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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“But if they are asked to come back to the Specialist Outpatient Clinics, which is normally the case, then it is considered to be another consultation in which case a fee of $10, or $12 if it is at SGH, would be imposed.”
“Mr Speaker, Sir, the Member for Anson has asked, what constitutes an emergency? Under the guidelines given to the public, an emergency is an illness or an injury which could end in death or serious complication if it is not treated immediately. Examples of emergencies would include major injuries such as fractures and dislocation of the skeleton, head injuries, deep cuts or large wounds on the body, severe bleeding and severe burns or scalding. Minor injuries such as bee and insect stings are also emergencies as they require immediate treatment. Non-traumatic emergencies such as heart attack, acute appendicitis, abdominal colic, renal colic, vomitting blood, etc, including high fever, are also considered as emergencies. What are non-emergencies? Non-emergencies are conditions that do not require immediate treatment, such as minor coughs and colds, mild fever, aches and pains which have been present for a long time. So those are the guidelines as to what are emergencies and what are non-emergencies. As to whether several people have been turned away because they do not have the $12, the answer is no. But recently we have been turning away people from the A & E departments because those were non-emergency cases. So they are turned away not because they do not have the money but because they are not considered as legitimate emergency cases. As to whether cuts and wounds on bodies are considered as emergency cases, it depends on the degree of the cuts and wounds. If they are minor cuts, no. If they are major cuts and wounds, definitely. As to repeat attendances in terms of surgical dressings, if they are asked to come back for surgical dressings immediately, ie, the next day, they could be considered.”
“The bulk of the patients will be locals, but the hospital will not turn away foreign patients who are prepared to pay the full price. Sir, all these developments together will help make Singapore a centre of medical excellence. Sir, I support the motion. 11.35 am”
“The Member for Ulu Pandan had pointed out the other day that unfortunately the foreign clientele had declined over the past few years, mainly because of the following reasons: (1) The economic situation and exit levies imposed by neighbouring countries. (2) The high charges imposed by Singapore doctors, private hospitals and other supporting facilities. Well, we cannot do anything about the external constraints. On the other hand, the recent drastic drop in hotel charges will help somewhat. I agree with the Member for Ulu Pandan that the key factor must be some self-discipline or self-regulation on charges by the profession and by the private hospitals. Let us not kill the goose that lays the golden eggs. A reputation once damaged will be very difficult to rebuild. The Ministry has also recognized that some medical research and development must be carried out if we are to progress further. We will look into how this can be achieved, especially in view of budgetary constraints. We will also encourage the organization and sponsorship of local and regional medical conventions, seminars and workshops so as to act as a catalyst for further clinical research. On the National University Hospital, I would like to allay the concerns of the Member for Ulu Pandan about its priori- ties. As a University Hospital, its objectives must necessarily be teaching, research and service, in that order. Unfortunately one cannot divorce service for patients from undergraduate training. In addition to formal lectures, medical undergraduates learn by following the doctors and teaching staff in the hospital wards. They assist in patient care, supervised by the senior doctors.”
“Mr Speaker, Sir, please allow me now to comment on the development of Singapore as a centre of medical excellence, as mentioned in the President's Address. The hon. Member for Ulu Pandan has also made some very interesting suggestions on this topic. The Ministry will carefully study them. The Ministry is presently working on the next stages of the process to attain medical excellence. The present standard of medical expertise and services in Singapore is generally high in the context of our immediate region, but has not reached the standard of the internationally renowned medical centres. Although our doctor to population ratio is adequate, there is still a relative shortage of specialists in certain specialities. This is especially so in the public sector. Modern medical services are delivered not by doctors alone but by a whole health team. So we will need to train not only more specialists but also other members of the health team, such as specialist nurses, laboratory technicians and technologists, bio-medical engineers and many others. Our hospitals will be restructured gradually to allow autonomy and flexibility in operations. Better services can therefore be provided for the general public as well as to provide greater motivation to the staff. The private sector must also play its part actively and constructively in making Singapore a centre of medical excellence. In 1984, foreign patients made up 45% of admissions into private hospitals. They generated export revenues of $82 million. In addition, $62 million was spent by patients and their family members on non-medical services and goods.”
“Upon his arrival, to his great horror, he found that the Indians had already started producing similar items with comparable quality but at a much cheaper price. The Indian Government had apparently, in the middle of last year, removed restrictions on certain high quality raw materials that were needed for this product. He was really in a fix. There he was in India trying to sell his samples and not finding anyone who was prepared to look at them. His mind boggled at the thought of these same products being exported to Singapore. In his mind, he could see himself as a bankrupt, just a year after embarking on his own business. He thought such are the vagaries of business. However, not one to be beaten, he located one of the Indian manufacturers and after a few days of hard bargaining, convinced this Indian gentleman to let him be his Asia-Pacific distributor, of course, subject to certain performance commitments. Today, he has made plans to visit Australia to market his Singapore and Indian products and has started trial shipments to some Malaysian and Indonesian dealers. There is no guarantee that he will succeed. But one thing for sure, he will never be held down. But if he succeeds, he will create more jobs for other Singaporeans. Sir, I have brought up this second example to urge Singaporeans to emulate his positive thinking and his fighting spirit. The markets outside may be competitive and tough, and tough they are. But someone is still selling the goods. We can ensure a fair share of those goods will be ours, but only if we are competitive, both in price and quality. Then not only will jobs be preserved but more jobs created.”
