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 Inter-Ministerial Committee would also be responsible for formulating policies which the Government will then review, and those policies which are accepted will then be implemented through the various Ministries. The Member for Changkat has asked whether the Government is going to adopt very different population policies. The policies that we have at the present moment will be continued, and that is, we will still stress on the need for small families. However, in line with the concern about the lop-sided procreation patterns in which it has been analysed that women in the higher socio-economic group tend to have a smaller family, for example, one or two children, it is therefore necessary for such women to be encouraged to bear their share of procreation requirements of the country. The policies will be continually reviewed and they will be modified as and when necessary. But I think we all realize that population trends are long-term trends. So we do not expect policies to change rapidly. The Member for Anson has asked about the building and the land presently occupied by the Singapore Family Planning and Population Board at Dunearn Road. The land was leased from the Government. The building was paid for by a grant from IPPF. This building was subsequently handed over to the Government when the SFPPB was formed. Therefore, under this Repeal Bill, all the assets and liabilities of the Board will be handed over to the Government. The Member for Ulu Pandan has asked about the need to review new contra- ception products and whatever other services are required. Such review will be continued, as is already being done by the Ministry's staff. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House.”
“Mr Speaker, Sir, one common question which has been asked by the various Members who have spoken is why the need to repeal, especially in view of the fact that the population procreation pattern has been changing; we are seeing a decline in the growth rate. So why not continue with the Board and let the Board address these problems. I think the key statement which I have made just now was that over the years because of the increasing complexity and the scale of the operations, much of the actual day-to-day running of the Board has been integrated with the work of the Ministry. Let me give Members some examples. The Chairman of the Board is the Deputy Director of Medical Services in charge of Public Health. The Executive Secretary of the Board is the Director of the Maternal and Child Health Clinic. The various specialists who undertake projects for the Board are specialists from the Ministry. So, in actual fact, the day-to-day operations of the Board form part of the operations of the Ministry. The same staff who are now providing the leadership and the specialized expertise will therefore be able, despite the fact that the Board will be dissolved, to continue with their work of first monitoring the trends in population growth, analysing those trends and com- ing out with the solutions, which is exactly what they have been doing over the past years. The Government has also formed an Inter-Ministerial Committee on Population comprising Permanent Secretaries of various Ministries. This will allow the Government to monitor on a much broader basis the population trends and to implement programs which should be better coordinated between the various Ministries, thereby making them more effective for the future.”
“The National Kidney Foundation started its publicity campaign on the proposed opting-out legislation in the middle of April. During the two weeks of April, the National Kidney Foundation received a total of around 8,000 petitions supporting the proposed legislation. It is continuing to receive petitions at the rate of about 500 a day. The National Kidney Foundation has also embarked on a programme to visit the community centres in order to publicize the proposed legislation and to explain the circumstances under which kidney transplants will be done. The response to these visits so far has also been very promising and the Foundation has been receiving an overwhelming support from the participants of such functions. NOTICES OF SITTINGS”
“Sir, the existing two clinics at Ang Mo Kio and Toa Payoh will be adequate to cater for the needs of all the new towns around these two clinics, including the new town of Bishan. However, the Ministry will continue to review the utilization of these two polyclinics and will take the necessary measures if they are fully utilized. ADJOURNMENT TO A LATER DAY (Motion)”
“Let me move on now to the points brought up by the Member for Bo Wen. He has asked about the redevelopment programme for Toa Payoh Hospital which serves Ang Mo Kio, Bo Wen and Bishan. There are plans now to upgrade Toa Payoh Hospital. The timing has not been fixed. But it is likely that when the redevelopment programme proceeds, Toa Payoh Hospital will be redeveloped with an increase of 150 beds, making a total of 560 beds. The renovations of the existing building will be carried out to upgrade and provide more B2 class beds, for which there is a tremendous demand and which unfortunately is not available at the moment. The facilities and services which are presently inadequate would be upgraded and this would be included as part of the redevelopment programme. With the completion of the redevelopment, Toa Payoh Hospital will then definitely be in a good position to service the new towns around the area, namely, Toa Payoh, Ang Mo Kio and Bishan. As regards the enquiry by the Member for Pasir Panjang, he has asked a few questions. Firstly, is there an A&E service available at NUH? The Emergency Department of NUH will be opened in May this year, ie, in two months' time. What are the number and class of beds available? At the moment, we have 47 private rooms, ie, single-bedded rooms. We have 92 beds in 4-bedded rooms and we have 145 beds in 6-bedded rooms. The 6-bedded rooms are equivalent to the B2 beds in Government hospitals. The charges are similar and they are very heavily subsidized. When fully commissioned, we will have 81 beds in the single-bedded rooms, 156 beds in the 4-bedded rooms and 403 beds in the 6-bedded rooms, making a total of 640 beds.”
