Committee of Supply – Head O (Ministry of Health)

Healthcare Challenges in Singapore

Dr Lam Pin Min: Mr Chairman, Sir, I beg to move,

That the total sum to be allocated for Head O of the Estimates be reduced by $100.

Sir, I would also like to declare my interest as a healthcare worker in a restructured hospital. As I was preparing for my speech on healthcare challenges in Singapore, I chanced upon a powerpoint presentation in my desktop computer entitled "My Hero", which was prepared by my eldest daughter, Kate-Lynn, for her English assignment. Before opening up the file, I thought it would probably be describing world famous personalities, like Mother Theresa, Mahatma Gandhi, Abraham Lincoln or contemporary pop singers like Taylor Swift, Katy Perry or Justin Bieber.

However, to my pleasant surprise, one of the slides reads as follows: "My hero is my father. He works as a Paediatric Ophthalmologist and he helps little children who have problems with their vision." This kept me thinking and allowed me to see the healthcare challenges facing Singapore from a different perspective.

6.30 pm

Being in the GPC for Health for the past six years, I have spoken on various healthcare issues, namely, the affordability, accessibility of healthcare to Singaporeans, working towards a seamless healthcare system, mental health issues, medical tourism and the impact of the impending silver tsunami on our healthcare infrastructure.

We have emphasised so much, and rightly so, on the receivers' end of the healthcare system. But in order to achieve a first-world efficient and compassionate healthcare system, we need good people. Healthcare workers, including doctors, nurses and allied health professionals, play a critical role in delivering the best healthcare service we so desire and expect.

Healthcare workers are often forgotten until major disease outbreaks happen, such as in SARS and in the H1N1 pandemic, or when disasters struck, such as the collapse of Hotel New World and Nicoll Highway. In fact, healthcare workers are constantly fighting a battle against diseases and facing the threats from bacteria, viruses and other micro-organisms.

Whilst there may be a few black sheep in the profession, I believe this is few and far in between. I believe the majority serve in the healthcare sector because they have the passion and the compassion to heal. To quote Sir William Osler, the Father of Modern Medicine, "The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head."

As a Paediatric Ophthalmologist, I derive great joy and satisfaction treating young children and seeing them get well. As a surgeon, I often have to perform surgery on young children. As you may know, surgeries in the paediatric age group are usually performed under general anaesthesia. Parents would usually accompany their children into the operating theatre and coax them till the anaesthetists administer medicine to make them fall asleep. What happens after that is something I always find very touching. After the child is asleep, the parents would often reluctantly leave the operating theatre. With tears of apprehension welling up in their eyes and a helpless countenance, they leave the child in full trust and faith in the surgeon and the team. There also seems to be this telepathic conveyance of the message, "Please take good care of my child".

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It is this very special feeling of unquestionable trust that I feel ever so compelled and inspired to do my best for my patient. And I sincerely believe this to be so in many of my colleagues in the healthcare sector.

To illustrate further, there is one comment made of nursing as a profession which I want to share with the House: "The hours and duties of a nurse are endless. Understanding human emotions in connection with their physical illnesses can only be undertaken by a very compassionate person. Nurses truly are the doctor's other hand and usually do not receive the thanks that they should. The only people who should go into nursing are those who do not expect gratitude for their giving. They also should desire to be a bright light in someone's day even when the going gets tough."

As Singapore attempts to attract healthcare workers to meet our own needs, our very own healthcare workers are also being lured by better salaries and prospects overseas. At the same time, the growth of the private sector also contributed to higher attrition from the public sector. With the setting up of Ng Teng Fong General Hospital and the Sengkang General Hospital, we will face severe shortages of healthcare workers in almost all disciplines.

I hope the Ministry can look into the recruitment, professional training and development, recognition and well-being of healthcare workers, from doctors, nurses, allied health professionals, to clinic assistants, porters and the Ah Mas , who work tirelessly to ensure that Singaporeans are well cared for in our healthcare institutions.

Besides the shortage of healthcare workers, the rapid growth in the residential population also puts tremendous strain on our healthcare infrastructure. Over the past 10 years, our total population comprising Singaporeans, PRs and foreigners has grown by over 25% from four million to almost five million. A recent newspaper article reported that Tan Tock Seng Hospital had to resort to putting some patients along the corridors, where they usually had to spend a night. These are scenes reminiscent of news reports in 2010 and 2011. Even Singapore's latest hospital, Khoo Teck Puat Hospital, has had to convert its rooftop garden into an additional ward despite having opened only in 2010, so as to cater for the need for more hospital beds.