“Moaning and bickering or waiting for even more help from the Government will not bring us a single step closer to salvation. Over the past few months, I have had the chance to meet various people, many of them reasonably optimistic, others were resigned to their fate or pessimistic. At one function recently, I was approached by several businessmen who wanted to unload their complaints to me. One of them was describing how bad his business was. Turnover was down, profits were down, everything was depressing. The only good thing that had gone down, in his mind, was his golf handicap. To take his mind off his problems, he was playing more golf. He was, in fact, travelling less on business trips in order to cut down on expenses. "Anyway," he said, "why travel? Business is equally bad elsewhere." Sir, I fear that in such a rapidly changing and competitive environment, the only continuing improvement he will achieve will be in his golf game. He will see his business further eroded by aggressive marketing by his competitors. Sir, let me bring up another example of the opposite frame of mind. I met a young man in his 30s recently. When I asked him how was his business, he started off by saying that he had rotten luck. Up to early last year, he was the happy general manager of a relatively successful small local company. Feeling the urge to be his own boss, he resigned and started up his own company doing a bit of printing and selling various items to the local and regional markets. Finding the local market pretty tough, he looked around and, anticipating that India under Prime Minister Rajiv Gandhi might present a huge attractive market, decided to visit India late last year to market his products.”
“Mr Speaker, Sir, I rise to thank the President for his Address. Over the past few months, one topic or worry has been foremost on all our people's minds, ie, the recession in Singapore. Hardly a week went by without an article on this subject appearing either in the local press or in the foreign press. During this period, members of the Economic Committee and its sub-committees spent long hours gathering and, sifting through masses of data, collecting feedback and viewpoints, carefully and systematically analyzing the information and, finally, identifying the causes of the recession and formulating the recommendations needed for correcting the situation. Two days ago, the First Deputy Prime Minister in this House announced the measures this Government is implementing to lift us out of our problems. My fellow PAP MPs have over the past four days very thoroughly, constructively and critically debated the Report of the Economic Committee as well as the measures designed to nurse our economy back to health. All the important points have already been well covered. There is no need for me to repeat all their arguments. I therefore urge all Singaporeans to focus their minds and energy on the key objective which must be to regain our competitiveness, to preserve the existing jobs and to create new ones. Let us not indulge in further debating and arguing over the desirability of certain marginal changes to the bold measures that have been announced. We must waste no time in ensuring that the $2.8 billion that will be injected directly into the economy this year will not be frittered away. Lost time in business equals lost opportunities and such opportunities may never return. It means all of us must view our situation with positive frames of mind.”
“2 notified job vacancies to each new job registrant in September last year. With the recession, it has become more difficult for new job seekers and retrenched workers to find work. Nevertheless, employment opportunities, for example in the hotel industry, are still there if our workers are prepared to make the adjustment and accept lower paid jobs.”
“The whole scheme is currently under study. But for such a scheme to succeed, it is very likely that it will have to be a scheme that covers the bulk of the population, that means it would in some ways have to be compulsory. JOBS CREATED AND JOB OPPORTUNITIES (Figures) 20. Mr S. Vasoo asked the Acting Minister for Labour (a) how many new job openings have been created since the beginning of 1985 up to the latest convenient date; and (b) whether there are sufficient job opportunities for new job seekers as well as retrenched workers. The Acting Minister for Labour (Mr Lee Yock Suan): Mr Speaker, Sir, my Ministry does not compile statistics on new job openings created by establishments. Employers are not obliged to report such data. In any case such information can be misleading because new job openings in some establishments may be offset by job losses in other establishments. Job vacancies also arise from resignation, retirement, deaths and other causes not related to new job creation. What my Ministry does is to keep track of the overall employment situation. In the first half of 1985, there was a net job loss of 36,200 jobs mostly from the construction and manufacturing sectors. About 7,000 Singaporean workers were retrenched during this period whilst larger numbers of foreign workers returned home. The unemployment rate as at June 1985 has been estimated at about 4.1%. This is slightly higher than the average unemployment rate of about 2.9% over the last four years when the labour market was very tight and large numbers of foreign workers had to be imported. In September 1985, the Employment Service Department of my Ministry received approximately one notified job vacancy to each new job registrant. This compares with 2.”
“The Ministry has all along been encouraging members of the public who are self-employed to contribute to the CPF as well as the Medisave Account, and we will continue to do so.”
