Committee of Supply Debate: Ministry of Health
Medisave Minimum Sum requirement to be scrapped next year
Maximum sum to be renamed and fixed for each cohort at age 65
By Salma Khalik, Senior Health Correspondent, The Straits Times, 13 Mar 2015
FROM next January, people no longer need to have a minimum sum in their Medisave account before they can withdraw their Central Provident Fund (CPF) savings at age 55.
The requirement will be scrapped.
Currently, the stipulated amount is $43,500, and those with less have to top up their Medisave with money from the Ordinary Account in their CPF.
The change, announced by Health Minister Gan Kim Yong in Parliament yesterday, affects many people, as almost half of those who turn 55 currently do not have this sum in their Medisave.
But the maximum sum for Medisave will not be scrapped, Mr Gan said in his reply to Dr Chia Shi-Lu (Tanjong Pagar GRC), chairman of the Government Parliamentary Committee for Health.
This sum, which will be raised annually to keep pace with the higher draw on Medisave by the elderly, will go up from $48,500 today to $49,800 next January.
Excess amounts will be moved to the Special and Retirement Accounts.
Mr Gan also said the Medisave maximum sum will be renamed Basic Health-care Sum from next January and will be fixed for each cohort when they turn 65, with no subsequent changes in their lifetime.
At present, any increase in the maximum sum applies to everyone, regardless of age.
The changes are part of a move to improve the Medisave scheme, said Mr Gan.
The first step was taken in January this year, he added, when the Medisave contribution rate of employers was increased to help Singaporeans save more for their health-care needs.
Another major change he announced concerns the amount of Medisave people can use to pay for the premiums of the private health insurance they buy. These schemes incorporate the basic MediShield insurance.
Now, the maximum they are allowed to use from Medisave for these Integrated Shield Plans (IPs) is a flat rate of $800 for people aged 65 and younger, rising to $1,400 for those aged 81 or older.
After MediShield Life replaces MediShield later this year, the amount that can be used for IPs will be tiered according to age groups. For the basic MediShield Life, there will be no limit on the use of Medisave for the premiums.
Mr Gan said: "We will have to balance between helping Singaporeans pay for their IP premiums using Medisave, and ensuring that Medisave is adequately preserved for health-care needs, especially for the lower- income."
Several MPs, including Dr Chia and Non-Constituency MP Lina Chiam, asked for Medisave to cover more chronic ailments.
Mr Gan said it will not include eczema, which Mrs Chiam had asked for. But he assured her there is subsidy for its treatment and financial help for those who still cannot afford to pay.
But from June 1 this year, Medisave can be used to pay for treatment of four more conditions: epilepsy, osteoporosis, psoriasis and rheumatoid arthritis. It brings to 19 the number of chronic conditions covered by Medisave.
The amount allowed is up to $400 a year. But people aged 65 and older can use an additional $200 from next month.
The various moves are part of a masterplan to build a quality health-care system that will be sustainable in keeping Singaporeans healthy, said Mr Gan.
"We have made a lot of progress... but we must also look ahead into the future," he added.
More clarity on private health plan premiums
Insurers have to present products more transparently in future: Gan
By Salma Khalik, Senior Health Correspondent, The Straits Times, 13 Mar 2015
WHEN Singapore introduces the MediShield Life insurance scheme for large medical bills this year, it will affect how much a person can withdraw from his Medisave savings to pay for the premium of his private health insurance.
Up to 60 per cent of Singaporeans have bought such private insurance. These schemes incorporate the basic MediShield plan.
These Integrated Shield Plans (IPs) pay for a better-class ward than the subsidised B2- and C-class wards covered by the basic MediShield plan.
Dr Chia Shi-Lu (Tanjong Pagar GRC) expressed concerns over the depletion of Medisave through the escalation of IP premiums.
He argued that as people get older and their Medisave runs low, they "will naturally downgrade to MediShield Life, leaving IP providers to cream off all the premiums already paid over the years".
Replying, Health Minister Gan Kim Yong noted that, at present, "Singaporeans are not aware of how much Medisave is being used for MediShield and how much is directed towards the additional private insurance component".
In future, insurers will have to "present their products more transparently and accurately" to help people make informed decisions, he added.
How Medisave can be used to pay for premiums in future will reflect this with greater clarity.
BEFORE MEDISHIELD LIFE STARTS
People up to age 65 can use a maximum of $800 every year from Medisave to pay for the premiums of MediShield or any private IP.
The amount increases with age to $1,400 a year for those aged 81 and older.