While Singapore has to meet its challenge of ensuring adequate hospital beds to meet the growing demand, this will be exacerbated by the silver tsunami. A growing, ageing population would add to the hospital bed crunch as many people would have more health needs and are likely to require longer stays. There is an urgent need to enhance the capabilities and capacity of intermediate and long-term care services, including the infrastructure, financial, manpower and professional developments. In addition, it is also imperative to look into homecare and caregiver support as another priority area in managing the needs of the elderly sick. The "right-siting" of care is, therefore, necessary to free up resources in acute hospitals.

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In addition, our healthcare system must adjust accordingly as new disease patterns emerge. Chronic diseases, such as hypertension, diabetes, stroke and ischemic heart diseases, are also increasing. Mental health and illnesses, such as depression and Alzheimer's disease, are important as Singapore's lifestyle becomes more fast-paced and with the ageing population.

While we ensure that our healthcare systems should remain relevant to the needs of a rapidly growing and ageing population, let us remember that Singapore is a global city, with excellent connectivity by air, sea and land. In 2011 alone, over 13 million people entered Singapore. In this age of globalisation and with the influx of foreign workers to Singapore, we need to be constantly aware of the importation of infectious diseases and the emergence of possible pandemic in the future. We need to continue to ensure that our medical surveillance system remains robust, alert and strong and that our emergency systems to control and curtail the spread of diseases could be set up quickly.

The SARS crisis in 2003 imparted many important lessons for us in Singapore. The precious lives lost during SARS have taught us the very painful lesson of being prepared for any eventuality. I hope the Ministry can update the House on our national medical surveillance system and how the healthcare sectors, both in the public and in the private sectors, have prepared themselves to handle any future pandemics.

Sir, the standard of healthcare services in Singapore is one of the best in the world. Our health financing policies have enabled us to provide first-world healthcare in spite of a modest GDP spending. The challenges confronting the Singapore healthcare system are real and our health policies need to continually evolve and improve to cater to the changing needs of Singaporeans.

Policy Matters

Dr Lily Neo (Tanjong Pagar): The annual healthcare provision for our MOH Budget will be increased to $8 billion over the next five years. How does MOH prioritise this allocation of funds to ensure long-term affordability of healthcare costs and mitigate the burden of healthcare costs of Singaporeans in our fast-ageing population?

I have spoken frequently in the past in Parliament on the challenges for MOH to ensure healthcare for the elderly will be efficient and affordable in the years ahead. The challenge for MOH on the care of the elderly will be in assisting them to live as independently and for as long as possible in their own homes with appropriate support.

Sir, the aim is to maximise independent living and social functioning and to minimise hospital admissions and premature or avoidable dependence on long-term care in institutional settings. Priority for MOH is to provide adequate step-down care facilities, such as nursing homes, community hospitals and community homes, in accordance with the growing number of elderly for right-siting.

Homecare with medical care, homiciliary services, day care and rehabilitation facilities, occupational therapy services as well as equipment adaptation setting should be made available. We need to train more medical personnel, community nurses, homecare nurses and caregivers. New courses need to be conducted to teach the various types of community care. I feel MOH should establish a centre to facilitate and to conduct courses for the establishment of home care.

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On cost-saving measures, does MOH need to review the feasibility to integrate our healthcare clusters and sectors for better economies of scale and maximising on limited resources instead of encouraging competition between our hospitals and institutions?

Mental disorders are on the rise here. Public awareness needs to be further stepped up for early recognition of the condition, acceptance and minimising stigma and enabling those afflicted to seek early treatment for better prognosis. Current community support for people with mental illnesses is not adequate. I am most concerned for those in the lowest income families. Can there be special attention and care given to this group? Due to the poor home environments, such patients will have deficient support that will make their conditions worse. These patients will also cause negative impact to the family members who are already struggling themselves. They may also cause disturbances to their neighbours and the community due to the exacerbation of their conditions with unacceptable behaviours. For doctors, as soon as patients are clinically stable and are ready to be discharged back to the community, I feel we need a holistic approach in discharging their psychiatric patients back to the community. We need to give tailored assistance individually in the areas of financial, family and home support upon discharge. Medical certificates for such patients should be issued by doctors more willingly and for longer term so that at least they are eligible for ComCare or Public Assistance, as it is often difficult for such patients to find employment. There should be synergy between MOH and MCYS on discharging such patients. MCYS can play a bigger role to ensure better provision of community environments for such patients.

