MEDICAL ENDOWMENT SCHEME BILL

Order for Second Reading read. 2.30 pm

The Minister for Health (Mr Yeo Cheow Tong): Sir, I beg to move, "That the Bill be now read a Second time."

The Prime Minister announced during his National Day Rally in August 1991 that the Government will be setting up an endowment fund, called Medifund, to help poor and indigent Singaporeans pay for their medical care. During last year's debate in the Committee of Supply on my Ministry's budget, I also gave Members some details of Medifund.

This Bill is to enable the Government to establish Medifund.

Sir, we have today one of the best health care systems in the world. To achieve a similar level of health care, most developed countries have to spend over 7% of their GNP, with the USA topping the list at over 13% in 1992. In Singapore, we spend about 3% of our GDP on health care. This shows that overall, our health care system is a very efficient and cost-effective one.

Health care costs are very much influenced by the nation's wage levels. Health care is very labour-intensive, requiring highly trained personnel such as doctors, nurses and other professional staff. As a result, labour costs make up over 70% of health care costs. Hospitals must pay their staff fairly and competitively. Otherwise, they will not be able to retain their staff or recruit new ones. It is therefore inevitable that the healthy pay increases enjoyed by Singaporeans over the last 10 years have had a significant impact on health care costs. Expensive modern drugs and advanced medical equipment, and high-tech medical tests and procedures have also helped to push up costs.

The best way for individuals to keep their health care expenses low is to adopt a healthy lifestyle, and to reduce their chances of falling ill. For those who do fall ill, the Government is committed to ensuring that every Singaporean is able to obtain good basic health care.

For lower income Singaporeans, this has been achieved through our nation-wide network of polyclinics, and the provision of heavily subsidised Class B2 and C beds in our acute hospitals. In the Class C wards, the Government pays $4 for each dollar paid by the patients, and in the B2 wards $2 for every dollar paid by the patients. Medisave helps Singaporeans meet their hospitalisation costs. And our catastrophic medical insurance scheme, MediShield, provides relief to those who are seriously ill and who require long hospitalisation and therefore face bigger hospital bills.

However, we recognise that there would be some who, for various reasons, cannot even afford to pay the heavily-subsidised Class B2 or C bills. At the moment, they can apply to have their bills fully or partially waived. In 1991, about 6,000 patients out of a total of over 160,000 Class B2 and C patients in the Government and restructured hospitals applied for waivers. About 98% of the applicants were granted waivers, amounting to a total of $1.7 million.

When this Bill is passed, Singaporeans using the heavily subsidised health services who face problems paying their hospital bills can apply for waivers from Medifund. The scheme will have more flexibility when considering appeals for fee waiver. The Medifund privilege will be extended to only Singaporean citizens, and not to non-Singaporeans.

The Government will establish Medifund with an initial capital of $200 million, and thereafter increase the capital by $100 million per year, provided that there is continued economic growth and a budget surplus. Only the income from Medifund will be used.

However, as there will be no income for the first year, the Government will provide Medifund with a more than adequate sum of $5 million to fund its first year operations. This sum will not be regarded as part of the capital money of the Medifund.

Sir, Medifund will act as a safety net for those needing medical treatment. Initially, it will provide grants to approved hospitals and medical institutions for them to help Singapore citizens who, either by themselves, or with the help of their families, cannot afford to pay their hospital bills. Additional schemes to help Singaporeans meet their health care expenses will be considered later when Medifund has more resources.

Singaporeans eligible for Medifund support will include, first, the destitute and indigent, who presently apply for hospital fee waivers; second, elderly Singaporeans with no Medisave, or who did not accumulate enough Medisave before retiring because the scheme was implemented too late for them; and third, younger Singaporeans who have not worked long enough to accumulate sufficient Medisave, but who are unexpectedly faced with high medical expenses.

Medifund will give greater support to those who have contributed regularly to their Medisave accounts, and who are covered by MediShield.

The Bill provides for the establishment of an Advisory Council to advise the Minister on the use of the income of Medifund. We will be decentralising the processing of Medifund applications to the individual hospitals. Each hospital will have its own Hospital Medifund committee to consider and to approve applications, and to decide on the quantum of remission according to the guidelines recommended by the Advisory Council.

The Advisory Council and the Hospital Medifund committees will largely comprise members who are actively involved in community and social work. They would be familiar with the needs and problems of lower-income Singaporeans, and would be able to adopt a flexible and helpful attitude towards applicants.