“Anyone who approaches our hospitals and informs us that he is unable to pay for various reasons, will have his case investigated. We will review his employment circumstances, his family circumstances, and if it is a genuine case we will give him full assistance. Sir, he also said that some members may not be prepared to use their Medisave because they would like to leave some balance for future living purposes. My advice to them is that they should use the Medisave in relation to the balance that they have. If they have a low, Medisave balance, they should go to the C class and the bills will be low, and if the balance is still not enough they are allowed to overdraw. If they are jobless and they cannot afford to pay, we will then investigate and, if necessary, give them a waiver. Mr Jeyaretnam: Why can't we have a rule that those who are unemployed can avail themselves of free treatment?”
“" That is the correct advice to give and I hope he will abide by this practice in the future.”
“It is therefore important for private practitioners to also participate in counselling abortion patients. The Ministry is finalizing plans to make abortion counselling mandatory for all seeking abortion at Government and private hospitals and clinics. This abortion counselling programme will involve the following: 1. Advising patients that abortion is not without risks and should not be resorted to unless absolutely necessary; 2. Emphasizing that abortion should not be used as a method of family planning and that there are other safer and simpler methods of family planning; 3. Encouraging women to continue with the pregnancy if she is psychologically, socially and economically in a position to do so; and 4. Motivating the women to use a reliable contraceptive method after the abortion if she insists on continuing. The abortion counselling programme will be closely monitored in all Government and private institutions. Sir, abortion is a social, more than a medical, issue. Any reduction in the number of abortions will require a change in society's attitude towards not only abortion but also marriage, responsible parenthood, illegitimate children and unwanted children. The Ministry will work closely with the Ministry of Education in this respect. Sir, I am not hopeful that we can erase the need for abortion. What we can do is to try to restrain and eventually reduce such demands. Let me move on to the Member for Anson. He has made a plea that the Ministry be less rigid in collecting charges. He has mentioned a case of a man who is now jobless who has approached him for advice. I am very happy that for once he has given him good advice, and that is, "Please go to the hospital, inform them of your plight and the hospital will help you.”
“Sir, yesterday the Member for Whampoa, true to form, made an impassioned and emotional speech on abortion. Unfortunately, because of shortage of time, he was unable to complete his arguments but I am aware of his stand. One needs only to refer to the Hansard to note his firm and unwavering position on this issue. I understand and appreciate the Member's strong religious convictions. While I do not intend to repeat all the past arguments which are still valid today, two points bear repeating. The Government's prime concern must be for the safety and health of the expectant mothers. Depriving them of legalized abortion will not eliminate the existence of the operation. It merely erases the official data on the number of abortions that have been carried out. A woman who is determined not to complete her pregnancy will only be forced to go to the back-street abortionist. It will be very unwise to return to the 1960s when septic abortions by back-street abortionists were the order of the day. Secondly, it will be totally erroneous to blame the availability of abortion on demand for permissiveness. Singapore is an open society. We are completely exposed to western influence and lifestyles. It is inevitable that a number of our impressionable youths and others will adopt some of these lifestyles, including undesirable ones. It will be folly to try to turn the clock back and isolate ourselves from the rest of the world. Since we cannot, we must find other alternatives. My Ministry has all along been counselling patients seeking abortion in Government institutions. This has made our hospitals unpopular despite the fact that it costs only $5 for an abortion. Today, two-thirds of all abortions, as pointed out by the Member, are carried out by the private sector.”
“Because of the rush, the doctors run the risk of missing vital symptoms. The result has been frayed nerves and tempers and unhappiness all around. The Ministry reviewed the situation and late last year decided on a two-prong approach. We launched a publicity blitz in the mass media. We used posters. We distributed plenty of pamphlets and the whole programme took off on 1st November 1985. At the same time, we started a pilot project at Tan Tock Seng Hospital whereby non-emergency cases were identified using triaging nurses and during the evening peak hours they were re-directed to the evening clinics that have been established within the hospital for this purpose. The pilot project has been found to be very satisfactory and by the beginning of this year all the four A&E departments, namely at SGH, Toa Payoh, Tan Tock Seng and Alexandra Hospitals, have started re-directing non-emergency cases. During the daytime they are re-directed to the OPDs that are close by and to the GPs. In the evening, they are re-directed to our evening clinics. The results have been good. We have seen a drop in attendances from about 8,100 per week before the scheme started to about 6,500 in February this year, representing a decline of 20%. The proportion of non-emergencies has also reduced from 57% to only 22% in February. Waiting time has also been reduced and now 85% of all patients only wait for less than half an hour. The remaining are seen to within an hour. We will continue to educate the public and we will continue to triage and turn away the non-emergency cases to ensure that genuine emergency cases will be given their proper treatment. Let me move on now to the remarks made by the Member for Whampoa.”
