SECOND SUPPLEMENTARY ESTIMATES OF EXPENDITURE FOR THE FINANCIAL YEAR 1ST APRIL, 1980 TO 31ST MARCH, 1981 (Paper Cmd 8 of 1981)

Order read for consideration in Committee of Supply [Allotted Day].

[Mr Speaker in the Chair]

3.28 p.m.

The Chairman: Second Supplementary Estimates of Expenditure for the financial year 1st April, 1980 to 31st March, 1981, contained in Paper Cmd 8 of 1981.

Notice of an amendment has been received in respect of Head P, and I shall therefore take this head of expenditure first.

Head P -

Dr Tan Cheng Bock (Ayer Rajah): Mr Speaker, Sir, I beg to move,

That the sum to be allocated for Head P be reduced by $10 in respect of Subhead PC-03 Object Group 1410.

Mr Speaker, Sir, I beg your indulgence as to why $78,500 in additional allowance is required when Accident and Emergency charges are already so high at $10 which is higher than what most general practitioners charge.

Sir, at the last Parliamentary sitting the Minister for Trade and Industry and Minister for Health hinted at the possibility of raising the A & E charges. The reason given was to discourage attendances at A & E by so-called 'non-emergency' cases.

Like all good, systematic, hard-headed analysts, our Health Ministry officials took attendances at A & E units, divided them up into emergency and non-emergency cases, put one figure upon the other and came out with an attendance of 46% non-emergencies. And what better way to cut attendance and maintain income than by raising charges - the perfect solution.

If the Health Ministry has valid reasons for increasing the A & E charges - like the increased petrol prices, wages, building costs, etc - let them come out and say so. But if their purpose is to stem abuse, they will fail again.

Let us examine this so-called 'non-emergency' cases closely. Are the criteria for non-emergency cases based on the doctor's opinion after examination? Or are they based on the layman's perception of what is emergency? Obviously they have based it on the doctor's, but this is inadequate because the layman has not got the benefit of medical training and his perception will not coincide with the doctor's. How is he to determine what is emergency? To him a chest pain may indicate a heart attack, but it may be just bad indigestion. Diarrhoea, high fever, vomiting, stomach cramps and many other symptoms are regarded as emergencies by the layman. Many such symptoms can be treated as non-emergencies but only after the doctor has ruled out heart attack, appendicitis, meningitis or severe food poisoning.

Mr Speaker, Sir, do we penalise a man for his ignorance? Would any person, thinking of saving his own life or easing his pain, be deterred by $10 or $20, or even $50? Should we make more money out of him just because he does not know better and has no one else to turn to in the dark of night? Which Singaporean would want to give up watching those compelling Chinese shows on TV, and go and wait for hours in the Emergency unit to see a harassed doctor for a dose of medicine if he did not think his life was being threatened? Besides the $10 charge, please add another $10 for return taxi fare.

Mr Speaker, Sir, has the Ministry examined deeper into its figures to see if attendances rise after 5.00 p.m. when OPDs are closed, and after 9.00 p.m. when all private clinics are closed? If the bulk of attendances comes after 5.00 p.m. (and still more after 9.00 p.m.), it reflects a need for such A & E services. Raising charges will in no way deter them.

If the Ministry wants to unclog the A & E departments, then it must look for other ways. As a long term solution, I suggest education of the public on how to use the A & E unit. This could be effectively done by the Training and Health Education Department of the Ministry of Health which in the past has produced excellent brochures on various health aspects. Apart from the press and TV, our RCs and CCCs can help to disseminate this message to the lay public.

Extension of OPD' hours will impose too great a burden on the Ministry in terms of operational cost and personnel. I would suggest to the Minister to request the cooperation of the private hospitals to have an A & E unit in their hospitals, if they do not have one at the moment. The reasons for requesting private hospitals to have their own A & E unit are as follows. First, they will take some of the load off the A & E units in public general hospitals. Secondly, it will make medical attention more readily available at night, as these private hospitals are quite conveniently located.