Sir, Medifund will grow over time, provided our economy continues to improve and grow, and we achieve budgetary surpluses. It will be a valuable safety net. With Medifund, no Singaporean need ever fear that he or she will be unable to receive good basic health care, no matter how much financial difficulties he or she is facing.

However, we must not let Medifund lull us into a false sense of security. It is important for every Singaporean to maintain a healthy lifestyle in order to reduce the risk of falling ill. Singaporeans must use their Medisave wisely, by using the class of ward that best suits their income level. This way, we will have enough finances to look after our health care needs in our old age.

Sir, I beg to move.

Question proposed.

Mr Loh Meng See (Kampong Glam GRC): Mr Speaker, Sir, I rise to support this Bill. I am very happy that the Government has finally come up with this proposed Bill. It is indeed a very important safety net to the less well-to-do Singaporeans. They can count on the Government to help them in time of need.

The Minister mentioned that the amount spent in waivers and remission of fees in 1991 was $1.7 million. We do not know what the amount was in 1992, but certainly the initial sum of $5 million is a generous one.

Sir, I think there is concern when the amount of capital money added each year is made dependent on budget surplus and economic growth because the concern is one that there is a need by the less able Singaporeans. And if you were to tie it to economic growth and budget surplus, it means that we are not addressing that need. One difficulty is that medical condition can be recession-proof and people do get sick under all economic circumstances.

I presume what the Minister has said is that the eligibility for such assistance will only be confined to patients admitted to Class B2 and C wards and it will not be for any other wards. So maybe the Minister would like to clarify and confirm the class of ward eligibility.

The Minister has not told us what those approved hospitals are likely to be. Is it mainly the Government restructured hospitals or will they include the new community hospitals that we are going to have? Because in the new community hospitals, we believe they are built to provide for more affordable hospitalisation of patients.

We would like to know, at least in preliminary terms, how the grants will be allocated to each of the hospitals and on what basis we are likely to be depending on in allocating the grants to the various hospitals. Is it based on historical experience that we have so far with the number of waivers or is it based on the number of beds of subsidised wards?

I welcome the inclusion of community leaders in the Hospital Medifund committee. The Minister had said so in the past and he has put it into practice, and we certainly look forward to the participation of these local community leaders in helping out in the decision-making and in approving applications for Medifund from the less able Singaporeans.

One last point, Sir. We understand that there is a cost involved in the auditing and administration of the accounts. We know that the respective hospitals are to maintain their accounts. We hope that the hospitals do not have to levy a high charge in the administration of the accounts which will take away money from these people who are in need.

Sir, I support the Bill.

Mr Low Thia Khiang: ( In Mandarin): Mr Speaker, Sir, in March last year, during the debate on the budget for the Ministry of Health, I told the Minister for Health that people in Singapore had described our medical service as one in which "people can die but cannot fall sick". I wanted the Minister for Health to assure the House that the Government would pick up the medical bills for any Singaporean who could not afford to pay the medical expenses.

At that time, the Minister for Health replied that the Government was already subsidizing 80% of the class C ward charges, and that if the patients cannot afford to pay for the remaining 20% of the charges, Medifund would pay for them. I quote (in English): "And for those who cannot afford to pay the remaining 20%, we have Medifund to help them."

Mr Speaker, Sir, now the Medical Endowment Scheme Bill introduced in this House allows the Government to set aside a sum of money for investment and to get the revenue of the investment to help those patients who cannot afford to meet their medical expenses pay their bills.

Clause 15(1) of the Bill clearly states that it would depend on whether there is money in the Hospital Medifund Account to effect the said payment.

This Bill does not tie in with the Government's original promise. Singaporeans who cannot afford to pay for their medical expenses cannot expect the Government to keep its promise of writing off their outstanding medical bills. They have to pray that the investment committed by the Medical Endowment Fund would reap big profits all the way, and that the Medifund Account of the hospital which they are admitted to is also receiving profits from all sources of investment, so that they will have a chance to make use of this Fund. Can this be truly said to be a form of protection?

I have yet a number of other doubts about the Bill. Firstly, if unfortunately, the investment does not yield any profit, or even suffers losses, then Medifund will have no money to pay the medical bills of those people who cannot afford to meet their own medical expenses. What will happen to these people? Although the Minister said that in the first year the Government will make available the money for the Fund, what if, in future, the investment is not getting any positive returns?

Secondly, under the Bill, the Government will allocate the money to the approved hospitals to set up their own Medifund accounts. What will be the criteria for the allocation of funds?