“The Member for Whampoa has also asked that the Medisave ceiling of $15,000 be lowered to enable more people to use it for house-ownership. The Government has already announced a wide range of measures to overcome problems faced by house owners because of the CPF cut. They can also use the amount in their Special Account if need be. The Medisave scheme has just been extended to private hospitals. We have also liberalized recently and more liberalization will be considered. I think it is prudent for us to study and analyse the usage pattern for the next 12 to 24 months, as I have just mentioned, and then make appropriate modifications when necessary. Let me move on now to the question on the A&E problem. Let me first give an overview of the problems facing the A&E departments. Up to the end of 1985, the A&E departments have been overly utilized. The fundamental problem is that the large number of patients which stood at 211,000 in 1975 increased to a total of 470,000 in 1984. This represents an increase of 122% over a 10-year period. Analysis of the patients revealed that only 43% of the patients had an emergency condition, the remaining 57% were actually non-emergency patients. The misuse of the A&E facilities has created huge problems. Firstly, you have the problem of long queues with long waiting times. Yes, certain patients during the peak periods have had to wait up to three hours. The doctors, the nurses and the supporting staff also face tremendous pressure from the large crowds who are all clamouring for early treatment. The sad part is that because of this pressure, genuine cases sometimes are not able to obtain immediate treatment as they fall into the queue. The doctors are also unable to give adequate treatment time.”
“Sir, we must learn from the experience of others who have gone through the route of general medical insurance for the whole population. These countries are now facing difficult problems in relation to funding the system. Let us learn from their mistakes. It has been shown that a general medical insurance scheme when extended to the whole population inevitably end up creating the "buffet lunch syndrome". What is this? This is a situation where the insured, after having paid for his insurance, decides that he should use the benefit. Yes, of course. Initially there will be caution and reluctance to use the scheme unnecessarily. But after a few years when he starts toting up how much he has paid up, he will be wondering, "what am I paying for? I have not used any of it, I'd better use it up when I have the next opportunity." What does that do to the insurance companies? Very easy. They just increase the premiums and the careful and sensible account holders end up paying unnecessarily for those who abuse it. So eventually even the cautious get into the act. This ends up in a big usage spiral. The Member for Jalan Kayu also stated that with a general medical insurance system Singaporeans will end up taxing the taxpayers less because they will be using their own insurance system. They will not be using subsidies. I think he is totally wrong on that point. In fact, we will end up paying more subsidies to the hospitals. The reason is that at the moment 80% of all hospital services are provided for by the Government. Out of these services 75% of all beds are in the heavily subsidized B2 and C wards. Sir, the Ministry is definitely not in favour of using Medisave as payment towards a general medical insurance system.”
“He is also afraid that, with the extension to the private hospitals, the doctors in the private sector may not practise restraint and liberally hospitalize their patients. Sir, I sounded a similar reminder some three weeks ago to Medisave account holders that they should not overlook the fact that the money in their Medisave account belongs to them and that, if they conserve their funds carefully, they will over a period of time reach the ceiling that has been imposed. The contribution in excess of the ceiling will then be transferred to the Ordinary account which can then be used for paying their housing loan or for investment, as the case may be. More importantly, nobody can predict when they or their family members may fall ill. It may be from an accident or from contracting various diseases. It could be from normal wear and tear of the body because, after all, one's body does wear out. Whatever is the cause, when it does happen and one is hospitalized, the Medisave funds will be a great relief. At least the account holder and his family need only worry about recovery from the illness and not about availability of funds. However, while there is a need to periodically sound a note of caution on the use of Medisave, there is presently no cause for alarm. The usage over the past two years since Medisave started shows a very cautious usage pattern. For the six months to the end of December 1985, 90% of all withdrawals were for less than $1,000. I am confident that Singaporeans are by and large very careful with their money and they will spend it wisely, provided they realize it is their own. The Member for Jalan Kayu has also suggested the possibility of using Medisave for payment towards a general medical insurance.”
“The Members for Toa Payoh and Ulu Pandan have also pointed out that, in considering the implementation of such a legislation, Government must be aware of and be sensitive to the views of Singaporeans who, for various reasons, either religious, cultural or personal, may not be in favour of joining such a scheme. Sir, their objections must be respected. The Ministry must therefore make sure that when such a legislation is being considered, we must make available convenient means for such people to opt out of the scheme. However, whilst respecting the wishes of those who do not wish to join and who wish to opt out, we must also be fair and safeguard the interest of those who are participating in the scheme. We must ensure that they are given first priority if they happen to need an organ and if such organs are available. The Member for Toa Payoh has also made some very relevant comments on catastrophic health insurance. He voiced concerns about the impact of the high cost of dialysis on this insurance scheme. He has estimated that over the period of ten years the annual cost of dialysis may increase to about $24 million a year and that this huge sum will overload the insurance system. It may end up depriving other patients who are suffering from other serious illnesses from benefitting from the insurance scheme adequately. Sir, we will definitely need to consider certain safeguards and I wish to thank the Member for Toa Payoh for his suggestions. Let me move on now to the question of Medisave as raised by the Members for Jalan Kayu and Telok Blangah. The Member for Jalan Kayu has expressed fear that Medisave account holders may misuse their medisave funds by getting hospitalized when their medical condition does not warrant it.”
