day]. 12.44 pm [Mr Speaker in the Chair] Head V -”
“The average amount in the Medisave account of persons aged 55 years and above is currently $2,682 per account. Please see Appendix 1 for breakdown of the Medisave accounts. The low balance is to be expected as the contribution period for persons in this age group has been short since Medisave Scheme was only introduced in 1984. Based on the rate of hospitalisation of those age 55 and above, the total hospitalisation expenses that one is expected to incur at subsidised wards in Government hospitals is estimated to be $10,000, taking into account future increases in hospitalisation cost. The average balance of $2,682 therefore cannot cover all the hospitalisation needs of the people in this age group. In most cases they will need to be supplemented by their children's Medisave accounts. The average balance in the Medisave accounts of those 55 and above has increased by 35% since 1985, or about 12% a year. As the Medisave Scheme matures, the average Medisave balance of those aged 55 and above will improve with each cohort corresponding to the longer period of contribution. Appendix 1 DISTRIBUTION OF MEDISAVE ACCOUNTS BY BALANCE GROUPS FOR THOSE >= 55 AS AT DECEMBER 1988 ____________________________________________________________ Balance Groups No. of Accounts Proportion ($) < $1000 46,682 39.4 1000 - 4999 45,848 38.6 5000 - 6999 11,119 9.4 7000 - 9999 10,197 8.6 >= $10,000 4,795 4.0 ____________________________________________________________ 118,641 100.0 ____________________________________________________________ Annexes - ENROLMENT OF PUPILS IN PRIMARY AND SECONDARY SCHOOLS BY LANGUAGE MEDIUM, CHOICE OF CL1/CL2 AT PSLE IN 4 PRIMARY SCHOOLS (Cols. 567 - 570) Annex - RELIGIOUS KNOWLEDGE OPTIONS AT SECONDARY 3 (Cols. 571 - 572)”
“Sir, my Ministry plans to build a new Institute of Health at a site within the Singapore General Hospital compound to replace the present building at Outram Road. My Ministry is currently seeking approval and funds for the development of the new building. Design of the building will commence as soon as approval is obtained. We hope to get the new Institute of Health building ready in 1992. MAIN AND DEVELOPMENT ESTIMATES OF SINGAPORE FOR THE FINANCIAL YEAR 1ST APRIL, 1989 TO 31ST MARCH, 1990 Order read for consideration in Committee of Supply [2nd Allotted Day]. [Mr Speaker in the Chair] 12.52 pm Head T (cont.) -”
“Sir, of the various incentive measures to encourage family formation, the tax incentive and the Medisave incentive schemes are the only ones which specifically relate to the year in which the child was born. The other incentive measures apply to families with three children, irrespective of the dates of birth of the children. The tax relief and rebate for children born in 1988 will only be applicable to taxpayers in the Year of Assessment 1989. Such data are therefore not available now. As for the Medisave Scheme, 3,316 claims were made by Medisave account holders for the births of their third child for the period January to June 1988. This represents 78% of the total third order births during the same period. Information for the second half of the year is not available as yet. NEIGHBOURHOOD POLICE POST IN CHANGI 6. Mr Teo Chong Tee asked the Minister for Home Affairs when will a neighbourhood police post be set up in Changi Constituency.”
“Mr Speaker, Sir, a total of 5,281 Singaporeans have opted out as at 1st January 1989. The Ministry is not doing anything to persuade these people to change their status because our commitment is that everybody has a free choice and we will only persuade them through public education rather than on an individual approach. Secondly, a total of 203 Muslims have opted in to-date. With regard to objections from families of those who have died from accidental causes, Sir, only a few of the family members were unhappy but, after our counselling and persuasion by doctors and our medical social workers, they accepted the fact that the donation of kidneys is allowed under the Act and it is an important gesture by the family. INCENTIVE SCHEMES TO ENCOURAGE PROCREATION (Particulars) The following Question stood in the name of Mrs Yu-Foo Yee Shoon - 5. To ask the Acting Minister for Health how many women out of the total number that gave birth in 1988 benefitted from the various incentive schemes implemented by the Government to encourage population growth.”