2014-07-11

MEDISHIELD LIFE DEBATE

'No tax rise planned' for subsidies on MediShield
Current Budget has taken that into account, says Health Minister
By Salma Khalik, The Straits Times, 10 Jul 2014

ALTHOUGH the payouts from MediShield Life will be more than the current scheme, the proposed mandatory medical insurance will be both sustainable and affordable over the long term, Health Minister Gan Kim Yong assured the House yesterday.

"We do not plan to raise taxes for the purpose of paying for these MediShield subsidies."

Part of the reason it will be sustainable is that the premiums collected will be enough not just for the year's payouts but also "for long-term commitments such as continuing claims for dialysis and cancer treatments", he said.

Closing the debate on MediShield Life, which will give lifelong cover to all Singaporeans and permanent residents, Mr Gan said the current Budget has taken into account the subsidies to tide people over the higher premiums when the scheme starts at the end of next year.

Over two days of debate, 24 Members of Parliament raised various concerns, including how premiums are decided, the need for social responsibility or strong oversight to keep costs under control, as well as a call to better regulate the Integrated Shield Plans (IPs) offered by commercial insurers.

Mr Sitoh Yih Pin (Potong Pasir) said the average person is not seized by how much of the scheme is funded by the Government. "The two biggest things on everyone's minds are how much will the premiums be in the long run, and how much will the payouts be when we need to use MediShield Life."

He also felt the scheme needs government control over what is covered.

Mr Gan agreed that hospitals "play a critical role in managing costs", and he promised to "develop and enforce strong clinical protocols to guide doctors on what is clinically appropriate".

Associate Professor Fatimah Lateef (Marine Parade GRC) and Workers' Party Non-Constituency MP Yee Jenn Jong suggested close monitoring of insurance claims and health-care consumption patterns.

Mr Gan replied: "We will need to curtail unfettered choice which does not translate into outcomes. We must work together to keep a lid on health-care inflation."

To the MPs who stressed the need for people to play their part by staying healthy, Mr Gan said this should include going for health screening regularly and treating chronic ailments.

He also told MPs, who asked for regulation of IPs covering private medical care, that his ministry will look into the issue.

But he warned against over- regulation, which could limit choice or increase premiums.

Mr Gan also took note of the MPs' call to explain the scheme clearly to people. Indeed, several Members of the House were themselves confused about the scheme.

One of them obviously failed to grasp the slogan "Better Protection. For All. For Life" when she asked why the Government is not "making all Singaporeans buy MediShield Life".

1-year premium respite for 50% of IP top-ups
By Joanna Seow And Royston Sim, The Straits Times, 10 Jul 2014

ABOUT half the people who buy private insurance to get improved hospital benefits will not have to worry for one year about paying higher premiums for the extras.

They just have to pay whatever is the increase in their premiums under MediShield Life, to be introduced next year.

The Life Insurance Association (LIA) gave this assurance yesterday for the premiums of the Integrated Shield Plans (IPs) for hospitalisation in B1 and A wards in public hospitals.

These policyholders make up less than half of the 2.3 million IPs. The rest - 52 per cent - are for stays in private hospitals.

The LIA statement said the move will allow for a smooth transition for people renewing their IPs. The association includes the five insurers providing Medisave-approved IPs - AIA, Aviva, Great Eastern, NTUC Income and Prudential. It had previously said the increase in MediShield Life premiums would have "minimal impact" on IP premiums.

After the one-year grace period, the insurers will re-assess the IP based on actual experience, by looking at claims for instance, said LIA president Khoo Kah Siang.

He also said current B1 class plans are up for review as part of discussions with the Government on a standardised IP for B1 coverage, as suggested by the MediShield Life Review Committee.

All IPs currently incorporate MediShield and in future MediShield Life, which provides hospital cover for subsidised wards for all residents for life. So any changes to the basic scheme will affect the IPs.

Dr Khoo added that the commitment to not raise the insurers' portion of the premiums is "based on the assumption that there is no significant change to the regulatory and competitive environment".

Health Minister Gan Kim Yong said in Parliament on Tuesday that the overall increase for IP premiums resulting from the introduction of MediShield Life is expected to be the same, if not lower than the increase in Medi-Shield Life premiums. These will remain constant for the first five years.

But calculations for private medical care under IPs may take longer as costs are harder to anticipate than those for subsidised government care, and business considerations may come into play, said Dr Chia Shi-Lu, chairman of the Government Parliamentary Committee for Health.