I have always been an advocate of preventive healthcare, and I hope that we can do more on this area. For example, the chronic diseases which can prevent renal failures and stroke and early detection of breast cancer or pre-cancerous stage of the cervix that can prevent premature death. Breast cancer is the commonest cancer for women and, in view of rising expectancy of age, could MOH step up the promotion in getting better participation of women in cancer screening in order to save lives?

Rise in Demand for Healthcare

Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, recently, a few Members have brought up in this House the issue of lack of beds at our restructured hospitals. I began to feel and witness such phenomenon when I saw many patients being lined up along corridors at the emergency department of a local hospital when I was there recently. When I asked about such a phenomenon, I was told that it was due to the lack of beds at the hospital. I understand that this phenomenon is common at a few other hospitals, too. I began to feel concerned about this and realise that there is a gap in the demand for healthcare and the available infrastructure to meet this demand. I feel more concerned when I start thinking about the impending "silver tsunami".

Therefore, I would like to ask the Minister to share with the House on the current gap between the demand for healthcare and the available infrastructure in Singapore. How is the Ministry tackling these stress points on our health infrastructure and how does it ensure that Singaporeans receive the necessary and reasonable healthcare standards? In the short run, can the Ministry work with the private hospitals to take up a portion of the demand so that Singaporeans' health matters are not compromised due to the current constraints in the infrastructure? With the impending ageing population, what are the Ministry's short-term and long term-strategies to meet these needs?

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Beds in Restructured Hospitals

Mrs Lina Chiam: Sir, as our society ages, recovery beds, in particular, will be high in demand. Our hospitals will also have to further divide the demand for beds into two levels – hospitalisation and recovery needs.

Between the detection and surgery phase, the patient will have to stay in the hospital. After surgery, patients can stay in recovery beds that will require less intensive medical investments. Recovery beds can be housed in facilities adjacent to hospitals.

The Ministry's KPI is that patients in the Accident and Emergency ward should not have to wait more than 12 hours for a hospital bed of the selected wards.

I suggest that the public hospitals clearly inform patients that they will be transferred to another public hospital with an available subsidised ward bed, so that they will know that the wait for a bed should not be more than 12 hours. Otherwise, patients may be unduly stressed into deciding to upgrade to a non-subsidised higher class ward.

6.45 pm

Managing Hospital Resource Constraints

Mr Gerald Giam Yean Song (Non-Constituency Member): Sir, for some time now, our Government restructured hospitals have been facing a bed crunch, as several Members before me have mentioned. With the current high bed occupancy rate, can we be sure that our hospital system will be able to cope in the event of a major outbreak or national disaster without resulting in preventable deaths? I appreciate that hospital staff and administrators are doing their best to manage these space constraints, but perhaps we need to explore other ways to free up bed space.

Currently, about 22% of all beds in acute care Government hospitals are non-subsidised beds. In our largest hospital – Singapore General Hospital – non-subsidised beds make up 28% of its beds. This is according to a reply from the Minister to my Question last month. If these hospitals convert some of their private wards to subsidised wards, can more bed space be created?

Sir, another concern I have is the doctor shortage in our public hospitals. I recognise that this is a long standing and multi-faceted issue which has no simple solution. Apart from recruiting more doctors, I believe more can be done to make the best of the existing resources. According to The Straits Times ' report on 1 March 2012, the pay structure in public hospitals includes three components: first, a basic salary, which is the same across doctors of the same grade; second, an allowance pegged to medical speciality with doctors doing surgery getting more; and, third, a fee scheme determined by the type of patients the doctor treats. A doctor who sees non-subsidised patients will earn more under the scheme than one who treats more subsidised patients. A doctor who sees non-subsidised patients who are foreigners earns even more.

Sir, there is a third component, the fee scheme has an effect of incentivising doctors to see private and foreign patients over subsidised local patients. Is it possible that some senior doctors are seeing a high proportion of private patients and leaving the subsidised patients to the more junior doctors? If so, would the subsidised patients be losing out because the more senior doctors spend less time seeing them? Or will the junior doctors get burnt out by the high patient load contributing to their departure for private practice?