Supposing one of the approved hospitals has more patients who cannot afford to pay for their medical bills, and hence exhausted the money in its account, does it mean that the patients in this particular hospital will be unable to get financial assistance? If that is the case, then will the hospital concerned allow the patients to check the amount standing in its Medifund account before their admission to the hospital?

The Bill states that so long as a hospital is approved by the Minister, it will be entitled to maintain and operate a Medical Endowment Fund. I would like to ask the Minister which are the hospitals that he will be approving for this purpose. For example, if a patient stays at Mount Elizabeth Hospital, can he consider Mount Elizabeth Hospital as an approved hospital?

Concerning the application for use of Medifund, clause 13 of the Bill merely states generally that anyone who is a Singapore citizen staying in an approved hospital and who cannot afford the hospital expenses can make application to the Medical Endowment Fund Board. My questions are :

(1) If the patients who stay in class A and class B wards cannot afford to pay for their hospital charges, can they apply to make use of the Medisave?

(2) If a patient has stayed in an approved hospital for some time and he subsequently succumbed to his illness, leaving a hefty hospital bill outstanding, then can the medical social worker of the hospital apply to make use of Medifund to pay for the outstanding bill? Then the hospital will make a profit instead of a loss, and the Government will not have to end up with the bad debt.

Under clause 15(5) of the Bill, even if an applicant satisfies the conditions as laid down under clause 13 to become an eligible applicant, the Medifund Board of the hospital or the persons authorized to approve such application may not necessarily approve the application by the eligible applicant.

What then are the criteria for any Singaporean who cannot afford his medical expenses to be entitled to make use of Medifund to pay for his medical bills? How can the Government ensure that the persons who are authorized to approve such applications are exercising their power fairly and justly?

More importantly, in the case of those who cannot afford to pay their medical expenses and whose applications to make use of Medifund have been rejected, what would happen to them? Do they just hang on and wait for time to die or for the Government's letter demanding payment of their medical bills, and even be made bankrupt because they cannot afford to pay for their medical expenses?

Mr Speaker, Sir, from the points that I have raised, we can see that Medifund cannot truly ensure that the poor people in Singapore can get the proper medical care that they need.

With the increase in wages, rising cost of medical services, and the fact that Government hospitals have to be responsible for their own profits and losses after privatization, coupled with the Government's long-term target of subsidizing only 80% of class C ward charges, we can expect hospital charges to keep on going up. Some Singaporeans, particularly the older ones who have no Medisave account, or with inadequate amount in their Medisave account, will have trouble meeting their expenses once they are sick and have to be hospitalized.

Among these people, some might have retired. But, do not forget that they too have contributed to the prosperity of Singapore. Some of them might be from the low-income group, but they are, nonetheless, part of us. When they are sick and they require medical care, should it not be the responsibility of the Government to look after them? They should be given the assurance that when they are sick, they will be given proper medical care, even if they cannot afford to pay for the medical expenses.

But here, we have Medifund which can only pay the medical bills of those who are in need if the Fund can generate revenue. Furthermore, even an eligible applicant is not assured that his or her application for waiver of medical bills will be granted. Is this the safeguard that the Government is providing for the people of Singapore? Do not tell me that this is what the Government meant when it promised in its Next Lap that it will "continue to provide free medical service to the poor and indigent"?

Mr Speaker, Sir, if the Government is sincere in fulfilling its promise of "providing free medical service to Singaporeans who are poor and indigent", as stated in its Next Lap, then the Government should make good use of the money to provide the people with good and proper medical safeguards, with a clear statement as to the circumstances under which medical assistance would be available, so that those Singaporeans who genuinely cannot afford to pay for their medical expenses and who stay in C class wards will not have to worry about the ever rising cost of medical care.

Mr Speaker: Order. I suspend the Sitting and will take the Chair again at 3.15 pm.

Sitting accordingly suspended at 2.50 pm until 3.15 pm. Sitting resumed at 3.15 pm

[Mr Speaker in the Chair]

Debate resumed.

Dr Kanwaljit Soin (Nominated Member): Mr Speaker, Sir, I support this important and commendable Bill as it ensures that no Singaporean will be denied basic medical care even if he or she is unable to pay for it. Many of our senior citizens do not have adequate financial resources. 31% of the males and 74% of the females have no personal income. Only 13% of the elderly males and an abysmal 2% of the elderly females have CPF accounts. It is therefore very important that the safety net exists for these senior citizens.