Health-care expert Jeremy Lim of consulting firm Oliver Wyman said the private insurers probably want to reassure policyholders of pricing certainty for at least the next two years, so they will not make hasty decisions on whether or not to cancel their plans.

For retiree George Chiang, 73, a one-year freeze is "not good enough". He pays around $3,000 in annual IP premiums in total for him and his wife and is considering cancelling the plan. He said: "What if they double the increase the next year to make up for it?"

Govt not collecting more premiums than needed
Sums received not meant to build up huge reserves, says Health Minister
By Salma Khalik, The Straits Times, 10 Jul 2014

MEDISHIELD Life will not collect too much in premiums in order to set aside huge reserves, Health Minister Gan Kim Yong made clear yesterday, saying it is a "misconception that MediShield is collecting more premiums than needed".

He was responding to Non-Constituency MPs Gerald Giam and Lina Chiam, who questioned the way the Government calculated the amount of reserves needed by MediShield and the impact this would have on premiums.

Other MPs, including Dr Lily Neo (Tanjong Pagar GRC) and Ms Tin Pei Ling (Marine Parade GRC), asked how MediShield Life premiums are decided.

Mr Gan said they are decided based on actuarial principles, and take into account benefits and expected claims, provisions for premium rebates as people age, reserves, and capital and administrative costs. He also rejected suggestions to cap premiums or to have the same premiums for all ages as that would mean older people would be claiming more than the premiums they paid. "The deficit will have to be paid for by the younger generation," he said.

Mr Gan also explained that long-term health insurance schemes like MediShield and MediShield Life must set aside enough reserves to honour not just current-year claims but also long-term commitments, such as continuing claims for dialysis and cancer treatments, and premium rebates for older age groups.

"It would not be responsible to all Singaporeans and policyholders if yearly premiums for MediShield just exactly balanced yearly payouts, as Mrs Lina Chiam has suggested, for this would mean that it cannot meet any continuing commitments for long-term dialysis patients or premium rebates," he said.

On Tuesday, Mr Giam, a Workers' Party NCMP, had suggested that the Government might be "setting aside too much for reserves". He also asked why MediShield has a target capital adequacy ratio (CAR) of 200 per cent when that set by the Monetary Authority of Singapore (MAS) is 120 per cent.

CAR compares an insurance fund's financial resources with the capital it has to hold under MAS regulations. It is to hedge against risks - higher amounts represent safer products.

Mr Gan explained that 120 per cent is the minimum that MAS requires, and that "most commercial insurers typically aim for 200 per cent or higher".

Mr Giam also pointed out that last year, out of every dollar in premiums collected, MediShield only paid out 44 cents. In the United States, insurers that pay out less than 80 cents per dollar collected have to give premium rebates.

The minister explained that the figure of 44 cents did not take into account future liabilities. A better comparison was with the incurred loss ratio, which did. For example, someone with kidney failure will make dialysis claims not just in the first year, but also for the rest of the person's life.

If this payment is included in the calculations, then MediShield's incurred loss ratio over the last five years was 96 per cent - "sufficient to ensure sustainability of benefits but not excessive".

He added that a buffer is also needed in case there were unexpected claims.

Said Mr Gan: "I am keenly aware of the impact on premiums, but I would rather have sufficient reserves in MediShield Life and provide the necessary premium subsidies, than to put Singaporeans' health-care needs at risk."

No answers yet on three issues

ANSWERS on three major issues that MPs raised during the two-day debate on the new MediShield Life insurance will come later, Health Minister Gan Kim Yong said yesterday. He promised to give "details when ready" on:

- The proposed standard Integrated Shield Plan (IP), that provides coverage based on charges of the B1 ward in public hospitals, for people who want more than the basic subsidised care.

- The pre-existing medical conditions which will require a person to pay an extra 30 per cent in premiums for 10 years.

- How application for the permanent premium subsidy will be made as simple and convenient as possible for people.

MPs suggest regulation for Integrated Shield plans
By Rachel Au-Yong, The Straits Times, 10 Jul 2014

INTEGRATED Shield Plans (IPs) ought to be regulated by the Government to prevent profiteering, said several MPs yesterday as they raised concerns about these private insurance health-care plans.

One of them, Mr Sitoh Yih Pin (Potong Pasir), urged it to go further and take over the running of the standardised B1 plans, which are set to be rolled out next year, along with MediShield Life.

Get private insurers out of the B1 segment of the market, he said. The reason: They are unlikely to offer competitive benefits if the B1 plan is standardised across the board.