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May I suggest adjustments to the fee scheme component to reward doctors based on the number of patients they see and the complexity of the cases, regardless of whether these are subsidised or non-subsidised patients. I believe this will more fairly compensate doctors who shoulder a higher patient load and, at the same time, better ensure that the more experienced doctors are available where they are most needed. This could help reduce waiting time as well as improve the quality of care, especially for subsidised patients.

Healthcare Issues and Challenges

Mr Patrick Tay Teck Guan (Nee Soon): Sir, this year's Budget has seen significant increase in spending for healthcare and rightly so with an ageing population in Singapore. I would like to thank the Government for the various measures ranging from hospitalisation subsidies for the middle income, increase in hospital beds and top-ups to Medisave accounts. With the doubling of the healthcare budget, I would like to understand from the Minister how are we able to ensure that it would not lead to an over-consumption of health services, such that it will stretch the system beyond the threshold of our healthcare professionals.

As we know, healthcare is a very challenging profession which can be both physically and emotionally draining. As the Executive Secretary for the Healthcare Services Employees' Union, we are often concerned about the welfare, working conditions, recruitment and retention of quality healthcare employees and professionals in our restructured hospitals, community hospitals and nursing homes. We do not want to have a return saga of seeing how another elderly folk has been mistreated and being thrown onto the bed in a nursing home due to stressed out and unmotivated healthcare staff. There should be an overall improvement in the quality of services rendered as well as a better environment to help the patients to recover.

I am aware that MOH is looking at a review of the pay of healthcare workers, in particular, doctors, nurses and allied health professionals across our public healthcare institutions. I thank MOH in advance. But I sincerely urge MOH, in its review, to also consider the non-nursing staff and employees who work alongside these healthcare professionals in our public healthcare institutions who provide the necessary support and backbone to ensure the entire healthcare eco-system "works". In particular, I am extremely concerned for this group of non-nursing staff, such as the patient-care associates and ward clerks, who are often at the frontline with patients and whose salaries are at the lower end of the pay scale. NTUC, e2i, the Healthcare Services Employees' Union as well as the institutions have been working very closely at projects to raise the productivity, re-create and re-design the jobs at this lower end in the institutions. I hope the efforts will not be derailed by the revision of wages of only the professionals. In fact, I hope MOH and MOH Holdings will take an even bolder step to work with the healthcare cluster of unions and the institutions to uplift these healthcare employees at the lower rung of the pay scale so that they will receive "better jobs, better pay and better prospects".

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I applaud the move towards greater emphasis for home care. While the increase in financial subsidies will be greatly helpful to families, it would be even better if there can be integrated home care comprising of a multi-disciplinary team of nurses, therapists and healthcare workers to provide the necessary support systems and structures. As a team, they can better look after the patients while the primary caregivers are away at work. Recently, I met a resident who had wanted to keep her aged mother at home to care for her instead of a nursing home or a community hospital. However, she encountered difficulties in the application for a work permit to employ a domestic worker whom she planned to engage to help look after her mum due to her monthly remuneration. My point is, besides the various initiatives and programmes by MOH and its community partners, our policies should support, encourage and incentivise home care to ensure we create a whole-of-Government approach to healthcare.

Another area of concern would be the increase in elderly psychiatric patients and how effective we have been in taking care of them. I would like to ask the Minister with regard to the Budget, will we see an increase in the funds to be allocated to set up more rehabilitative facilities? How are we also able to increase the financial support to needy families with mental patients so that they can better take care of them? If early detection helps in the treatment of mental illnesses, how are we able to provide the education to the public to raise awareness for early checks?

Manpower to Care for An Ageing Society

Assoc Prof Dr Muhammad Faishal Ibrahim: Sir, as Singapore progresses in its ageing population journey, we will certainly require additional manpower to care for our elders and the rest of the population. We will need to attract more Singaporeans to enter the healthcare workforce, develop and retain them. I feel that we need to do more to attract Singaporeans medical professionals who are practising overseas to come back and serve our nation's needs. In addition, we may need to rope in more stakeholders in care giving to ensure that we have a comprehensive network that cares for one another. This also implies that we will need to increase the intakes of students in health-related disciplines at the polytechnics and universities.