These amounts are enough to pay in full the premium of the current basic MediShield for people of all ages.
It is also enough to cover in full the most expensive private IP premium for those under the age of 50, without them having to use cash from their pockets.
But older people with private IP premiums higher than the maximum $800 to $1,200 have to fork out cash to pay the difference.
AFTER MEDISHIELD LIFE STARTS
THERE is no change for people who have only the basic MediShield Life. Their entire premium can be paid using Medisave.
But the 60 per cent of people with private IPs will get a new formula later this year on how much Medisave they can use.
The premium for the MediShield Life portion of their IP can be paid in full with Medisave.
But the additional premium for their private plan will face a new Medisave cap that will vary with age - with younger people allowed to use less and older people more.
The precise amounts will be announced later, but these are unlikely to cover the entire premium of the pricier IPs for treatments in A-class or private hospitals.
In future, even young people with expensive IPs will likely have to pay for part of their premiums in cash.
Ensuring patients get 'bang for their buck'
By Salma Khalik, The Straits Times, 13 Mar 2015
SINGAPORE has to start planning now for the changes the country's health-care system will need beyond 2020, in order to keep costs affordable as the population ages, said Health Minister Gan Kim Yong.
And for it to remain sustainable in the long term, "deeper transformative changes (are needed for) both the way care is organised as well as the way it is delivered".
Mr Gan said enhancing subsidies, introducing MediShield Life and putting more money into Medisave are all steps in the right direction. "But such measures are insufficient on their own. We must also ensure that our health-care bill grows at an affordable pace so that we - as individuals and as a society - can continue to afford it," he said.
One way is making the best use of available health-care resources. He said patients rely on health-care providers to advise them on appropriate treatments. These providers must "play their part in delivering cost-effective services".
To help them, the Health Ministry will place more emphasis on assessing new health technologies, including both devices and drugs, to ensure they are useful and cost effective.
"This will ensure that patients get the most bang for their buck for the treatment and medications they receive," Mr Gan said.
In the long term, the plan is to fully integrate the various aspects of health-care provision - from general practitioner clinics to hospitals to nursing homes, and among the private, public and volunteer sectors.
The aim is to have one integrated national health-care system, he said. Hence, by the end of this year, all community hospitals will have their computer systems linked to public hospitals and polyclinics, so patient information can be shared and is complete.
This should improve patient care, Mr Gan said.
Casting his eye over the changes in recent years, he said a lot of progress has been made under the Healthcare 2020 masterplan, including ramping up infrastructure.
The rate at which more hospital beds are being added "is more than double that in the last decade". Rehabilitation facilities will also more than double by 2020.
While work on increasing facilities will continue, Mr Gan said "we must also look ahead to the future".
"We have started our planning processes to prepare for the future. We must continue on this journey to innovate and transform our health-care system to ensure a quality, sustainable one beyond 2020 to keep Singaporeans healthy."
New Bukit Panjang polyclinic to help ease strain
By Linette Lai, The Straits Times, 13 Mar 2015
A NEW polyclinic will be built in Bukit Panjang as part of the Health Ministry's efforts to make primary care more accessible. The new facility will help relieve the strain on other nearby polyclinics, such as the one in Choa Chu Kang, Health Minister Gan Kim Yong said yesterday.
The ministry had earlier announced plans to build six new polyclinics - to add to the existing 18 - by 2020. The six include the Bukit Panjang polyclinic and two others in Jurong West and Punggol announced earlier. Mr Gan added that the existing Yishun and Marine Parade polyclinics are also undergoing re-development.
Elaborating, Minister of State for Health Lam Pin Min said the Yishun polyclinic will move to a new location at the junction of Yishun Central and Yishun Avenue 9 by 2018. It will also be expanded.
Meanwhile, the Marine Parade polyclinic will be expanded from one to two storeys by next year. Dr Lam said: "These expansions will allow us to meet expected demand even as the population in the estate grows and ages."
He said construction of the new Jurong West and Punggol polyclinics will start later this year.
Dr Lam also announced a new primary care centre in Sembawang, which will treat a range of patients similar to those seen by regular polyclinics. But it will likely adopt a different model of care.
"It will be a test-bed for the introduction of new care models, innovative ideas and care processes," he said. The centre will be developed by the Alexandra Health System, which also manages institutions such as Khoo Teck Puat Hospital.