Currently, two-thirds of Singaporeans are on IPs, which are optional plans run by private insurers for hospitalisation in higher-class wards and private hospitals.

Their place and relevance have come under scrutiny now that all Singaporeans will be covered by MediShield Life at the end of next year. MediShield Life will provide hospital coverage for everyone in C and B2 wards.

The MediShield Life Review Committee, which came up with the MediShield Life proposals, recommended that the five private insurers offer a standardised B1 ward IP and the Government has accepted this recommendation.

Expressing the fears outside the House, Dr Lily Neo (Tanjong Pagar GRC) yesterday said insurers might "cherry-pick" the young and healthy to take on enhanced benefits at attractive premiums, but divert them to MediShield Life as they age.

They would do this by raising premiums at an age policyholders are more likely to make claims.

It is also likely that those who have run out of their Medisave money to service the private plans will end up downgrading from IPs to MediShield Life coverage, she added.

Insurers "stand to reap actuarial profits... at the expense of MediShield Life", she said.

To combat this, Dr Neo suggested that the Health Ministry extract a share of private insurers' actuarial profits.

Ms Denise Phua (Moulmein-Kallang GRC) went one step further, and asked the Government to play a regulatory role so that those with pre-existing conditions "would not be at the mercy of for-profit providers".

About 60 per cent of Singaporeans have bought IPs in various forms, which shows significant public interest, she noted.

"Persons with pre-existing conditions should not be deprived of the choice of upgrading to a B1 ward, because of either unfair risk-loading practices or private insurers' lack of interest to cover this target group," she said. "I ask the ministry to offer the standard IP for all, regardless of health conditions."

But Mr Sitoh was the boldest of all: Private insurers should concentrate on providing products for A-class and private hospital services, and exit the B1 segment altogether, he suggested.

"If you think about it, we'd want several providers for a certain product so that through competition, innovation and differentiation between providers, the consumer can benefit.

"But once a product is standardised, there is very limited, if any, scope for competition."

He added that the B1 ward is a "uniquely restructured hospital product", as it receives a 20 per cent subsidy. Most private hospitals offer few four-bed wards, and these are not subsidised.

Calling on the Government to take over the administration of IPs for B1 services, he said: "A single insurance provider will enjoy economies of scale and better risk-pooling."

In wrapping up yesterday's debate on MediShield Life, Health Minister Gan Kim Yong said his ministry will study how to "strengthen the current regulatory and accountability framework for IP insurers, while being mindful not to over-regulate" them.

"Imposing requirements which are too onerous could limit choices or result in higher premiums for policyholders," he said.

He also said he will take members' suggestions into consideration when designing the B1 plan.

Putting a 'human face to the message'
Outreach to also clarify misconceptions, give assurances, says Amy Khor
By Andrea Ong, The Straits Times, 10 Jul 2014

HEALTH-CARE financing is a subject many Singaporeans know little about, which is why Dr Amy Khor has a plan to explain how MediShield Life will work for them and put "a human face to the message".

The Senior Minister of State for Health was responding to calls from many MPs to step up communication on the new universal health-care insurance scheme.

She promised that the outreach will go beyond merely explaining the technical nuts and bolts of the system, which may be difficult and off-putting for some.

It will also clarify misconceptions, give assurances and put "a human face to the message" so people know help is at hand if they need it, said Dr Khor, who stressed several times that people need not worry about whether they can afford premiums.

She said that when the MediShield Life review committee consulted the public, "what was very clear... was that many Singaporeans only have a very rudimentary understanding of the health-care financing system".

She singled out three areas that will need extra attention in the outreach exercise.

One, enhancing awareness of how Integrated Shield Plans (IPs) work. About 60 per cent of Singaporeans have these plans.

Dr Khor said not many people know that everyone who has an IP is already on MediShield, or MediShield Life when it is launched.

She compared MediShield to the base of a cake. IPs, provided by private insurers, are the "icing on top" that offer enhanced benefits like better ward classes.

Singaporeans may not be aware that while the premiums for MediShield and IPs are fairly similar when the policyholder is young, they will rise significantly with age, said Dr Khor.

"Many realise this only when they are in their silver years, when premiums rise sharply and the Medisave withdrawal limit becomes insufficient, making it necessary to top up their premium payments with cash," she said.

The Government will help IP policyholders understand how their plans work with MediShield Life so that they can make informed decisions. For instance, they might want to consider whether the wider base of MediShield Life's improved benefits is sufficient for their needs, or whether they still need IPs, said Dr Khor.

