MEDISHIELD

MEDISHIELD:

(Coverage for special needs children): 6.

Ms Denise Phua Lay Peng asked the Minister for Health (a) whether MediShield is self-funded by the Central Provident Fund; and (b) how much will it cost to enable families to cover special needs children (i) born with congenital or pre-existing illnesses and (ii) attending special schools, to allow them to enjoy the same health insurance coverage as normal children.

Mr Khaw Boon Wan: Sir

,: Basic MediShield and the enhanced rider plans offered by private insurers are all self-funded. In other words, the premiums collected from policyholders must more than cover the anticipated payouts claimed by patients. For the plans to be sustainable, premiums are determined on an actuarially-sound basis.

Persons with congenital illnesses can join MediShield to obtain coverage for

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medical treatment that is not related to their congenital condition. However, it will be unusual for insurers to cover pre-existing illnesses or to cover treatment related to known congenital conditions. To do so will be to load the burden on the rest of the policyholders who may not support a manifold increase in premiums to take on this additional liability. More importantly, if MediShield were to cover pre-existing illnesses, it will encourage potential policyholders to delay subscription until they are sick. This will defeat the whole principle of insurance which is based on the sharing of burden among policyholders with similar risk profile.

Nevertheless, some private insurers do offer cash benefit products which pay lump sum amounts if a baby is diagnosed with specific congenital anomalies. They include the Prudential PruSmart Lady's Maternity Rider, HSBC Lady FirstCare, and NTUC i-Maternity. Subscription to these products must of course be made prior to the discovery of any known congenital anomaly.

As for children attending special schools or with special needs, the basis of coverage is the same as the basis for other children, that is, they should be healthy at the point of entry and have no pre-existing illnesses. We therefore encourage all parents, including those who have children with special needs, to cover them under MediShield as soon as possible, before they develop any other illnesses that could disqualify them in future.

Ms Denise Phua Lay Peng (Jalan Besar): Families do not ask to bear special needs children. Many of them have defects probably before they are born. They are also sons and daughters of Singapore. So when congenital or pre-existing medical conditions are excluded, families have to pay lump sum expenses themselves. This is especially hardship for the low-income

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and even average-income families. I would like to ask if, since MediShield itself is administered by CPF, the Minister would consider studying having MediShield include pre-existing or congenital conditions for these children up to, say, a maximum claim limit of $200,000, which is the current MediShield limit. And if there is a need for extra loading, then perhaps those who can afford can pay themselves. But the Government can do something for those who cannot afford. So I would like to ask the Minister to consider this.

Mr Khaw Boon Wan: Sir, I am sympathetic to those parents - a small minority of parents - with children born with such congenital difficulties. About three years ago, I had in fact asked our actuaries and consultants to take a look at how much would this additional burden be because if it is quite inexpensive to load onto the rest of the population, I could try to make a case to let us share this burden. I was hoping that the increase in the premiums on Basic MediShield, if we take on this additional liability, was not too much. Unfortunately, it was a lot. The MediShield premium for a young Singaporean below 30 years of age today, I think, is only $30 a year which is very inexpensive. But if we were to load this liability on - I rely on my memory now - the consultants' recommendation would be something like a seven-fold increase, so from $30 per year to something like more than $200 per year, and even then, it is to limit the payout to just the first year of birth, in other words, before the child hits one year old. That is the difficulty we are faced with. And to load such hefty increase of premiums onto the rest of the population I think it is hard to justify. So we have to look for other means, which is the families themselves, and of course the society. Where they require additional medical treatment, then Medifund can come in, and we can be more helpful by making use of Medifund as a tool. Of course, NGOs, VWOs on

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specific causes, if they want to chip in, I think that is certainly welcomed. So I am afraid to load it onto the rest of the population with such hefty increase of premiums, I would find it very difficult to explain and justify.

Mdm Ho Geok Choo: Thank you, Minister, for the clarification. I am just wondering whether, nationally, the Minister would encourage a scheme where we allow parents who are planning for a family to actually buy the insurance in advance and, in that way, perhaps we could actually reduce the risk for consultants.

Mr Khaw Boon Wan: I did not quite catch the last few words, but let me try to guess. When I explored this scheme about how to insure financial protection against pregnancy that leads to babies born with congenital difficulties, I was looking at MediShield. But I also asked them to study how to load it onto all pregnancies so that as soon as you discover you are pregnant, buy an insurance policy which would then cover all these eventualities. It is the same old thing. The premium is hefty, and to make it compulsory, it becomes very difficult for us to justify. It was because of those series of enquiries and discussions I had with the private insurers, which led to products which I have just named a while ago, which are offered by NTUC i-Maternity, and so on. Even then, the insurers were careful in not saying that the insurance would then cover all medical treatments. It just says that if the baby is unfortunately born with certain conditions, here is the cash amount which you can claim, and how you spend the money is left to the parents. I will continue to look at the other countries on how they take care of problems like this through the insurance route, but because of our very small market, unfortunately, the situation is what I have just described.