“The quantum must be large enough to provide for the expected hospitalization expenses of the account holder's grandparents, parents, spouse and children. It must also take into account that topping up will be available in-between hospitalization episodes since the account holder will still be working. Since this modification will require amendments to the Central Provident Fund Act, it will probably take six to nine months to implement. (d) Extension to 100% of Class A bills in Government hospitals. The Ministry is currently analyzing the Medisave withdrawal pattern and balances to ascertain the feasibility of increasing the scale of withdrawal for Class A wards from the existing 80% to 100%. We expect the study to be completed within the next three to four months. (e) Catastrophic Health Insurance. The Government recognizes that persons with prolonged or major illnesses may not have sufficient balances to pay their hospital bills. Hence, some form of medical insurance scheme would have to be introduced to supplement the present Medisave Scheme. The Government is considering a catastrophic or major medical insurance scheme to cover certain major and high-cost medical conditions. The Ministry is holding discussions with the health insurers in Singapore and hopes to finalize such a scheme within the next year.”
“The philosophy behind the Medisave Scheme is that the individual should set aside a small sum of money each month in the form of compulsory savings to meet the cost of hospitalization should he or any of his immediate family fall ill and require hospitalization. It is also to ensure that the individual will have sufficient savings to meet the cost ofhospitalization in his old age. In the light of the experience so far, and taking into consideration the balances in individual Medisave Accounts, the Government has been studying how to liberalize utilization of the Medisave Scheme without deviating from the basic objectives of the Scheme. The following are the likely modifications: (a) Extending the Medisave Scheme to cover expenses in private hospitals. The Government is ready to extend Medisave to private hospitals along the same line as that for the National University Hospital and to the same extent as in the Govern- ment hospitals. How soon this can be achieved will depend on how quickly the private hospitals and the private doctors can come to an agreement amongst themselves on an equitable and acceptable implementation procedure. (b) Extension of Medisave for Grandparents. This is in line with Government policy to encourage filial piety. However, the grandparents must be Singaporeans, permanent residents, work permit or employment pass holders. Medisave Accounts will not be allowed to be overdrawn to pay the hospital bills of grandparents. We expect to implement this within the next three months. (c) Setting a limit on Medisave Balances. Setting a limit on Medisave Balances makes good sense, as it will further encourage account holders to stay healthy. The Ministry's statisticians are presently studying what this limit should be.”
“To advise the Ministry on the interpretation of the data, we currently have demographers from the National University of Singapore as well as statisticians from several Government departments. MEDISAVE (Extension of Scheme) 19. Dr Ang Kok Peng asked the Minister for Health, in the light of the experience in the implementation of the Medisave Scheme, whether he will consider (i) liberalizing the use of the Medisave Scheme such as to cover patients other than the immediate members of the family and private hospital charges; and (ii) setting a ceiling on the amount to be retained in the Medisave Account; and, if so, when will such extension of the Scheme be effected, and what will be the maximum amount to be retained in the Medisave Account, stating how this amount is arrived at.”
“The plan has always been to try to rehabilitate them and, for those who have been cured, to release them back to their families. PARLIAMENTARY OPPOSITION (Motion) Order read for Resumption of Debate on Question [14th May, 1985], "That this House regrets the obstructionist attitude of this Government to the growth of a genuine Parliamentary Opposition in Singapore in accordance with the will of the electorate.". - [Mr J.B. Jeyaretnam]. Question again proposed. 11.22 am”
“I understand the Unit looking after the chronic sick and the aged has been taken over by the Ministry of Community Development.”
“There are no plans at the moment. But it is still under study in terms of the overall health care services.”
“As I have stated earlier, we have current plans to expand the various outpatient clinics and specialist outpatient clinics. However, there is a limit as to how fast we can expand because of the availability of trained personnel. The hon. Member can be assured that we have a programme and we will be taking steps to implement the programme as stated.”
“I am sorry I do not have the figures at hand. But if the hon. Member likes, I will arrange to send it to him.”
“The present trend, on a world-wide basis, is to try and retain those who are less mentally ill in the home environment so that they are not fully isolated from a real-life situation. For those who are violent, for those who are unable to be restrained at home, they can be referred to the Woodbridge Hospital and most of those cases are retained at Woodbridge Hospital for observation, which normally stretches from between four and six weeks. If they are found to be suitable for release, they will then be released to their own homes where the home environment is more conducive to their recovery. However, they will be given the proper medication to ensure that they are under the correct treatment.”
“They are not just restricted to those on the public assistance programme.”
“For long-term stay in the Hospital, no fees are charged if they are unable to pay. In fact, we have many patients who have been staying in the hospital for many years and who have not been paying a single cent. Most of them do not have to pay, mainly because they have been left there by their families who are unable to take them home. Therefore, we have not been charging most of such patients. The fees for the outpatient clinics are also very minimal and if the Member wants to know, I can provide him with the whole range of the fees.”