Mr Speaker, Sir, however, I do know of cases of abuse. Examples have been quoted to me by a doctor working in the A & E unit. For instance, many of those who are entitled to free treatment at Government clinics prefer to go to the A & E unit at night for treatment when they should have gone to the OPD during the day time. One reason given is that the waiting time at the A & E unit is much shorter than the waiting time at the OPD. I would regard such attendances as abuse but to raise the A & E charges will not stop them because they do not have to pay for it anyway. Raising charges will penalise the genuine patient and indirectly help these abusers. How many of the so-called non-emergency cases are contributed by this group of abusers? I would request that the Ministry look into this matter. Let us not penalise the majority for the wrongs of the minority.

The Minister for Trade and Industry and Minister for Health (Mr Goh Chok Tong): Mr Speaker, Sir, the Member for Ayer Rajah seems to labour under the impression that revenue collected by the A & E Departments can be ploughed back into running costs. Government accounting does not permit this to be done, as all revenue must be credited to the Revenue Account controlled by the Ministry of Finance.

The supplementary sum of $78,500 for Subhead PC-03, Object Group 1410, is needed because of the increase in fixed specialist allowances and the implementation of the Consultation Fees Scheme on 1st September, 1980.

I observed in Parliament on 20th February, 1981, that the increase in A & E fees on 1st April, 1978, has not controlled the rapid rise in A & E attendances, especially non-emergency cases. I suggested that my Ministry might have to consider whether to increase the A & E fees further if attendances continue its upward trend. The rationale for doing so, as I put it the last time, is to cut down on the number of attendances at A & E units. In other words, we want to try and deter the non-emergency cases from coming to the A & E Departments.

The Member for Ayer Rajah raised the point of who is to determine whether the case is an emergency case or not. In my view, it must be the doctor who has to determine whether a case is an emergency case or not after examination. The Member is right, of course, that a patient pays great attention to his own health and he is unable to determine whether the pain which he is suffering is in emergency case or not. Whenever there is pain, the patient rightly believes it is an emergency case.

The number of attendances at the A & E units would appear to suggest that patients do take advantage of the A & E units. 47.7% of the total number of A & E attendances occur between 8.00 a.m. and 4.30 p.m. In other words, 47.7% of A & E attendances took place during the day. Between the hours of 4.30 p.m. and 8.00 a.m., the percentage of attendances is 52.3%. Therefore, there is a fairly even spread between attendances in the day and in the evening. I have also been given to understand that most of these attendances take place before midnight. There is a sharp decline after midnight. This would appear to suggest that patients generally are aware that their cases need not necessarily be one that must be attended to urgently by the doctors at the A & E units.

I agree with the Member for Ayer Rajah that raising the fee for attending A & E units would not solve the problem. I also agree with him that we should educate the public, and his suggestion that we should do so will be taken up.

The Member has also come up with what I would regard as an excellent idea if it can be implemented and, that is, to request the private hospitals to have their own A & E units. Perhaps the Member for Ayer Rajah can suggest to his colleagues that they volunteer their services to help these private hospitals to man their A & E units, especially after working hours or after 9.00 p.m., say, from 9.00 p.m. to about 2.00 a m

Dr Tan Cheng Bock: Sir, I beg leave to withdraw my amendment.

Amendment by leave, withdrawn.

The sum of $7,603,840 for Head P ordered to stand part of the Second Supplementary Estimates of Expenditure for the financial year 1st April, 1980 to 31st March, 1981.

Question, "The sum of $14,222.890 shall be supplied to the Government under the heads of expenditure for the public services shown in the Second Supplementary Estimates of Expenditure for the financial year 1st April, 1980 to 31st March, 1981 contained in Paper Cmd. 8 of 1981 ". put and agreed to.

Resolution to be reported.

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

Mr Goh Chok Tong: Mr Speaker, Sir, I beg to report that the Committee of Supply have come to a certain resolution.

Resolution reported -

"That the sum of $14,222,890 shall be supplied to the Government under the heads of expenditure for the public services shown in the Second Supplementary Estimates of Expenditure for the financial year 1st April, 1980 to 31st March, 1981 contained in Paper Cmd. 8 of 1981."

Mr Goh Chok Tong: Mr Speaker, Sir, I beg to move that Parliament doth agree with the Committee on the said resolution.

Question put and agreed to.

Resolution accordingly agreed to.