Making home and community services more affordable
Private operators can bid with VWOs to run subsidised care services for elderly in move to raise capacity
By Kash Cheong, The Straits Times, 13 Mar 2015
BETTER subsidised home and community services are on the cards as private operators have been invited to join voluntary welfare organisations (VWOs) to bid for them, said Senior Minister of State for Health and Manpower Amy Khor yesterday.
These services include home nursing, day care and day rehabilitation services.
All operators can now take part in the Ministry of Health's (MOH) Build-Own-Lease tenders for the provision of subsidised aged care services, she said.
Previously, most subsidised home and community services were provided by VWOs.
The change in policy would help Singapore scale up capacity and provide affordable care for a greying population, she said.
Capacity was an issue, given feedback about long waiting lists at certain care centres, said Ms Ellen Lee (Sembawang GRC).
But this has already improved somewhat, Dr Khor noted, citing how an elderly patient now faces a shorter wait of about 20 days for admission into day care, down from 30 days last year.
When it comes to choosing providers of home and community services, the Government will look at care models and affordability of fees, she added. The Government may also request more bundled services for future centres.
Recently, it solicited proposals from private organisations and VWOs for a senior care centre at Ci Yuan Community Centre in Hougang. Providers had to tender to operate day services in the senior care centre as well as offer home-care services out of the centre.
Extending the tender of subsidised services to private operators is part of an ongoing effort to expand home and community services for seniors to age in familiar surroundings.
"We want to fulfil our seniors' aspirations to age in place and enable their children to take care of their parents at home for as long as possible," Dr Khor said.
Besides expanding capacity, the Health Ministry will also pay close attention to the quality of home and community care.
Last year, new home-based, community and palliative care guidelines were proposed. These have been finalised and will be implemented soon.
With Singapore's population ageing, several MPs raised concerns about health-care manpower. "Caring for the elderly requires much human touch and many aspects cannot be automated through productivity measures," said Ms Tin Pei Ling (Marine Parade GRC).
She noted that in Britain, for example, one in five nursing homes was found to have a lack of staff to provide adequate care.
Fortunately, Singapore is on track to meet its health-care manpower targets of expanding the workforce by 20,000 staff from 2011 to 2020, Dr Khor said.
In the last four years, Singapore's health-care professional workforce expanded by 9,000. Health-care job roles have also expanded as technology takes over more mundane jobs.
Senior patient service associate Rajasoluchana Rasayam, 34, for instance, needs to do less administrative work with advanced IT systems at Tan Tock Seng Hospital nowadays.
Instead, her role has been expanded to include more meaningful tasks such as drawing blood for patients, which helps in the diagnosis of diseases.
"There is career progression and I have been given more opportunities to grow," she said.
MOH will continue to look into training, remuneration and flexible work arrangements to encourage a higher take-up of health-care jobs, Dr Khor said. She also hoped more mid-career entrants, women re-entering the workforce and retired nurses will join the health-care workforce.
Ramping up mental health care
By Kash Cheong, The Straits Times, 13 Mar 2015
MEASURES to tackle mental health problems through a community approach will be stepped up to ensure timely help to those at risk and peace of mind for neighbours.
Dementia care facilities will also be ramped up to meet the needs of an ageing population, said Senior Minister of State for Health and Manpower Amy Khor.
"Sometimes, it does take a village to enable patients to recover, and recover well in the community," she said during yesterday's Budget debate.
She was addressing the concerns of several Members of Parliament, including Ms Tin Pei Ling (Marine Parade GRC), regarding mental health issues.
"Real day-to-day issues such as neighbourly disputes due to alleged smells, conspiracies on fixing each other and littering... threaten to deepen the animosity between neighbours, making it even harder for patients or family members to consider mental health issues and seek professional help," said Ms Tin.
In response, the Health Ministry plans to build more local community support networks made up of grassroots leaders, volunteers, social work agencies, the police and town councils.
At Kembangan-Chai Chee, for instance, volunteers have been given basic mental health and eldercare education to help them identify residents at risk and link them up with appropriate resources.
The Health Ministry is exploring the possibility of setting up such networks in 50 constituencies. General practitioners (GPs) will also play a part. The ministry aims to train 120 GPs by 2017 and set up more allied health and specialist-led teams to tackle mental health issues in the community.
The Institute of Mental Health's aftercare services - where discharged patients at higher risk receive phone calls and home visits - will be expanded.
Capacity for dementia care will also be beefed up, said Dr Khor. The number of dementia day care places will be increased from 650 to 3,000 by 2020.