“One of the priority activities in this programme is educating the public on stress management. This will be done through seminars, health fairs, talks and information materials. For example, a seminar on stress control was conducted for secondary school teachers last month. A stress management booth was included in the Health Fair held on World Health Day on 6th April this year. In addition, Woodbridge Hospital will continue with its various educational activities such as the following: (i) Educating patients and their relatives on the symptoms and treatment of mental illness, the need to seek medical advice and treatment early and regular follow up to ensure maximum success in treatment. Relatives will be taught to cope with patients after their discharge. (ii) Staff will give talks on mental health to interested groups, for example, at schools and work places. Interviews, talks and articles will be given through the mass media. A series of articles on mental health contributed by the Hospital's Psychiatrists will be featured in the news media in the near future. (iii) Hospital staff will continue to work closely with the Singapore Mental Health Association in its mental health education programme and will promote activities that will benefit psychiatric patients. Mr Jeyaretnam: Mr Deputy Speaker, Sir, may I know from the Minister of State the range of fees that are being charged at Woodbridge Hospital? I suppose there must be patients in this Hospital who have been there for a considerable length of time. Are they being charged at the rate that is being prescribed for short-term patients? Does the Ministry consider the hardship of families who may not be able to meet these fees?”
“There are also five Psychiatric Outpatient Clinics at Maxwell, Bedok, Pegu, Bukit Merah and Lim Ah Pin Polyclinics/Outpatient Dispensaries. Additional Psychiatric Outpatient Clinics at Polyclinics to be developed at Woodlands South, Yishun and Bukit Batok are being planned for the next three to four years. (ii) There are two Day Centres, namely, the Mandalay and Alexandra Day Centres. These centres have proved effective in rehabilitating discharged psychiatric patients and preparing them for return to the community. At these centres, patients undergo group therapy and are given training for simple job assignments in a sheltered environment. They are paid a token allowance based on their output. The maximum capacity of both Centres is 180 patients at any one time. In 1984, both Centres took in a total of 525 new cases and found employment in private firms for 99 patients. The Ministry is considering setting up a third Day Centre at the Lim Ah Pin Polyclinic. (iii) The Ministry is considering developing psychiatric units in general hospitals for the less severe mentally disturbed cases. A ward in Tan Tock Seng Hospital will be converted to function as a psychiatric unit by the end of this year. Similar units will be established in Toa Payoh and Alexandra Hospitals to provide inpatient, outpatient and day treatment. This way we hope to treat the early or mild cases of psychiatric disorder within a general hospital rather than purely in Woodbridge Hospital. The promotion of mental health will be a part of the Ministry's overall health education programme. This programme seeks to promote both the physical and mental health of school children, patients, the workforce and the community through healthy lifestyle.”
“Mr Deputy Speaker, Sir, the present Woodbridge Hospital was built in 1928. It was built at a time when the treatment of psychiatric patients was custodial with compulsory confinement in an institution isolated from the city centre. The many buildings which make up Woodbridge Hospital are spread over a very large area. They are old, out-moded, inefficient to manage and do not meet the needs of a modern psychiatric centre. As envisaged in the National Health Plan, the Ministry plans to demolish the present hospital and replace it with a new, compact and multistoreyed hospital complex that is in keeping with a modern centre for psychiatric treatment. A Study Team comprising two Consultant Psychiatrists and two Architects recently visited new psychiatric hospitals in Hong Kong, Canada and the United States. A Planning Committee is being established to prepare a Master Plan for the redevelopment of Woodbridge Hospital. The team will be finalizing the plans to submit to the Ministry and the Ministry hopes to obtain approval for the building of the new Psychiatric Centre and to commence construction work in 1986. The project should be completed within three years. The main thrust in modern psychiatric treatment is on non-institutional ambulatory or outpatient care. The Ministry's future plans for day and community care programmes for discharged patients will include the following: (i) Increasing the number of Psychiatric Outpatient Clinics for the follow-up treatment of patients discharged from hospital and for those who do not require hospitalization because of the early or mild nature of their illness. At present, there are a number of Specialist Outpatient Clinics at Woodbridge Hospital.”
“Mr Deputy Speaker, Sir, I would like to bring up two observations and make two suggestions to the Ministry for consideration. Over the past 12 to 18 months, the HDB has been completing and allocating a very large number of flats, and this high building programme will continue for the next few years. Therefore, a large number of Singaporeans are being relocated from one part of Singapore to another. Some of these people who are shifting are also hawkers and it is only natural that they would like to be able to move their stall from its present location to one that is nearer their new home. Sir, I would like to make a suggestion for the Ministry to review as to whether it will be possible for the Ministry to perhaps set up a registry of hawkers whereby hawkers could register the location of their present stall and to state the location that they desire. They can then mutually have a swop scheme. The second area of observation is the state of our public toilets. Normally, after a good meal at the hawker centre or after a hard day's shopping, one goes to a toilet and what does one come up with. First, before he even gets in, he is struck by the heavy, stale and humid atmosphere in the toilet. And when he goes into the toilet, he has to walk on a very wet floor. Sometimes, if he is lucky, just a damp floor and this is because the toilet attendant normally tries his or her best to mop up the floor. Sir, the reason for this very stale atmosphere and the damp floor is that most of these toilets are very, very poorly ventilated so that the stale air cannot be cleared nor can the moisture on the floor evaporate. I would, therefore, like the Ministry to consider whether they could in any way improve the ventilation or insist that the ventilation of the toilets be improved.”