“They suffer emotionally in terms of worrying about the possible infections, they agonize with him in his treatment and financially it is a burden as well. The patient's work or career is normally affected because of the need to undergo regular dialysis. Sometimes the spouse's own career may be affected. The correct solution is to ensure that there is a supply of kidneys for transplantation. Where can this come from? There are two sources. One is from a living sibling, from a parent, or in the case of a parent from the child. The other, which is preferred, would be cadaveric organs. Sir, for the cadaveric organ programme to succeed, we need to have at least 800,000 kidney pledges. Over the last 15 years the Ministry together with the National Kidney Foundation have been publicizing widely the need for Singaporeans to sign up as a kidney pledger. However, despite all the wide publicity, only 24,000 have signed up to date. What are the reasons for this reluctance? Well, it is partly due to the lack of public awareness, awareness that only when there is an accidental death will a person's organs be required or be appropriate for transplant. Secondly, some Singaporeans show they are prepared to sign up, by obtaining the necessary forms. But after taking the forms, because of apathy or other reasons, they fail to send in the form. The Ministry has been studying this problem and one measure that is actively being considered now is the possibility of legislating for automatic organ donation when there is accidental death. This has been mentioned by both the Members for Toa Payoh and Ulu Pandan. Sir, this is not a new legislation because many other countries already have it. We are now studying the experience of such countries but the initial reports are quite encouraging.”
“The Ministry is participating in a study on the socio-economic consequences of the ageing of the population. Research emphasis is also being given to the medico-socio- and psycho-geriatric problems of the aged. A teaching Fellow in geriatric medicine is presently attached to the Department of Socio-Medicine and Public Health at the National University of Singapore. The Ministry has also sent two doctors for training in geriatrics over the past two years. We plan to send at least one doctor and, if possible, two, a year for training in geriatrics for the next five years. Let me now move on to the points raised by the Members for Toa Payoh and Ulu Pandan. Sir, many Members of this House must have read the various articles appearing in the press on the plight and suffering of kidney patients. They have publicized the predicament of these patients in the hope that more Singaporeans will step forward to join a scheme that amounts to the only long-term solution to their problem. Sir, as mentioned by both Members, dialysis can only be a temporary measure. It is prohibitively expensive. As mentioned by the Member for Toa Payoh, it costs a patient $1,000 per month to undergo dialysis. Not only is it expensive, but the quality of life for both the patient and his immediate family is also lowered. The patient is tied literally to the dialysis machine for about five hours each session three times per week. Usually while undergoing dialysis, a family member needs to stay with him to assist him. There are also long-term side effects, such as brittle bones. Sir, not only does the patient suffer, but the family members suffer along with him.”
“Sir, with the ageing of the population, the HNF has plans to expand its scope or function and activities. Being a voluntary organization, it will be mobilizing greater community participation in its activities and in fund raising. HNF will consider being part of the Community Chest when its functions and activities are consolidated. The services to be provided in the senior citizens' health care centres will include day-care, rehabilitation, health screening, health education and counselling. The senior citizens' health care centres will be located in the new polyclinics to be built. They will be sited in relation to the number of the aged and the absence of other day-care centres for the aged. The setting up of health care centres required a considerable amount of organizational and infrastructural support in terms of professional manpower and volunteers. It is not necessary nor is it possible to provide every constituency or community centre with one health centre. The HNF has therefore decided to build ten centres in the next five years. This should be adequate to cover the needs of the aged in the community. We would like to discourage the proliferation of health care centres all over the island. However, if any private organization, residents' committee, or community centre, management committee, wished to set up such centres, they should be consolidated into a few areas where the need exists. The Ministry will assist private and voluntary organizations in the setting up of such centres together with the Ministry of Community Development and in training their staff and volunteers. With the ageing of the population, there is more in gerontology amongst the medical profession and sociologists and economists.”
“Let me move on now to the specific questions and points raised by various Members yesterday and this morning. The Member for Changkat has asked several questions relating to the Home Nursing Foundation and the care of the aged. The Ministry plans to build two community hospitals during the next 6-7 years. The community hospital is not meant for the use of the aged exclusively. It provides inpatient care to all those who do not need complicated or sophisticated medical care irrespective of whether they are young or old. The first community hospital will be built in Ang Mo Kio New Town where there is a large concentration of population and the large number of elderly as well. A second community hospital is meant to be built in the early 1990s. The exact location has not been decided yet. The Home Nursing Foundation (HNF) does not intend nor is its objective to take over the entire care of the elderly at home. One of its main tasks is to teach and train family members to nurse the elderly in the home environment. In addition, the semi-ambulant will be encouraged to make use of the rehabilitation and day-care facilities at the health care centres which will be opened. The target is to cover all who require home nursing care in five years' time. The Ministry currently provides 23 nurses to assist the HNF in its activities. This will be increased to 42 with the expansion of the Foundation's activities and the opening of the two senior citizens' health care centres later this year. The Ministry also provides the HNF with medical and surgical supplies at Government rates. The Ministry will be prepared to provide the Foundation with more assistance and subsidies should the need arise.”