However, it appears to me that there is one needy group of people for whom we are not extending the safety net. Because of discriminatory immigration laws, children of Singaporean mothers and foreign fathers born outside Singapore have no right to become Singapore citizens. Many of these children live in Singapore and go to local schools and live with their mothers who are forced to become single mothers because their fathers cannot get permanent residency. Some of these women have contacted me or the Association of Women for Action and Research and told us of their plight. These children are not eligible for Medifund if clause 13 is not changed. These children would be eligible if they have chosen to have foreign mothers and local fathers, and not foreign fathers and local mothers. I therefore urge that we change the amendment so that needy children in this category will not be denied basic medical care because of unfair and outmoded immigration laws.

The other point that I would like to make concerns the funding of Medifund. At present, the main CPF account can be withdrawn at 55 but the Medisave account has to stay, and what is left in this account after one's death goes to the nominees. I suggest that an opting-in scheme be devised so that each Medisave account holder is given the option to donate all or part of the Medisave account into Medifund after one's death. This will enable Medifund to grow through the altruism of Singaporeans and not only be dependent on budget surplus.

Dr Toh Keng Kiat: Mr Speaker, Sir, I rise to speak in support of this Bill.

Increasing cost of health care is a world-wide problem for a variety of reasons which have already been touched on by the Minister. In Singapore, we also have to contend with a huge wage bill. Our pragmatic Government has made it an avowed objective to contain health care cost so that it does not rise beyond affordability for both the country as well as the individual. One way of doing this is to discourage over consumption through excessive subsidy. The Government's health subsidy has over the years fallen from 88% in 1965 to 57% in 1990. In the last five years, it has remained at 0.7% of the GDP. This has been achieved by either reducing subsidy to those who are deemed not to need it or by increasing co-payment from those who can afford to do so when public health services are consumed.

For the lower-income group using C class hospital facilities, the subsidy has remained at 80%. Despite this, there are some in this group who find it difficult to co-pay in part or in full the recoverable 20%. For them, there is a genuine fear that as costs rise and subsidies are trimmed, even basic health care may become inaccessible. To them, the Medical Endowment Scheme Bill 1993 is welcome legislation and the Scheme, when implemented, will gain political mileage for the Government as still a caring and concerned one.

Apart from the conditions for obtaining grants, clause 13 in the Bill spells out the criteria from which one could draw from Medifund. However, in clause 15(5), there is a provision that notwithstanding all this, nothing in the Act shall be construed to require approval of an application. Like speakers before me, Sir, I am worried about this. The Medical Endowment Scheme pared to the bones is a welfare scheme to help the needy. No self-respecting person would like to turn to welfare for aid if this could be avoided.

I am worried that some deserving and eligible applicant may be denied because of petty bureaucracy from an approving authority as a result of clause 15(5). To safeguard against this, when an eligible applicant has been denied aid perhaps there should be recourse to an appeals committee.

On interpretation, I hope, like others before me, that "approved hospital" will not be only confined to Government or restructured hospitals but include gazetted institutions where alternative medicine is sought, and also the nursing homes, the rehabilitation centres and even the hospices.

Initially, Sir, we are informed that $5 million will be made available for drawing on in the first year of implementation and another $200 million will be paid in as capital money. There is no target set as to how much this capital should grow. But there is a provision for topping it up when the capital sum should be diminished for one reason or another. Theoretically, disbursements from Medifund may no longer be available as a result of this in some lean years. It is perhaps necessary that a minimal sum be set based on the level of subsidy that is thought desirable and pegged to the consumer price indices below which income from Medifund should not be used for topping up capital under clause 4(4). As it stands, the scheme is too open.

Sir, with these reservations, I support the Bill.

Mr Tong Kok Yeo (Nominated Member): Mr Speaker, Sir, I support the Bill as it provides an avenue, particularly for those in the lower-income group, to seek defrayment in whole or in part the medical cost incurred. However, I would like to seek clarifications from the Minister with regard to two clauses of the Bill.

Clause 13(1)(b). In the context of this clause, I would like to know whether any treatment received or required means treatment arising from hospitalisation. Or does it mean any treatment, be it for hospitalisation, ordinary or specialist outpatient treatment which sometimes can be quite a substantial amount?

The other clause is clause 15(1). This clause says:

' ... the Hospital Medifund committee of an approved hospital may, if it thinks fit and subject to the availability of moneys in the Hospital Medifund Account, approve the application of any eligible patient ... ' The clarification I wish to seek is: what recourse can the eligible patient seek if there is no money in the Hospital Medifund Account? If there is none, I must stress here that the Act must provide for one, or else it will defeat all intents and purposes of this Bill.