“Again, Sir, the Member for Anson is trying to cast insinuations and innuendoes on the policies of the Ministry. I would like to assure him that we will continue to have Class C wards in our Government hospitals. Our poorer Singaporeans will never have to fear that they will be deprived of the proper level of medical care in our Government medical services.”
“Sir, as you can see from the figures in the Table, we have made much progress in these two areas. The Table, which has been circulated, as you can see, is self-explanatory.”
“From the Table, Members can see that, in terms of comparison with the other countries, the number of population per dentist in Singapore is still quite high when compared to Australia, France and the other developed countries. In the National Health Plan, the Ministry has planned for a dentist to population ratio of one dentist to every 3,000 persons by the year 2000. The plan was to increase the intake of dental students into the NUS to about 60 per year over the next few years. However, after a further review, this has been reduced to 40 a year for the next few years, compared to the average of 37 a year from 1974 to 1984. My Ministry's policy will emphasize on preventive services and curative care in dental clinics in hospitals, outpatient clinics and primary schools. The plan is to shift from curative to preventive dentistry. Greater emphasis will be given to dental health education, to improve and extend the school dental service to eventually cover the pre-school, primary and secondary school population. My Ministry will also concentrate on the provision of specialized dental services. The better graduates will been encouraged to undergo further training in the dental subspecialties, both local and overseas. These specialized dental services will be provided mainly at the dental clinic in Singapore General Hospital and in the major general hospitals. In line with the above, my Ministry will continue to employ new dental graduates on a short-term basis to provide them with some experience before they set up practice in the private sector. Sir, I would also like to refer to the second Table, which I have given out, which shows the health indices in our country, ie, the health indices in terms of mortality rate and in terms of our life expectancy.”
“The Ministry is now working jointly with the Ministry of Labour to extend the Medisave to the self-employed in the near future. Regarding his query as to whether the Medisave balance is adequate and how many accounts have been overdrawn todate, the experience in the first nine months of the Medisave Scheme has been that almost all patients who use Medisave had adequate balances to meet their hospital expenses. As at 31 st December 1984, of the 47,843 Medisave Account holders who had made withdrawals to pay hospital bills, only 174 or 0.4% overdrew their Medisave accounts. Also, the amount overdrawn has been low, the average amount being $175. The statistics show that the monthly contribution of 6% to the Medisave Account is adequate at least for the hospitalization in Government Class B2 and C wards. In reply to the Member for Chong Boon regarding the supply of dentists and whether the Minister would also consider helping in the setting up of dental clinics in community centres, first, I would like to inform him that my Ministry would, in principle, agree to the equipping of a dental clinic in the Chong Boon community centre and to lease such equipment to him if he is able to secure a suitable place for this purpose. Regarding the supply of dentists, there are currently 475 graduate dentists at the end of 1984. This gives a dentist to population ratio of 1 dentist to 5,324 population. Sir, I would like at this stage, with your permission, distribute some Tables (Cols. 1517 - 1520). [Copies distributed to Members]. Tables - COMPARISON OF DENTISTS TO POPULATION RATIOS, COMPARISON HEALTH INDICES (Cols. 1517 - 1520)”
“Sir, let me go on to answer the last few points raised by the Member for Ayer Rajah as well as the Member for Chong Boon. I appreciate the concern of the Member for Ayer Rajah about whether any money has been wasted or wrongly invested in the manufacture of Hepatitis B vaccine. I can assure him that the Government is very prudent when it comes to spending public money. For the information of the rest of the Members in this House, Singapore Biotech Pte Ltd was incorporated in August 1983, to manufacture, under licence from an American company, plasma-based Hepatitis B vaccine and to sell this vaccine in Singapore, ASEAN and the surrounding region. However, in view of the rapid advances in technology for the manufacture of Hepatitis B vaccine, the company this year decided not to proceed with the original plan to manufacture Hepatitis B vaccine using the plasma-based technology. It has not invested in any manufacturing facilities. The company is now monitoring the progress made by various research groups and pharmaceutical companies in developing this new vaccine. It is currently negotiating with the American company to produce under licence the new generation vaccine after the American partner has been granted approval for manufacture and use of the vaccine by the relevant health authorities in US. 3.30 pm Regarding his other point on Medisave, I again want to thank him for bringing up the plight of those who are not on Medisave, the self-employed. We have invited the self-employed to voluntarily contribute to Medisave. To-date, only 332 selfemployed persons have voluntarily been contributing to Medisave. Their average Medisave balance is $2,253 per account.”