“About 136,000 representing 8.6% of total Medisave account holders have used their Medisave by the end of last year to pay their hospital charges. The feedback, as the Member for Telok Blangah has mentioned, is that the scheme is helpful. Sir, we recognize that the Medisave scheme in itself is not enough. There will always be the unfortunate who will fall sick with some major illness that may completely deplete his Medisave account. For such persons, my Ministry plans to introduce a form of major medical catastrophic health insurance scheme. The Ministry is currently working with the representatives of the insurance firms in Singapore and with the Council of Health insurers. We hope to be able to finalize details of the scheme by the end of the year. Sir, for the catastrophic health insurance scheme to succeed and to incur low premiums, it must cover all persons within the effective age group. Premiums will be paid using Medisave contributions. This should not pose any problems to wage earners with Medisave accounts. However, the self- employed are presently not required to contribute to Medisave although it was announced on 22nd June 1984 that the Ministry of Labour will amend the CPF Act to require the self-employed to contribute to Medisave. My Ministry together with the Ministry of Labour will be studying how best to extend the Medisave Scheme to the self employed may be implemented. We expect to complete the study within the next 12-18 months. Sir, further liberalization of the use of Medisave will be considered. My Ministry will also carefully study the usage pattern and changes in the profile of the balances over the next 12-24 months. We will then make whatever changes are necessary or feasible to the prevailing ceiling on the Medisave balance.”
“The Ministry is planning to redevelop in phases Toa Payoh Hospital, Tan Tock Seng Hospital and Kandang Kerbau Hospital over the next 5-10 years. Facilities or services like the accidents and emergency departments, specialist outpatient clinics, operating theatres and intensive care units will be upgraded if they are presently inadequate or substandard. Adequate numbers of the subsidized B2 and C class wards will be retained to meet the needs of the lower-income group. Mr Speaker, Sir, the redevelopment and building of new hospitals and polyclinics will cost large sums of money. Modern diseases are more complex and difficult to diagnose and treat. They often require sophisticated equipment which can be very expensive. For example, a computer tomography scanner can cost up to $2.7 million each. Higher level support staff are also needed to operate and maintain such machines and systems. Our health costs have gone up significantly, increasing seven-fold from $57.4 million in 1970 to $506.8 million 1985. Last year, the subsidy level for health services was 73% which works out to $144 per person for the whole year. The bulk of the subsidy goes to patients in B2 and C class wards and to the polyclinics. Sir, in line with the Government's aim to contain the growth in Government expenditure, it is necessary that the high subsidy level continues to be reduced. Singaporeans must therefore be prepared to pay their fair share of the cost of high technology medicine. However, as I have stated many times before, the indigent and the lower income groups need not fear as they can apply for remission or waiver of fees. Sir, I will now move on to the Medisave scheme. Since its inception on lst April 1984 in the Government hospitals, we have rapidly extended its usage.”
“My Ministry will concentrate, in particular, on dealing with the two major killers affecting Singaporeans today, namely, heart diseases and cancer. Special multi-disciplinary task forces have been set up to look into all aspects of these two disease conditions. They will shortly make recommendations to the Ministry on the strategies to be adopted and the developments needed to contain the rapidly increasing incidence of these two diseases. Members of this House will therefore note that to achieve medical excellence, we will need to upgrade the general standard of medical practice in Singapore and in the areas which affect Singaporeans most. It will benefit all Singaporeans. In the process, some foreigners will come to train or to work in Singapore. Others will come for treatment and all these will benefit the economy as well. Before we can hope to achieve any of the above, we must restructure our hospitals to give them autonomy and flexibility. They must be given management flexibility to allow them to innovate, motivate their staff and achieve greater efficiencies while providing good personalized services. The National University Hospital (NUH) was the first hospital to undergo this pilot project of restructuring. We are monitoring the performance closely and we hope to learn some valuable lessons from it. We are now studying the possibility of restructuring the Singapore General Hospital. The exact form it would take and the timeframe have not been decided. But it will probably take at least two or three years before it can be brought about. As for the other acute hospitals, the Ministry recognizes the need to upgrade the physical facilities first before they can be restructured.”