Sir, I would like to know how the Ministry is going to increase its supply of healthcare manpower. Are the current resources sufficient to meet the current needs? How long does the Ministry require to increase the manpower need to the optimal level and where are the sources from? Would technology and innovation significantly help to meet this need? How will the Ministry do so?

National Electronic Health Records

Mr Low Thia Khiang: Sir, the objective of having a national electronic health records system is to enable each person to have only one medical record that is accessible to all healthcare professionals. This system is good as it allows medical professionals, including those from private hospitals, polyclinics and step-down care services, to access the medical record of the patient they are treating, including previous diagnostic examination of the patient done at other medical institutions. This will enable them to do a more accurate diagnosis of the patient. I also believe this will help to cut down healthcare cost in the long run. I would like to know when will the whole system be completed and implemented, and what can the medical professionals as well as the public expect from the system.

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The recent abuse of the system by a medical professional highlights the concerns of the public on the issue of patient confidentiality. Also, sensitive information on conditions such as impotency and HIV may cause unnecessary embarrassment or stigma against the patients and should not be accessed unnecessarily. What safeguards has the Ministry put in place to prevent misuse of the system and to protect sensitive information?

Filling Prescriptions at Restructured Hospitals and Institutions

Mr Desmond Lee: Sir, currently a subsidised patient who gets a prescription from a doctor at a restructured hospital must go back to the pharmacy at that hospital to get it filled. If he goes to another restructured hospital or more likely a polyclinic nearer his home to get it filled, he will not get the medication at subsidised rates. Some restructured hospitals have home delivery services, but usually the fees are waived only if the cost of medication exceeds a certain sum.

Sir, with the availability of electronic medical records and e-prescription or e-pharmacy systems to verify the accuracy of prescriptions, I would like to ask the Minister whether he will consider allowing subsidised patients to fill their prescriptions at subsidised rates at other restructured institutions. Of course, I understand that not all pharmacies may stock the full range of drugs. This will provide flexibility and convenience to subsidised patients who require long-term medication.

Pricing of Drugs by Public Hospitals

Ms Sylvia Lim: Sir, in the parliamentary answer on 14 February this year, the Ministry confirmed that public hospitals operate their pharmacies as revenue centres. In other words, public hospitals mark up their drugs for sale to patients. It was stated that the typical range of mark-up was between 5% and 30%, implying that the mark-up could be even higher than 30% for certain drugs. The rationale for this is to help hospitals earn revenue to defray their overall operating costs. This latitude given to public hospitals results in the same drugs being priced differently at different hospitals. Take for instance the drug Mycophenolate mofetil (MMF) which is used in the treatment of auto-immune diseases and for transplant patients. One tablet of MMF 500 mg is sold at $2.75 at SGH and NUH but $3.31 at TTSH and $3.87 at CGH. The prices quoted are the subsidised prices for transplant patients under the Standard Drug List II, showing a variation of 40% among the public hospitals. I understand that non-transplant patients who need the drug for other conditions would pay significantly more. This disparity of one tablet is magnified manifold for patients who typically need to take several tablets a day over a prolonged period.

Another example is the drug Epoetin beta used in the treatment of anemia in kidney patients. This is a non-standard drug but recently included for means-tested subsidy under the medical assistance fund. An injection of 4,000 IU dosage costs $24.67 per syringe at TTSH, but $35.77 at CGH – a difference of more than $10. Members of the public have expressed surprise and confusion as to why different hospitals in the public sector charge such varying prices for the same drugs. Why are the prices of drugs not standardised throughout the public hospitals? Is the variation partly due to the hospitals being organised into two clusters which acquire their drugs separately? Is it feasible instead for all hospitals to buy drugs together for greater economies of scale to reduce prices for their patients? More importantly, should public hospitals use their pharmacies as profit centres in the first place?

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The Government has acknowledged that healthcare costs are upper most in many Singaporeans' minds, and that include drug costs. For non-standard drugs which are not subsidised, is it not more equitable to price them based on cost recovery, plus a small addition for administrative costs rather than to let public hospitals make profits from the sales?

Lastly, could the Ministry explain the nature of the subsidies given for drugs on the subsidised list and the Medical Assistance Fund? For instance, under part 2 of the Standard Drug List, the drugs can be subsidised at 50%. There are also 13 drugs under the Medical Assistance Fund list which can be subsidised up to 75%. Are these subsidies based on the selling prices rather than the cost prices, that is, if the drugs have been marked up, the subsidy is a discount of the marked-up price? Is it just a market subsidy?