“The First Deputy Prime Minister and Minister for Defence (Mr Goh Chok Tong): Mr Speaker, Sir, may I be permitted to say a few words on this question of a second drug store in the Singapore General Hospital. Sir, the Member for Anson in his usual manner has cast a slur -”
“The practice of prescribing standard drugs, according to their generic name, is a practice that is accepted in most countries. We cannot afford to stock a whole series of different proprietary brand names for a particular item just to meet the individual preferences of a patient or a doctor. When a patient or a doctor requires a non-standard item, the patient is given a prescription and he is asked to purchase it from an outside pharmacy. Requests for non-standard items by doctors for treatment of in-patients is generally approved on an ad hoc basis by the Medical Director of the hospital. When such a patient is discharged from the hospital, he will have to buy the non-standard drugs from private pharmacies. However, if he cannot afford to pay for these drugs, he can then make an application to the Ministry's Drug Advisory Committee for approval for such drugs to be supplied to him as an out-patient. In all instances, if, for medical reasons, he is required to have such drugs and it is confirmed that the patient has problems paying for such drugs, the Drug Advisory Committee would normally approve the application. Regarding the case that the Member has brought up whereby a person was in hospital for about 10 minutes and he had his bill charged, I am not aware of the facts of the case and I would appreciate if the Member could give me the facts and I will definitely look into it. Regarding the point that there is a drug store at the hospital, I can assure him that patients are not directed to any particular drug store. They are free to choose the drug store for their own drugs. They are not directed to any drug store.”
“I think it is a very relevant case. What the Member has raised is a very relevant case. I should explain the background of the case to show that that article was misleading so that it would not unnecessarily frighten our own citizens. Sir, the case in point relates to a permanent resident here who is suffering from Parkinsonism. This is a long-term debilitating disease and requires routine drugs to be given. Our Singaporeans should normally be able to utilize our C Class facilities. So can this person, in point. However, he has not decided to take advantage of our C Class and has insisted on going to the A Class ward, thereby incurring a very high medical fee. If he was prepared to take advantage of the facilities available in Singapore, facilities which are enjoyed by all our citizens, he would then only have to incur a bill of $20 per month for drugs, not $400 as reported in the papers. I would like to state the facts clearly. Regarding the case that he has brought up whereby a member of the public informed him that he had to pay $811.30 on drugs for a period of seven months, and he queried as to why the hospitals are not stocking such drugs, let me again set the record straight. Sir, the Ministry has a list of standard drugs totalling 603 items in all. This is normally considered to be very adequate because even the World Health Organization recommends a list of only 371 drugs for hospitals to stock. Therefore, our list is significantly larger. However, patients are occasionally given a prescription to purchase drugs from private pharmacists outside, and this is because either the patient requests for a particular brand of drug which the Ministry does not stock or because the doctor feels that a particular brand is more suited to the patient.”
“Okay, I will definitely review his advice and look into the matter. I will now take the points brought up by the Member for Anson. In terms of the example brought up by the Member regarding the recent appearance of an article in the papers whereby a person claimed that he could not get proper medical treatment here and he could not afford the proper medical care here and could not afford the drugs, and he had to go back to England, I fear the Member may have been misled by the article. Let me explain.”
“The Member for Ayer Rajah has very aptly brought up the increasing costs of medical care. He has suggested that we should work towards moving out medical care to polyclinics and hospitals in the community. I thank him for his advice and would definitely look into it.”
“A Class C patient, for such an operation, would pay only $248 while a Class A patient needs to pay $1,865, almost eight times more than the price paid by a patient in Class C ward. For a major operation, whilst a Class A patient will be required to pay up to $4,900 for the operation in operation fees alone, a Class C patient with the same service, using the same facilities of the Class A patient will need to pay for his operation only a maximum of $120, whilst the Class B2 patient will only have to pay $200. 3.15 pm As you can see, the operation charges are significantly and substantially subsidized. This heavy subsidy is also reflected in the Ministry of Health's recurrent expenditure which has increased by almost 75% over the past four years, from $217 million in 1980 to $376 million in 1984. And as I have stated earlier, if, with all these subsidies, a patient still cannot afford to pay, he can apply for a waiver or a remission. In answer to the Member for Changkat, in 1983, the number of cases in which patients were unable to pay and had their bills remitted, totalled 13,750 cases, involving a total bill of $1,020,000. Sir, there is absolutely no basis for the fear or belief that any Singaporean will be deprived of the proper medical care. I would like to assure Members of this House once again. In reply to the Member for Fengshan as to whether the NUH, being a private hospital, would deprive the other hospitals of the services of the lecturers and doctors from the University, I would like to assure him that the teaching of doctors in the other Government hospitals will still continue. Therefore, patients in other hospitals need not fear that they would be losing out on the services of such specialists.”