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Mr Speaker: Ms Phua, last question.

Ms Denise Phua Lay Peng: Disability covers a whole range of severity from mild to severe. Currently to say a blanket "no" to all special needs is probably fairly superficial. There is a group of volunteers who are willing to study together with the Ministry of Health to see if we can segregate or, at least, categorise different disability groups to see if there are some ways that we can help at least the lower and average-income group families cover this medical cost. To ask the VWOs to find some more funds will be quite difficult to bear.

Mr Khaw Boon Wan: Certainly, we will be most happy to work with any groups to help resolve the problem. But let me reiterate that not all babies born with special needs are not insurable. As I have explained very clearly just now, let us say, an autistic child, why should an autistic child not be insurable by MediShield? I asked CPF yesterday and they confirmed the policy. They will not cover conditions related to a congenital condition. Insurance will not cover treatment related to a congenital condition. But if you pay the insurance, you can cover for treatments for all the other conditions that may crop up - cough and cold, whatever that may crop up - like any other normal child. So my advice remains: please immediately go and insure your child now and do not wait when he actually falls sick, then you may find the insurance company is not willing to take your case.

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CYBER/GAMING CAFES:

(Control over excessive proliferation): 7.

Ms Ellen Lee asked the Deputy Prime Minister and Minister for Home Affairs (a) whether there is control over the excessive proliferation of cyber/gaming cafes, especially in the heartlands and within close proximity to schools; and (b) whether there are measures to control

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children and young persons, particularly students under 16 years of age, from patronising them.

The Senior Minister of State for Home Affairs (Assoc. Prof. Ho Peng Kee) (for the Deputy Prime Minister and Minister for Home Affairs): Mr Speaker, Sir, Police is aware of the potential problems of easy access by youths to cyber gaming. While computer gaming does not in itself lead to delinquency, ease of accessibility may encourage truancy and affect attitudes of students towards their academic work, which may eventually lead to youth delinquency and crime. Hence, the Police carefully assesses each application to set up a computer gaming establishment looking at the suitability of its location, amongst other criteria, before deciding whether or not to grant a licence.

Sir, the Police does not allow computer gaming establishments to be set up in HDB residential zones where most schools are located. This is because such locations offer high accessibility to youths. Computer gaming establishments are only allowed to be set up at shopping, recreational or commercial centres. This includes HDB town centres, which are part commercial and part residential.

Sir, in addition, licensees of computer gaming centres are required to keep out persons below 16 years of age before 6.30 pm on a school day. Further, the licensee has to ensure that students wearing school uniforms are not admitted into the establishment at any time, and is also not allowed to provide a change of clothes to students.

A breach of any of these licensing conditions is an offence under the Public Entertainments and Meetings Act. Errant licensees face a penalty of up to $10,000. There is also a demerit points system to help regulate the licensees. Repeat offenders may have their licences suspended or revoked.

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Ms Ellen Lee (Sembawang): Sir, I would like to ask the Senior Minister of State how frequent does the Police patrol these establishments to make sure that all the rules and regulations are being complied with, and would the Police be just relying on voluntary compliance of these rules rather than seeking some mandatory compliance, because I think it is known that there has been flouting of these rules and patronising of these establishments by students under 16 years of age.

Assoc. Prof. Ho Peng Kee: Sir, it is not a matter of voluntary compliance. These are licensing conditions for which there is the backing of the demerit points system, especially the revocation of licence, if there is any breach. Indeed, one such gaming centre has had its licence revoked because of a breach of these licensing conditions. The other point about patrolling, the Police has many things to do. While in so far that they patrol shopping centres to prevent crimes, they may also ascertain whether any of the conditions has been breached. I think the solution really must be a holistic one, in particular with regard to students being there either in uniform or before 6.30 pm, I think the other stakeholders have a role to play, which is the schools and parents. So I say this is the best way to move forward.

Ms Ellen Lee: Sir, since the Police has got other things to do, would MHA consider empowering the Volunteer Special Constabulary members to do this patrolling instead, because I am sure they possess certain powers of enforcement?

Assoc. Prof. Ho Peng Kee: Like I said, in so far as the students of certain schools may be violating these rules, the schools, together with the Neighbourhood Police Post, can set up, for example, a system where the Operations Manager of the school goes out to these centres. I know that that is happening. For example,

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under NYGR, there is a protocol on the ground where the Operations Managers of schools are in touch with the police officers in the Neighbourhood Police Centre to look out for students who may be out of school during school hours playing truancy.

This can be part of the set-up. But I do not think we should have dedicated officers just for the task of seeing whether or not students are in gaming centres during school hours.

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