“This will allow the phasing out of old outpatient dispensaries and maternal and child health clinics which are small, inefficient and poorly equipped. These new polyclinics will also provide facilities for the care and rehabilitation of the aged. Such health care centres will be run by the Home Nursing Foundation. In fact, two such centres will be opened this coming financial year at Kampong Ubi and at Kuo Chuan. My Ministry will be studying measures to provide a more efficient, effective and higher level of care in the new polyclinics. We will continue with our responsibility of providing primary health services to children, the elderly and the indigent. For those who are in the working age group, my Ministry will take steps to encourage them to use the private sector. I now come to the question of medical excellence at the secondary and tertiary levels. Here, we have to ask ourselves just how much we can hope to achieve. For the small population, we have to provide a limited patient base. With our limited manpower and financial resources, we have to be realistic and set attainable targets. Sir, we cannot hope to achieve excellence in everything but we can be good in some things. We have to set our priorities and decide what to invest in and which areas to specialize in. My Ministry has therefore decided that it will continue to emphasize on the specialities first identified by the Government in 1970 for further development. These are the specialities of cardiothoracic surgery, neurosurgery, plastic surgery, paediatric surgery and renal medicine. We have made significant advances in these areas. I believe that we can do more.”
“Mr Speaker, Sir, I will respond on behalf of my Minister. Sir, before I proceed to answer the points and questions raised by Members, I would like to give an overview of the broad direction my Ministry will take over the next three to four years. The thrust of my Ministry's programmes will be to lay the foundation for Singapore to develop into a Centre of Medical Excellence. Some people have asked what this involves and how this will benefit Singaporeans. Medical excellence involves the upgrading of standards of health care at all levels, whether it is at primary, secondary or tertiary level. While emphasising the upgrading of standards, my Ministry is committed to the philosophy that prevention of disease is as important as its cure. We will expand our efforts to educate the public on the need for healthy lifestyles and on the responsibility of the individual for his own health. Sir, today two-thirds of primary health care and one-fifth of hospital care are provided by the private sector. The private sector must therefore actively and constructively participate in our endeavour to further improve our nation's health standards. My Ministry will work closely with the academic and professional bodies to achieve this. My Ministry's Health Advi- sory Council has been expanded to include representatives from professional organizations, the University, the private sector, as well as non-doctors. The Council would provide feedback on future directions and developments of the health services in Singapore. Let me now outline some of the major programmes that the Ministry is or will be implementing. To improve the Ministry's primary health care services, 10 new polyclinics will be built over the next five years in the larger new towns.”
“Mr Deputy Speaker, Sir, I beg to report that the Committee of Supply has made further progress on the Main and Development Estimates for the financial year 1st April, 1986 to 31st March, 1987, and ask leave to sit again tomorrow.”
“Mr Speaker, Sir, since Question No. 9 is also on the same topic, may I have your permission to answer both questions at the same time. Mr Speaker, Sir, the Government has already announced a number of measures to assist house owners who are unable to service their housing loan repayments because of the scheduled reduction in employer's CPF contributions. There is therefore no need to consider exempting a working spouse from contributing to her Medisave Account. MARKET DEVELOPMENT ASSISTANCE SCHEME (Particulars) 7. Mr Philip Tan Tee Yong asked the Acting Minister for Trade and Industry, since the introduction of the Market Development Assistance Scheme in September 1985, (a) what was the amount granted as at the latest convenient date; (b) how many companies have benefitted from the Scheme; and (c) what kind of activities were promoted. The Minister of State for Trade and Industry (Dr Lee Boon Yang) (for the Acting Minister for Trade and Industry): Mr Speaker, Sir, I will answer on behalf of my Minister. Sir, the objective of the Market Development Assistance Scheme (MDAS) is to help companies penetrate new markets, introduce new lines of products and services and expand existing market shares. Since its introduction, grants totalling about $680,000 have been awarded to 83 companies. Activities given funding support under the Scheme include redesign of packaging for exports, opening of overseas offices, and overseas marketing and advertising. REVISION OF PUB TARIFFS 8. Mr Leong Horn Kee asked the Acting Minister for Trade and Industry, in view of the recent drastic fall in oil prices, when and by how much the next revision of Public Utilities Board tariffs will be made.”
“Mr Speaker, Sir, at the present moment our medical services are very, very heavily subsidized. If it is the intention of the Government, as it is, to reduce taxation and reduce the burden on business and on wage earners, then it is important that we are able to reduce these subsidies in years to come. However, whilst we are reducing the subsidies, the Government will still ensure, as I have stated many times in this Chamber, that the indigent and those who are unable to pay will still be given the appropriate level of medical care. That consideration must always be there. There is nothing wrong with the Government reducing the subsidy because the subsidy is still there and it is going to be still very substantial.”