It will also work with private insurers to ensure that they market their products responsibly.

The second area she identified involved portable medical benefits that ride on MediShield Life.

She pledged that the Government will work with employers and union leaders to help them better understand how MediShield Life and IPs interact with employer medical benefits.

A tripartite working group, involving the Government, the Singapore National Employers Federation and the National Trades Union Congress, will look into the issue of portable medical benefits.

The Government will consider strengthening incentives for companies willing to offer portable benefits, such as through additional employer Medisave contributions or paying for employees' MediShield Life premiums.

The third area is how MediShield Life will tie in with the Pioneer Generation Package.

About 110,000 pioneers who are currently uninsured will now be covered by MediShield Life.

Existing coverage exclusions will be removed, though pioneers with pre-existing conditions may need to pay loading on their premiums.

But Dr Khor stressed that the most important message for all pioneers is: they will pay less than what they pay for MediShield today, for better protection.

Those aged 80 and above this year will have their MediShield Life premiums fully covered.

Dr Khor, who co-chairs a pioneer generation taskforce with Senior Minister of State Josephine Teo, said the Government would learn from its efforts and experiments in communicating the Pioneer Generation Package.

She highlighted the importance of face-to-face contact to give a personal touch to the outreach. The Government will thus tap grassroots leaders, community organisations and self-help groups.

Pensioners 'not worse off' under new scheme
By Kash Cheong, The Straits Times, 10 Jul 2014

SINGAPORE'S 32,000 pensioners enjoy significant medical benefits from the Government and a couple of MPs expressed concern that they could be worse off under the new MediShield Life insurance scheme.

One of them is Workers' Party MP Png Eng Huat (Hougang), who said that under MediShield Life, pensioners will lose the medical coverage for their dependents.

"The additional out-of-pocket expenses for hospital bills and the annual premiums for MediShield Life coverage for their dependents are additional costs to them," he added.

About 40 per cent of pensioners are on plans like the Comprehensive Co-payment Scheme, which gives them and their dependents heavy subsidies for hospitalisation in public hospitals and outpatient treatment at polyclinics. Those on the Fixed Amount on Ward Scheme, Mr Png said, have their hospital bills capped at $8 a day and get free treatment at polyclinics.

He also said some pensioners may not have enough savings in their Medisave accounts for co-payments and deductibles, as they were "not required to set aside any Medisave because they enjoy life-long retirement medical benefits".

He asked if pensioners could choose to be exempted from MediShield Life.

Non-Constituency MP Lina Chiam called on the Health Ministry to address concerns on whether existing medical benefits of pensioners would duplicate those in MediShield Life, and how this could be avoided.

Dr Fatimah Lateef (Marine Parade GRC) wants to know how MediShield Life would affect pensioners.

Replying, Health Minister Gan Kim Yong gave the assurance that pensioners would not be worse off under MediShield Life.

"Under the current MediShield scheme, the pensioner's spouse will lose coverage when the pensioner passes away," he said. "But going forward, the spouse will be covered under MediShield Life for life, even after the pensioner has passed away."

Mr Gan also referred to a Government announcement last week that pensioners in the Comprehensive Co-payment Scheme will get an extra 1 per cent in Medisave, when MediShield Life starts next year to offset higher premiums.

Pensioners on older medical schemes, which provide better benefits than MediShield Life, will have their premiums paid for by the Government.

The Goverment will write to pensioners with details by October.

Subsidised care: Is every doctor a good doctor?
By Chua Mui Hoong, The Straits Times, 10 Jul 2014

FIRST, a mea culpa.

A year ago, I wrote about MediShield Life shortly after the Prime Minister promised Medi- Shield would be revamped to bring in people with pre-existing illness. At that time, I predicted bitter wrangling over who should foot the cost of bringing this ill group into the health insurance risk pool, saying such debates would be "fractious".

I wrote: "After decades of exhortations about personal responsibility and reward based on individual performance and effort, we probably need a booster shot of altruism and solidarity."

Eleven months on, details of MediShield Life (MSL) and premium increases to cover the very sick, and the very old, are now made public. The Government will pay three-quarters of the cost of bringing in those with pre-existing illness. This group will pay 30 per cent more in premiums for 10 years as their share of the cost. Everyone else co-shares a modest part of the costs.

The cost-sharing formula has gone down well, and was accepted with little angst. Hardly anyone questioned why they had to pay a bit more and why taxpayers' money should be used to bring the sick into the insured pool.