7.00 pm

Health Spending

The Senior Parliamentary Secretary to the Minister for Foreign Affairs and Acting Minister for Community Development, Youth and Sports (Mr Sam Tan Chin Siong): Sir, I thank the Finance Minister for being so generous in this Budget towards healthcare. Healthcare spending has been set to double to $8 billion in five years. So, over the next five years, much of this will go towards the expansion of hospital beds, community care and long-term care services. As our population ages, these services will be in more need than ever.

In the face of such largesse, I really hesitate to come forward again, hat in hand, to ask for more. However, I would like to ask the Minister to consider not just more spending, but how it is spent. With the increase to $8 billion over the next five years, we will spend about 2% on healthcare by 2017, and 3.5% or more by 2030. Sir, the easy question will be to ask: is this enough? Sir, a harder but perhaps more important question is: how do we spend it?

With the percentage of people aged 65 years and above estimated to increase to about 20% in 2030 and close to 30% in 2050, the issue of an increased need for healthcare services and expenditure is becoming more pressing. Even though we are one of the best countries in terms of healthcare effectiveness, but in terms of "fairness of financing", some will say that we are not doing enough yet. So, the issue now is not so much of our quality of healthcare, but rather how we can provide such quality healthcare fairly and for the long term.

Sir, in 2008/2009, direct Government spending on healthcare was only 1.1% of GDP, and 7.1% of the total public expenditure budget. This partly explains why people think that Singapore does poorly in terms of "fairness of financing" but ranks very highly in terms of healthcare effectiveness. Singapore's philosophy of self-reliance means that there are considerable out-of-pocket expenses. Even the 3M system – Medisave, MediShield and Medifund – only comprises 10% of the patient's total healthcare expenditure. This 10% figure comes from a published article by an NUS professor at the School of Medicine in 2004. Sir, I do not have the latest data. The Ministry of Health has it. I hope that the Minister can share it with us.

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Sir, in terms of "fairness of financing", I would like to speak about the American healthcare system a little. Dr David Himmelstein, the lead author of an important study on healthcare and personal bankruptcies and also an Associate Professor of Medicine at Harvard, said: "Unless you're Bill Gates you're just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick."

This professor had conducted a study which said that about half of the personal bankruptcies in America were due to healthcare costs. It found out that health insurance policies − with high deductibles, co-pays, and many exclusions − offer little protection during a serious illness.

A new study found that the majority of debt among bankrupt consumers comprised non-medical expenditures. When medical debts do partially contribute to bankruptcy, they are likely to come from expensive, cutting-edge and end-of-life treatments that are not covered by public insurance.

For me, the lesson is this – health is not just a matter of doctors and hospitals and drugs. It is also a matter for jobs, frugality and personal provision. Medical care and management is therefore a joint responsibility of government, medical institutions and professionals, and the individuals.

Sir, we see that at the moment the state funds about one-third of Singapore's total health costs. Individuals and their employers pay for the rest. With the increase, this proportion will be more, but the fact is that more than half of healthcare spending still comes from people or their companies. Financial literacy is therefore a big part of healthcare management in life, especially today, when there appears to be a tremendous number of decisions that can be made by patients.

Between doctors and patients − the information symmetry is important. Often, we are asked to make important decisions that have impact not just on health outcomes but also on finances. Who can then act as an honest broker between healthcare providers and patients? In my opinion, the Singapore Medical Association (SMA) can be the body to do this function.

Sir, I am of the knowledge that true, SMA is not a disinterested body, and true, it has the interest of doctors at its core because they are after all its members. But SMA answers to a higher ethical code, greater than the sum of its own part. Hence, in this case, I think that we need a band of doctors to look after patients, not in a specific medical sense, but in the sense of producing clear guidelines for fees, treatments and options.

The SMA has proven that it can do this role in the past when it provided guidelines for doctors' fees. This acted for many years as a general benchmark for doctors as well as for patients as to what is a fair expected fee. This guideline, however, was removed a few years ago because it was thought to be anti-competitive. However, on the ground, many patients do not see it that way. There have been senior citizens telling me that they would know their medical fees in the past. But, now, they do not know how much they need to pay until the nurses give them the bills. So to the elderly, knowing how much are doctors' fees in advance means a lot to them in managing their limited financial resources and savings. Hence, I hope the Ministry can consider bringing back doctors' fee guidelines.