“Mr Speaker, if the children have more than adequate Medisave balances, their excess will be paid into their Ordinary CPF account, thereby allowing it to be used for their own housing or investment needs. The children, if they are that well off, can easily provide for the daily needs of the parents, if that is the case. It is important for us to ensure that the elderly are able to look after themselves because in the years to come there will be a large number of elderly amongst us. As we have seen in the United States and in the United Kingdom and the other developed countries, the plight of the elderly is fairly serious. In fact, there was an article in the Newsweek magazine last week that highlighted the inability of the elderly in the US to afford proper medical care because of lack of funds. I think it is important for us to bear that in mind and to ensure that we do not get into that same situation in the next 20 or 30 years.”
“Mr Speaker, Sir, I think it is important for us to get the aim of the Medisave Scheme in the right perspective. The aim of the Medisave Scheme is to ensure that every one has adequate funds to look after primarily his own hospitalization needs and his immediate dependants' needs. If his parents do have the ability, through their own Medisave funds, to look after their hospitalization needs, I think it is important for the parents to continue using their own funds, and relying on the children only when their own Medisave balances are used up. This will ensure that their children will, in turn, have adequate funds of their own because they must inevitably also reach the age of 55.”
“Mr Speaker, Sir, if it is the objective of every parent to leave the minimum to his children when he dies, then I think we would have many of the elderly selling their house by the time they reach 55 years and take up rented accom- modation so that they can enjoy the fruits of their investment.”
“Mr Speaker, Sir, where the elderly have the means to support their own hospitalization needs, we should encourage them to do so without burdening their children, without increasing the financial pressure on their children. The amount at the moment retained in the Medisave balance of the elderly, ie, those people above 55 years old, is only $5,500. This will increase to $6,000 from 1st April. This amount, I can assure the House, will be barely adequate to look after his own hospitalization needs as well as that of his wife.”
“Mr Speaker, Sir, a person reaching the age of 55 before the end of this month will only need to retain in his Medisave account a sum of $5,500 or his actual Medisave balance, whichever is the lower. He can withdraw the amount in excess of this $5,500. It has been established that an average person can expect to be hospitalized a total of 59 days from the age of 55 to the time he dies. The bulk of these hospitalization days will be during the last six months of his life. This amount retained in the Medisave account will allow the elderly to look after their own hospitalization needs, and that of their spouse, thereby reducing the financial pressure on their children or grandchildren. A Medisave account holder who continues working after the age of 55 will also continue his Medisave contributions. The amount in excess of the prevailing Medisave limit may be withdrawn once in every three years.”
“It will help to correct the pattern if the target group finds that it is a useful benefit. But at the same time, we have to be sure that those in the lower-income group are not enticed by this liberalization into having more children, thereby jeopardizing their own chances of helping the family get out of their present predicament. CLOSURE OF MEDISAVE ACCOUNT FOR THE ELDERLY 5. Mr Philip Tan Tee Yong asked the Minister for Health, in view of the fact that a Central Provident Fund member can utilize his Medisave account for the payment of medical bills of his parents and grandparents, whether he will consider (i) allowing an elderly person with children and/or grandchildren to withdraw all his moneys from his Medisave account, and (ii) exempting an elderly worker from contributing to his Medisave account even if he has less than $15,000.”
“- to ensure that they will grow up with the proper training, proper education, so that they can contribute meaningfully to the growth of our country, they will be encouraged, in fact, to have larger families.”
“It is not a discriminatory measure. If a family can afford to bring up their children, provide the children with proper education, proper upbringing -”
“Mr Speaker, Sir, population policy is the responsibility of the Government as a whole. The Government has been analysing the procreation figures and the results of the lopsided procreation pattern have been well noted and well publicized. It is in the interest of the nation that this lopsided pattern be corrected and therefore the Medisave policy for higher order births was propounded and implemented as part of the national effort to remedy this lopsided policy. Based on the results to date, the Ministry has found that this policy of allowing Medisave only for the highly educated mothers has not produced the desired results. Therefore, we are in the process of reviewing it in order to broaden the policy but without jeopardizing the chances of people in the lower-income group of getting out of their present poverty trap.”
“This will make it even more difficult to build up a core of local construction workers.”
“The community hospitals will not be acute hospitals. Patients who require longer term care, for example, those who are recovering from orthopaedic surgery and who require a lower activity type of care will then be referred there and hospitalized there. FOREIGN WORKERS' LEVY (Request for reduction) 15. Dr Wong Kwei Cheong asked the Acting Minister for Labour if the government will further assist industries to reduce operational cost by reducing the Foreign Workers' Levy, since the government has already decided to reduce the employers' Central Provident Fund contributions by 15% points. The Acting Minister for Labour (Mr Lee Yock Suan): Mr Speaker, Sir, the Foreign Workers' Levy is applied to non-traditional source (NTS) workers who are allowed only in the construction industry, the shipyards and as domestic servants. Few NTS workers are left in the other sectors of the economy with the near-completion of the programme to phase them out from these other sectors by the end of the year. The levy is also applied to traditional source workers in the construction industry who are here on Block Work Permits. Foreign workers in the manufacturing and other industries are almost entirely on the CPF scheme. They are not affected by the levy. For the construction industry, the original plan was to increase the $200 levy per month to $350 by April 1986 in steps of $50 increase every six months. The objective was to narrow the substantial cost difference between hiring local and foreign construction workers. However, in view of the economic recession, the Government has frozen the levy at $200 per month until further review. Any reduction in the levy will further depress wages in the construction industry and discourage Singaporeans from seeking a career in the industry.”