I was wrong. And happily so.

There has been no fractious debate. Instead, MPs from three political parties joined forces in Parliament yesterday, to support a motion that the House endorses the MediShield Life Review Committee Report's proposals to implement universal health coverage in Singapore.

Over two days of debate, 25 MPs spoke. Workers' Party Non-Constituency MP (NCMP) Gerald Giam and Mrs Lina Chiam, an NCMP from the Singapore People's Party, were both concerned about MSL's long-term sustainability, an issue People's Action Party MPs like Christopher de Souza and Denise Phua were also seized with.

The promise of universal health coverage has attracted near-universal acclaim.

It's easy to forget how far we've come as a society. Not too long ago, government officials were robustly defending the status quo MediShield - one which leaves out the very old who most need financial security; excludes people with just one illness from all coverage; and leaves you out in the cold when you exceed lifetime claims limits. It wasn't too long ago that people argued it was unfair for healthy young people to pay more to cover the sick and old who are left out of MediShield.

Today, the acceptance of universal health coverage in MSL has changed us as a society for the better. How so? For one, MSL is based on solidarity. In the words of MP Sitoh Yih Pin, there's a spirit of "collective welfare", when everyone pays a bit to have universal coverage for all.

Solidarity also means not over- consuming health care, a point stressed by MP and general practitioner Lily Neo, warning against "unsavoury practices" from health providers, such as over-treating or over-testing.

Second, MSL reminds us that there are limits to personal and family responsibility.

Even if you take the best care of your health, you may fall sick and need expensive care some time. Even if your family members empty their Medisave accounts, it may not be enough.

Once MSL kicks in at the end of 2015, you no longer have to borrow or sell your home to pay your hospital bills. Instead, the rest of the community chips in.

Policy design used to be about protecting MediShield from people's large claims; now, it is about using MediShield Life to protect people from the anxiety of having to pay too-large claims. Some of the extreme risk is being shifted from the individual and his family, to the community (via the MSL risk pool) and the state (via subsidised premiums and Medifund).

What has not changed, though, are some basic principles that underpin personal responsibility, such as co-payments, and a high deductible so that small bills are still borne by the individual.

The Health Ministry (MOH) will also keep an eye on supplier- induced demand. For example, it has a Standard Drugs List, developed based on clinical and cost effectiveness. Drugs on the list are subsidised and the list is regularly reviewed to ensure access and affordability of treatments, said Health Minister Gan Kim Yong.

Which brings us to an important, rather under-discussed issue. MSL pays up to Class B2 and C charges. But how good is the care in these subsidised wards?

As Mrs Chiam remarked yesterday: "Some patients have even expressed the doubt of whether medications provided for patients have the same potency of those in B1 and A paying wards."

MP Fatimah Lateef, a doctor, assured Mrs Chiam that care, medication and treatment are the same across ward classes.

Anecdotally, however, the perception is rife that care at subsidised wards is inferior. It's not just about creature comforts like the lack of air-con.

It's sometimes whispered that some drugs and treatments not on the standard list aren't even offered to subsidised patients because doctors fear telling them about treatments they can't afford. And then there's the choice of doctors, which you don't get in subsidised wards. Can a rookie surgeon be as good as a senior consultant who's performed the surgery for 10 years?

With subsidised care being set as the norm, perhaps MOH should do what the Ministry of Education is doing, and embark on a campaign to say that B2/C care is just as good as care in an A/B1 ward, minus the difference in air-con and number of beds in a room.

Its tagline might be: Every doctor a good doctor.

KL has reassured Singapore over reclamation concerns: MFA
By Charissa Yong, The Straits Times, 10 Jul 2014

MALAYSIA has assured Singapore that no reclamation is currently taking place for its two controversial projects near the Johor Strait, said Senior Minister of State for Foreign Affairs Masagos Zulkifli yesterday.

It remains committed to fulfilling its obligations under international law and will take all necessary measures to avoid any adverse transboundary impact, he said in Parliament.

"Singapore is very concerned about the potential transboundary impact on Singapore from reclamation projects in Malaysia that are in close proximity to Singapore," he said in response to questions from Dr Lim Wee Kiak (Nee Soon GRC) and Mr Ang Wei Neng (Jurong GRC).

The Republic has conveyed its concern on a number of occasions to Malaysia, asking for more information on these reclamation and construction works, he added.

Prime Minister Lee Hsien Loong spoke and wrote to Malaysian Prime Minister Najib Razak on the matter in May.