Mr Walter Woon (Nominated Member): Mr Speaker, Sir, I rise to support this Bill.

I have two basic points to make, one on a point of general principle and the other on a rather more specific area. Social welfare is always an attractive thing, but I think that it is very easy to be seduced by promises of free treatment and the Government is absolutely right to go for this kind of scheme which goes for full funding rather than for free treatment out of revenues that may or may not arise in future years. Subject to the reservation that has been expressed by Dr Toh regarding the necessity to amend clause 4(4) to ensure that there is a minimum subsidy, I would fully support the idea of an endowment fund rather than the provision of free services.

The other point that I would like to raise is basically a point of principle on clause 13 itself. The scheme of the Bill is that an application for use of Medifund should be made by a Singapore citizen and this is as it should be. But because of the way clause 13 is drafted, I think you will find that there will be a certain class of citizens who will not benefit completely from Medifund. The application has to be made by a citizen. If a Singapore citizen falls ill and needs a subsidy, he applies on his own behalf. Or if he cannot, his immediate family applies. If a child of a Singapore citizen falls ill, the parent cannot apply under clause 13 as presently drafted. The application has to be made by the child which is of course not possible in most cases. So what happens? We rely on clause 14 to have the application made by the parent or a member of the immediate family. The problem arises where the child is not a Singapore citizen. Because if the child is not a Singapore citizen, under clause 13, no application can be made on his behalf.

There are two situations where you might have a Singapore parent with a non-Singaporean child. Firstly, in the case of adoption. When you adopt children, they do not automatically become citizens. So you might find that someone who has adopted a baby from abroad, the baby falls ill, he cannot pay. The child cannot get Medifund because the child is not a Singapore citizen. He does not fall within clause 13. Application cannot be made on his behalf.

The second situation is the situation that Dr Soin has brought up, where a Singaporean woman marries a foreigner and has a child abroad. The child is not a Singapore citizen. The woman is deserted. She returns to Singapore. The child is brought with her. The child falls ill. No application can be made because it is a foreign child, not a Singapore citizen. These are the people, I suspect, who are most in need of the Medifund subsidy. And you might say that there are very few of them. That may be true. There may be very few of them. But if the mother is a Singapore citizen, if she is a single mother, if she is struggling to bring up a child in Singapore, I think it is very cold comfort to her to be told, "Well, there are only very few of you." If the idea is to give some privileges to Singapore citizens, to give privileges especially to those who cannot help themselves, then I would suggest very strongly that this particular problem be looked into simply because it is so easy to cure. A simple way to solve the problems that I have highlighted is to allow the parent, being a Singapore citizen, to make the application if treatment is sought for his child, whether or not the child is a Singapore citizen. It may be said that if you allow this, then you reduce the disincentive for Singapore women to marry foreign men. If the aim is to provide disincentives, may I suggest that this is the wrong place to look for disincentives.

Sir, with these two points, may I reiterate my support for the Bill.

Dr John Chen Seow Phun (Hong Kah GRC): Mr Speaker, Sir, the Member for Hougang, Mr Low Thia Khiang, made essentially one point. His point is that the Bill does not ensure that all those who are unable to pay are covered by Medifund, and he cited clause 15(1) and (5) to support his point. Sir, first of all, when Mr Low heard from some Singaporeans that the situation is such that ke yi si bu ke yi bing [ ], I think he owes it to them to explain that the Government, through all the Government and restructured hospitals, has always waived in whole or in part the hospital charges and fees of those who are unable to pay.

Secondly, as the Minister for Health has mentioned earlier, in 1991 the Government spent $1.7 million in waiver of fees. Now that we are going to set up Medifund with an initial grant of $200 million, if we assume a 3% income annually, we are going to have $6 million. I think that is more than adequate for the time being to provide for the waiver of fees.

Thirdly, he cited clause 15(1) that because there is a provision that subject an application to the availability of monies in the Hospital Medifund Account, the applicant may not necessarily get the money even though he may be genuinely in hardship. Sir, this clause is needed to ensure financial prudence on the part of the hospital. He cannot use this clause to say that because it is there, therefore, the Government may not honour its commitment to look after those who are in need. The commitment is there and the Government would honour that commitment. I believe that in genuine circumstances, when the fund is not sufficient, the hospital can always turn to the Minister, and if the Minister is satisfied that more funds should be provided, I am sure the Government would provide the fund.