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Sir, I would also like to ask the SMA to take on an additional advisory and educational role, so that patients will make better decisions. I remember under Minister Khaw Boon Wan, the hospitals are obliged to make their fees transparent, which is a great step forward. But this may be more an incentive for hospitals to improve as they benchmark against one another. For the patients, not all things can be compared on price and medical treatments.

Hence, we need help, not just in terms of data on fees but interpretation of data of a wider and more nuanced scope. So, in this aspect, I urge the Minister to either provide SMA funding for this public advisory and educational role, or require the Ministry or the Health Promotion Board to do this function itself.

Healthcare in Restructured Hospitals

Mrs Lina Chiam: Sir, the Budget focuses on increasing the support level for rising healthcare costs through greater cash contributions into CPF accounts. Put simply, this is the same as asking Singaporeans to forgo cash to put up with rising medical costs. This is no different from past Budgets.

The Deputy Prime Minister shared his $8 billion budget to expand medical infrastructure such as ramping up healthcare services facilities. The question now is, how does that manage healthcare costs in the longer term in a sustainable manner?

I hear of countless incidents in Potong Pasir, in which Singaporeans might not be able to afford adequate treatment. Some Singaporeans, especially the elderly, have to seek treatment and surgery, and even buy standard drugs in Malaysia because they cannot afford these back home. The costs of subsidised drugs and non-standard drugs not covered by insurance are rising.

So, I believe our priority is to conduct an international benchmarking exercise of medical costs here against other developed cities in our region such as Hong Kong and Shanghai. It is a known conundrum that healthcare services will see ever-increasing costs as long as we fool ourselves by thinking that the problem can be solved just by increasing the pot of money available to cover the rising medical costs.

Two things should happen at the same time: one, the Government should help Singaporeans provide for future medical costs; two, the Government should proactively manage healthcare costs. The solution for increasing medical fees cannot always be a one-sided reduction of cash from Singaporean pockets.

So, improving the productivity of our healthcare industry is also very important. A consultancy study, led by the Ministry of Health, should be conducted to ensure our cost components are reasonable when compared to international standards.

I also propose that the medical records be digitalised at the national level, so that the patient records can be easily retrieved and transferred among medical institutions. This could set the ground for future virtual medical services, in which Singaporeans can have access to more affordable medical services by harnessing Information Technology.

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Dr Teo Ho Pin: Sir, there are three key challenges facing Singapore in our healthcare system, namely, first, rising cases of chronic illnesses; two, rising healthcare costs; and three, rising demand for healthcare services for an ageing population.

Sir, we need to implement more effective programmes to prevent chronic illnesses. The diet and lifestyle of Singaporeans affect the occurrence of chronic illnesses among our people. Thus, it is crucial that healthy lifestyle knowledge and habits are inculcated in our people. In this aspect, I would urge the Health Promotion Board to focus on sustained and effective healthy lifestyle programmes in the community.

As for rising healthcare costs, we should explore more cost-effective treatment to reduce healthcare costs for Singaporeans. At the same time, we should strengthen the partnership between the public and private healthcare sectors so that more cost-effective treatment can be accorded to Singaporeans.

An ageing population will pose healthcare challenges such as disabilities, dementia and vulnerability to diseased infection. We need to do more to build resilience and immunity among our aged and reduce their downtime.

In building maintenance, we use the three-pronged strategy to reduce downtime of our facilities: first, regular maintenance; two, quick repair; and three, upgrading where necessary. Similarly, we should also help our elderly to maintain their health, seek early treatment and upgrade their functionalities where necessary.

Sir, I wish to ask the Minister the following questions: (i) what are the key healthcare challenges facing in the future?; (ii) what are the Ministry's plans to reduce healthcare costs for Singaporeans?; and (iii) which policies and programmes are effective in promoting and sustaining healthy lifestyle among Singaporeans?

The Minister for Health (Mr Gan Kim Yong): Mr Chairman, may I seek your consent to move that the Chairman do leave the Chair? This is to enable me to move a motion to take the proceedings on the business of Supply today beyond 7.30 pm?

The Chairman: I give my consent.

Resolved, "That the Chairman do leave the Chair." – [Mr Gan Kim Yong].

Thereupon Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House.