National Development Minister Khaw Boon Wan, who co- chairs the Malaysia-Singapore Joint Ministerial Committee for Iskandar Malaysia, also wrote to his Malaysian counterpart the same month.

The issue was also discussed in May at a meeting of the Malaysia-Singapore Joint Committee on the Environment in Malaysia.

Malaysia had responded on June 30 to Singapore's request for the projects to be temporarily suspended until the Republic receives and studies information on them. The Straits Times understands that Malaysia's Department of Environment was responding to a letter sent by the National Environment Agency.

The Malaysian Foreign Ministry then sent a diplomatic note to the Ministry of Foreign Affairs (MFA) on July 1.

Malaysia has also given Singapore preliminary general information on the projects and promised to share all other information once ready, Mr Masagos said.

Singapore is seeking further clarifications on some of the information provided, and will study the projects' impact.

"We have proposed to hold consultations with Malaysia so that both sides can further discuss and exchange information on these projects," he added.

The major reclamation works first attracted controversy last month, with concerns over their possible impact on Singapore and the environment.

The first project, a luxury home complex on a man-made island three times the size of Ang Mo Kio, is located near the Second Link. Dubbed Forest City, it is developed by China's Country Garden Holdings and a Johor state company.

The second is a residential project by China developer Guangzhou R&F Properties named Princess Cove.

Singapore was not given prior information on either project, and it is concerned about the effect on the coastal environment and infrastructure, among other problems, said Mr Masagos.

Under international law, Malaysia is obligated to "not permit reclamation activities of this scale and nature to take place so close to Singapore without first conducting an environmental impact assessment", he said.

If damage to the environment has been caused or is imminent, Malaysia has a duty to immediately notify Singapore, he added.

Under a 2005 settlement agreement following a reclamation case, both countries must monitor their environments in the Johor Strait, share information and address any adverse impacts.

According to a Johor official, Forest City developers had voluntarily stopped work for about a week while awaiting approval from the Department of Environment. But a Straits Times check on June 25 found that work on a sandbank was still ongoing, as the developers had asked for more time to wind down operations.

'Handful' of Singaporeans went to Syria to join conflict: DPM Teo
By Imelda Saad, Channel NewsAsia, 9 Jul 2014

The Syrian crisis has raised the threat of terrorism in Singapore. Deputy Prime Minister Teo Chee Hean gave a sobering picture in Parliament on Wednesday (July 9) on the impact of the crisis to the country and why the developments go beyond security concerns and threatens social cohesion.

The Syrian civil war has been raging since mass protests broke out against the Bashar al-Assad government in 2011. The conflict has grown into a security concern for many countries including Singapore. As many as 12,000 foreigners may have already gone to fight in Syria, and the number is growing. A handful of Singaporeans have joined in the conflict too, Mr Teo, who is also Home Affairs Minister, revealed that a handful of Singaporeans have gone to Syria, to take part in the conflict.

“The Government knows of a handful of Singaporeans who have gone to Syria to take part in the conflict. One of them is Haja Fakkurudeen Usman Ali (Haja), a naturalised Singapore citizen of Indian origin. He brought his wife and three children then aged between 2 and 11 with him,” he said. “Another female Singaporean is believed to have gone to Syria with her foreign husband and two teenaged children. The whole family is taking part in the conflict in various ways, either joining the terrorist groups to fight, or providing aid and support to the fighters."

Several others had intended to travel to Syria or other conflict zones to engage in jihadist violence, but were detected before they could proceed with plans. Self-radicalised lawyer Abdul Basheer Abdul Kader has been detained under the Internal Security Act, while Zakaria Rosdan and Khairul Sofri Osman have both been issued Restriction Orders.

There are others who have expressed interest to join in the fight, and are currently under investigation. "We have established that they had been radicalised by the videos, articles and social media postings online. They subscribed to the sectarian-religious or ideological rhetoric that calls for engaging in militant jihad in Syria," said Mr Teo.

DPM Teo said the flow of foreign fighters into Syria poses a threat to the country as there are parallels between the current crisis and the Soviet-Afghan war in the 1980s. That war drew thousands of foreign fighters and led to the creation of Al-Qaeda. The Al-Qaeda, through Jemaah Islamiyah, had planned terror attacks on Singapore.

"The foreign fighters in Syria may similarly return from the conflict proficient in terrorist skills,” said Mr Teo. “They may undertake terrorist activities in their home countries or overseas, or at the very least provide logistical and operation

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