Sir, the setting up of Medifund is the realisation of one of the many election promises made by the Government. Compared to the existing practice, Medifund would put in place a far-sighted, more structured and more transparent scheme to help the poor. It will become an important pillar of our health-care system in Singapore.

It is far-sighted because we are setting aside a big sum of money now in good times to look after the present and future health-care needs of the poor. These needs will certainly increase as the population ages. Medifund, therefore, enlarges our social safety net and makes it much stronger.

It is more structured and transparent because of the different roles which will be played by the proposed Advisory Council, the Hospital Medifund committee and the way the scheme is administered and held accountable to Parliament.

Sir, clause 13(1)(a) of the Bill requires that an applicant for Medifund must be a citizen of Singapore. That is logical. But I also share the same concern expressed by Dr Soin and Mr Walter Woon. I would also like to bring up another possibility that we may have cases where the patient's son or daughter is a Singaporean and is financially unable to pay for the unsubsidized hospital bill. In such circumstances, should we not consider the plight of the Singaporean son or daughter and give some subsidy for the treatment of his or her non-Singaporean parent?

Sir, many speakers also expressed reservation on clause 15(5). I feel that we have a need for that clause because you may have a situation where a Singaporean patient is unable to pay, but we cannot be sure what other possible circumstances that might appear. Therefore, I believe that it is prudent to have that clause in to ensure that we only give benefits to those who are in need.

Sir, according to the Bill, the Advisory Council will recommend to the Minister the guidelines on the approval of applications from eligible patients. These guidelines can never be perfect, especially at the initial stage of implementation of Medifund. They must, therefore, be improved as actual implementation takes place. We, therefore, need the views and feedback from people who are involved and who are on the ground.

I therefore support the idea that community leaders be involved in a committee to assess applications to Medifund. Community leaders are involved in charity work either at the constituency or national level. They know the problems faced by the poor. The latter are also more willing to approach them for help. Community leaders' involvement in Medifund committees will strengthen social ties and help build a more caring and closely knit community.

Sir, Medifund is a good welfare system. Unlike welfare systems in the West, it does not put the burden on the taxpayers, both present and future. The welfare system fails in the West also because they provide benefits to everyone in broadly defined groups such as the old, the sick and the unemployed who may not actually be poor or need to be poor. Sir, we should avoid such pitfalls and ensure that benefits get to those who really need them. I believe we will succeed through schemes such as Medifund.

I support the Bill, Sir.

Dr Tan Cheng Bock (Ayer Rajah): Mr Speaker, Sir, before I start, can I just ask Mr Low Thia Khiang whether he supports the Bill or he is against this Bill. Listening to him at length, I am not sure whether he supports or he is against it.

Mr Low Thia Khiang: Mr Speaker, Sir, I support, in principle, providing a safety net for Singaporeans or those who cannot pay. But I would like the Minister to clarify the doubts that I have before I decide whether to support the Bill.

Dr Tan Cheng Bock: I thought you support the Bill but now you want clarification from the Minister. Anyway, Mr Speaker, Sir, I rise to support this Bill.

As a responsible Government, we should continue to make sure that those who cannot afford medical attention should be adequately provided for. Medifund is one scheme whereby we can ensure that the poorest Singaporeans are provided for, especially our older Singaporeans, those of our forefathers who came to this island and they are old now.

They really need a lot of assistance. As a medical practitioner, I have come across many cases of such people having difficulty in paying, and we usually refer them to the social worker. What I want to ask the Minister is that I hope the criteria for getting such funds would not be as strict as those in the Public Assistance Scheme. Many a time when we refer cases for public assistance we find that the criteria are so strict that many of them are really cheesed off because they have to answer so many questions and they are very disturbed by them that some of them give up trying to get assistance.

I feel that because Singaporeans have been working so hard we must make sure that at the end of their working life, they must never feel insecure, especially when we come for help. If they feel insecure, then something is wrong. The provision of a scheme like this to ensure that we take care of them when they really are in that difficult position is very good.

I notice that 6,000 patients out of 160,000 patients in B2 and C wards applied for waivers. Out of this, 98% were granted, and the sum was $1.7 million. Judging from the initial sum of $200 million for Medifund, that means we will have about $5 million or $6 million every year from investment income. I think that is very, very generous. On top of it, the Government is going to add another $100 million annually. I think that is very generous and Singaporeans should appreciate it.