“It will be very efficient and the patients in the low income group will be able to enjoy subsidized B2 class service. However, if, in spite of all this, there are patients who still cannot afford to pay the B2 charges, they could apply to the Hospital for a reduction or a waiver of their charges. This is in line with Government policy that applies to all the other Government hospitals. Such applications would be looked into by the medical social workers who are based in the Hospital, and I can assure Members that deserving cases will have their charges reduced or waived completely. The Member for Changkat has also asked whether the privatization of NUH will affect the programmes for polyclinics and plans for community hospitals. I can assure her that the NUH programme will in no way change our programme and plan for the setting up of polyclinics and community hospitals. To her other point about remissions, I would like to take that in conjunction with the fears that the Government is not providing adequate medical care and at a low enough cost to the low income group. This happens to be a favourite topic of the Member for Anson, and I would like to disabuse the Member of his frequently repeated criticisms. Let me first reassure him, as I have done about two weeks ago, that no Singaporean will ever be deprived of proper and adequate medical care. Our Class C and Class B wards are not only very heavily subsidized but safeguards are also built in to ensure that, for major surgical operations, there is a limit placed on how much such patients would be charged. Let me give some figures to illustrate this, giving the average charges for an appendix operation which involves about six days of hospital stay.”
“This is no different from the situation in teaching hospitals overseas where patients in the private hospitals are used for teaching. The most well known examples are the Mayo Clinic and the Cleveland Clinic in the US which are private hospitals with very large and well known undergraduate and postgraduate teaching programmes for the teaching of doctors and specialists. I would like to allay the fears of the Members for Fengshan and Changkat that this will make the health service more expensive and, therefore, not affordable to the low income groups. As I have explained earlier, the aim is to make the Hospital autonomous and thereby more efficient and economic to run. The NUH when completed will have a total of 767 beds, of which approximately 70% will be in the 6-bedded rooms. These beds will be the equivalent of the B2 beds in the new SGH. The remaining 30% are in the single or 4-bedded rooms equivalent to A and Bl class beds. All patients admitted to the 6-bedded rooms will be levied charges similar to those in the B2 class wards of the SGH, ie, they will be heavily subsidized to the order of about 75% of the running cost. If capital depreciation is taken into consideration, the subsidy for these patients would be even more subtantial. Patients attending the Accident & Emergency Department and the Specialist Outpatient Clinics will also pay charges similar to those in the SGH. Taking all these into consideration, the Government has agreed to provide a subvention of $20 million to the NUH for these subsidized services. The hospital will have to recover its other operating costs for all the other services from the A and Bl class patients. Thus, it will be seen that the running of the NUH will not be purely profit oriented.”
“Mr Speaker, Sir, on behalf of my Minister, I will answer the points raised. The Member for Changkat and the Member for Fengshan have raised the point about privatization and what is the background behind the formation of the National University Hospital (NUH) and how that would impact on the costs of health care to the patients there. Let me first explain about the thinking behind NUH and correct any wrong impressions that Members may have as well as the members of the public may have on the setting up of the Hospital. The main objectives for incorporating NUH as a private organization are: (1) To institute a new organizational and management system which will be fully autonomous and outside of the Civil Service, yet within the guidelines set by the Ministry of Health. (2) To allow the management to improvize and bring about innovative management systems which we believe can lead to greater economies and efficiency in the running of hospitals. (3) To enable the Hospital to establish and maintain the highest levels of excellence in medical education and research and in the delivery of patient care. Through better staff remuneration systems, we hope that the Hospital will be able to attract and retain the best medical staff. To answer the question from the Member for Fengshan, the NUH as a private hospital will not affect the role of the National University Hospital as a teaching hospital because approximately 70% of its beds are in B2 class wards. Sir, we have been using both C and B2 class patients in the SGH and the other hospitals for undergraduate and postgraduate teaching all along. In fact, if there are patients in either the A class wards or B class wards that have rare or interesting medical conditions, they will also be used for undergraduate instruction.”
“15 per kilogram for refined sugar in Singapore is comparable to prices in other ASEAN countries, and is lower than in most net sugar importing countries elsewhere. For example, Hong Kong relies entirely on the spot market for its sugar, yet their prices are higher than ours. Nevertheless, my Ministry is carefully monitoring the situation and will review and revise the existing policy when it no longer serves the interest of Singaporeans.”
“Plans for the redevelopment of these two hospitals are expected to be completed within the next 18 months. PRICE OF SUGAR 6. Mr Ng Kah Ting asked the Minister for Trade and Industry (a) if he is aware that the retail and industry price of sugar of $1.15 per kilogram is higher than the prevailing world prices of refined sugar and whether this is due to Government's protection of the Sugar Industry of Singapore Limited; and (b) whether the Government intends to liberalize the import of sugar and, if not, why not. BG Lee Hsien Loong (for the Minister for Trade and Industry): Mr Speaker, Sir, the prevailing world price of sugar is low, as there has been excess production in major exporting countries in the last three years. We do not expect the present glut to last long. Some producers have already reduced the acreage for planting of beet and cane sugar. Like most commodity prices, sugar prices fluctuate widely. The price of imported white sugar has varied from a high of $2,017 per metric ton in 1974 to the current low of $481. As sugar is an essential commodity, it is desirable to protect our consumers against these drastic swings. Hence, to safeguard the interest of consumers, the Sugar Industry of Singapore (SIS) has, since 1973, had long-term supply contracts with Australia covering about two-thirds of its requirements. These long-term contracts have enabled consumers to enjoy a stable price of sugar over a long period. On average, over the last decade, consumers in Singapore have paid slightly less than the world prices for SIS's sugar. The arrangement also assures Singapore of a ready supply of sugar during a crisis, as SIS is responsible to the Government to keep adequate stocks of raw and refined sugar. The current retail price of $1.”