“Mr Speaker, Sir, as I have just stated, the site has been reserved and the timing for the building of the hospital there will depend upon the demand and the occupancy of the existing hospitals.”
“Mr Speaker, Sir, the reasons have been given. There are various alternatives, and there is no need for the State to automatically offer free medical services. Those who wish so, can apply and we will then verify their need. TOWN COUNCILS (Status) 8. Dr Aline K. Wong asked the Minister for National Development what is the status of the proposed Town Councils.”
“They can either apply for a waiver or remission of fees provided they can show that they are unable to pay, or (2) they can obtain the consent of their siblings to use their Medisave accounts.”
“The Member for Anson should be aware that even though certain people may be unemployed, they still have their own Medisave account and they can thereby pay through their Medisave account. However, in the case of persons whose own Medisave account has already been expended, they can do one of two things.”
“Mr Speaker, Sir, the present regulations allow for those indigent or those who are unable to pay for their own hospital bills to apply for remission of fees. However, there may be some cases of persons who though eligible for remission, would rather have the bill paid, even though it is by a sibling.”
“Mr Speaker, Sir, the Ministry has been allowing patients in subsidized wards of Government hospitals to settle their hospital bills from the Medisave Account of a brother or sister, on a case by case basis, on hardship and compassionate grounds. The use of Medisave by a brother or sister will be allowed if it has been verified that the patient is a dependant of the Medisave Account holder, has no Medisave Account or insufficient balances in his Medisave Account, and cannot afford to pay the hospital bills.”
“The Member for Telok Blangah has made an error. He has asked what is the number of those 85% who have overdrawn? The number who have overdrawn, out of the total and not just the 85% who have below $5,000 in their accounts, the total number who have overdrawn in the last two years have been small. But I think that relates more to the fact that the scheme is still very new. JOBS LOST (Figures) 10. Dr Toh Chin Chye asked the Acting Minister for Labour what is the number of jobs lost for the years 1984 and 1985 and during the month of January 1986. The Acting Minister for Labour (Mr Lee Yock Suan): Mr Speaker, Sir, the number of jobs lost in 1985 was 95,900 and in January 1986 was 3,100. There were no job losses in 1984. In fact, 1,000 jobs were created.”
“The Member is assuming that $5,000 and below would be well provided for and those above $5,000 are over-provided. The answer is no. The realistic figure, or the appropriate figure at the moment, based on our computations, is $15,000. However, since the scheme has been in operation for only two years and we are still in the midst of liberalizing the usage of the scheme, it is prudent for the Ministry to monitor the operations of the scheme and observe the usage pattern for the next two to three years, and to make adjustments, if required, when the time comes.”
“Perhaps I would like to bring the point brought up by the Member for Bo Wen a bit further. I think this relates to how much flexibility should we have in the Medisave scheme. The Medisave ceiling has been computed based on certain assumptions relating to family size, whether they have children, whether they have parents or grandparents, or the lack of grandparents. If we are to extend the scheme and introduce flexibility into the scheme, then it would be very complicated to administer, especially since the Medisave scheme is on a national basis. From the point of view of the individual, flexibility would be both desirable and fair. I can understand that. Unfortunately, since we have to administer the Scheme on a national level, we must keep the Medisave Scheme simple and straightforward, in terms of administration. Therefore it is not possible for us to make exceptions dependent on the family circumstances.”
“He can make up for the deficit from future contributions.”
“Mr Speaker, Sir, for Medisave Account holders below 55 years of age, the Government has set a limit of $15,000 and any balance beyond this amount will be transferred to the CPF Ordinary Account. It will be implemented on 1st April this year. The Ministry does not intend to reduce this ceiling of $15,000 as the amount has been computed based on the anticipated hospitalization expenses of the Medisave Account holder and his family. The average Medisave balance today is still low, at $2,522 per account. 85% of Medisave Accounts have balances below $5,000.”
“If the Member for Anson has any information of that nature, I will be very happy to get the facts from him. As far as we are concerned, we have discussed with the doctors and they are all in agreement with the scheme.”
“Recently the public has been educated very thoroughly on what constitutes an emergency condition. Of course, for the individual, most people would tend to err on the side of safety and treat their own ailment as an emergency. At the A & E departments, the decision as to whether or not it is an emergency is made by the nurse who will triage the case. If there are any objections, then the case is referred to a doctor who will then make the final judgment.”