“This will allow the traffic to merge into the main traffic stream without causing any slowing down of the traffic.”
“In order to help the farmer overcome his initial difficulties, I would like to appeal to the HDB to perhaps allow such farmers to take in a partner who may be experienced in shop-keeping or running a busifiess but without penalising him and allowing him to continue enjoying the concessionary rental rate. 3.30pm Sir, if you could allow me to move on to the Roads Department. The Roads Department has certainly made driving in Singapore more efficient with its vast network of highways. Recently, there have been some refinements such as puffing up overhead gantry signs that have allowed motorists to filter into the correct lanes well before approaching such turn-offs. Now, an expressway is most efficient when traffic can be kept moving fairly fast and fairly smoothly, fast within the speed limit, of course, and without unnecessarily slowing down. Sir, unfortunately, quite often traffic has to slow down whenever there are entry points or exit points from the highways. This is because quite often we find only a short slip-road at, for example, the entry point leading into the expressway. The traffic joining the expressway often, therefore, has to slow down, often, almost to a stop. When they managed to filter into the main traffic stream, it takes some time for them to speed up, thereby traffic behind them has to either slow down significantly, or we often find the traffic in the inner lane frantically trying to edge out into the middle lane in order to avoid such slow-moving traffic. Sir, I would like to suggest that the design of the expressways at such points be improved by increasing the length of the slip-road at such entry points and allowing the slip-road to become the fourth lane in a three-lane highway for perhaps 100/150 metres.”
“However, many of them come to see me saying that after waiting for about 18 months the have still not been offered such shops. The other group of resettled armers apparently should be quite happy because they have been given shops. But that is not so because they come to see me claiming that although they have been allocated shops, those shops are generally very poorly located within HDB blocks, ie in locations where the general public would not like to tender. Although they have been given such shops, the rentals that they are charged for such shops are pegged to the lowest tendered price based on the better-located shops. Sir, if these two types of situation, as reported to me, are true, then I hope the Minister will allow me to offer some suggestions. Firstly, the HDB could perhaps ensure that those who have been promised shops will not have to wait for many more months. They could perhaps calculate a certain percentage of all the new shops that are going to be completed in the near future to be allocated to resettlement cases. However, the specific locations of such shops within a particular block should be truly randomly selected. That means some would be in good locations and invariably some would be in poor locations. The HDB should also establish a fair rental price for each of these shops according to the auractiveness of each shop's location, I am sure with its vast experience the HDB would not have much difficulty in ascertaining what should be the various prices befitting each shop and location. Sir, my other observation is that a successful farmer does not necessarily make a successful shopkeeper.”
“Thank you. Sir, before I proceed to offer some suggestions to the HDB, I would like to join my fellow Members in congratulating the HDB on its very remarkable achievements. In the process of achieving its tremendous goals, the HDB over the past 20 years has had to resettle over 100,000 families. Some of the more recently resettled families have seftled down in the new HDB flats ih my Hong Kah Constituency. In this constituency, Sir, there are also many families in the rural areas who are waiting to be resettled over the next few years. These two groups of families - those waiting to be resettled as well as some of those who have already been resettled - have over the past few months, during my Meet-the-People sessions as well as during my house visits, approached me with some of their concerns. Sir, resettlement can be a very traumatic experience, especially when it involves a person in his late 40s or mid-5Os who has spent much of his life as a farmer and who also has a few school-going children to look after. He is not only dislocated from his familiar surroundings but he also faces the bleak prospects of losing his livelihood. Fortunately, the HDB has recognized the difficulties and has come up with a commendable compensation package to help these resettled people tide over their problems. Those people who are waiting to be resettled have seen me recently to ask whether the HDB's compensation package is still valid under the present circumstances. I therefore join my fellow Member from Nee Soon in appealing to the HDB to look into this. Now, I come to the other group who have already been resettled. These people have been told that they would in due course be offered a shop at reduced rental rates.”
“Sir, may I have your permission to speak on my amendment* which centres on the HDB? The Chairman: Yes.”
“Mr Speaker, Sir, let me first answer the question from the Member for Radin Mas. The age groups that we have in the data relate to those below 15 years and those between 16 and 19 years. We have no further breakdowns other than these. The figures for those below 15 years are quite constant. They are in the region of 20 a year. To the question posed by the Member for Punggol as to whether the Ministry is having second thoughts on the Act, in terms of repealing the Act, the answer is No. But we feel that certain provisions in the Act may have to be modified in order to reduce the ease with which teenage abortions can be obtained. RULES OF DEBATE (Compliance with Standing Orders) Announcement by Mr Speaker”
“Mr Speaker, Sir, a teenager is defined as someone who is below 18 years of age.”
“Mr Speaker, Sir, yes, the Ministry is very aware of the debates and they were well recorded in the Hansard. We will definitely refer to them.”