MOH may standardise packaging for cigarettes, ban display of tobacco products at cashiers
By Rachel Au-Yong, The Straits Times, 12 Mar 2015
A public consultation on the standardised packaging of tobacco products - plain boxes with graphic health warnings - will be carried out at the end of 2015, said Parliamentary Secretary Muhammad Faishal Ibrahim on Thursday.
If implemented, tobacco products will get the same plain packaging and have any promotional aspects - like trademarks, logos, colour schemes and images - removed. But the mandatory health warnings will remain.
The objective is to decrease the appeal of cigarettes and other tobacco products, and increase the visibility of health warnings.
Australia is the only country to have implemented standardised packaging, which it did on Dec 1, 2012. New Zealand, Ireland, France and the United Kingdom have also announced their intention to introduce such packaging.
Associate Professor Faishal announced the public consultation as one of several tobacco control measures, in the debate on the Health Ministry's budget. The Government will continue to help smokers quit through health campaigns. His ministry will also push to ban point-of-sale displays of tobacco products, like cigarettes at a cashier, later this year.
New and emerging tobacco products that appeal to the youth may also be banned, he said. In a statement, the Health Ministry highlighted that some countries have prohibited the sale of tobacco for oral use, while others have prohibited electronic cigarettes.
Shisha - one such emerging product - was banned in Singapore in November 2014, "to prevent its proliferation and entrenchment in Singapore."
"We intend to do the same for other types of emerging tobacco products later this year."
Associate Professor Faishal also told Parliament: "I would very much like to hear your views."
One in 3 Singaporeans now on health help scheme CHAS
By Linette Lai, The Straits Times, 12 Mar 2015
One in three Singaporeans - or 1.2 million people - are now on the Community Health Assist Scheme (CHAS), said Minister of State for Health Lam Pin Min on Thursday.
This includes members of the pioneer generation, who are eligible for special CHAS subsidies.
And around 500 new general practitioners (GPs) and dental clinics have come on board the scheme in the past year, making for a total of more than 1,300.
Dr Lam also said that the Health Ministry will be keeping a close eye on these clinics to make sure they do not abuse the scheme.
He was responding to a question by Jurong GRC MP Ang Wei Neng, who said he had received feedback that the cost of treatment at some CHAS clinics is unexpectedly high.
Dr Lam noted that different clinics charge different prices, and that prices tend to vary depending on a patient's condition.
"But we expect CHAS GPs to price reasonably, bearing in mind CHAS patients are expected to be lower- to middle-income," he said.
"MOH closely monitors CHAS claims submitted by clinics, and clinics will be called upon to account for any exceptional claims."
He encouraged patients to ask for itemised receipts if charges are not made clear, and added that they should call the CHAS hotline if clinics do not make satisfactory replies.
Singapore will have a continued supply of obstetricians, says Lam
By Linette Lai, The Straits Times, 12 Mar 2015
Between 60 and 70 new obstetricians will graduate over the next five years, ensuring that there will be no shortage of obstetric services, said Minister of State for Health Lam Pin Min on Thursday.
He added that Singapore also has enough trained, experienced midwives who are also able to deliver babies in restructured hospitals.
He was responding to a question from Nominated MP Kuik Shiao-Yin, who asked how changes in medical indemnity coverage for doctors could affect the supply of obstetricians.
In February, The Straits Times reported that more than a quarter of obstetricians here said they planned to stop delivering babies within the year following a change in the terms of their insurance plans.
Ms Kuik suggested that the Health Ministry (MOH) provide post-retirement protection for these doctors so that they will continue to practise.
"MOH is discussing with professional leaders and other stakeholders how best to address the issue," Dr Lam said. "MOH will also consider ways to work with relevant parties to minimise impact on services and expectant mothers."
What seniors want: To learn new things, volunteer skills
By Linette Lai, The Straits Times, 13 Mar 2015
SENIORS want to spend their golden years meaningfully, and the Health Ministry is working on ways to help them do so.
This includes the chance to learn new things or volunteer their skills, said Health Minister Gan Kim Yong yesterday.
He was sharing the findings of focus group discussions on successful ageing, in which more than 1,300 Singaporeans had taken part.
"At the community level, seniors also enjoy social activities with their families and friends and suggested having more spaces and programmes in the community to support these interactions," he said.
Mr Gan said the ideas raised in discussions would be studied by the various ministries and developed under the Action Plan for Successful Ageing.
For example, the Health Ministry (MOH) is working with the Education Ministry to study how to expand the scope and scale of learning opportunities for seniors.
It is also working with the Ministry of Culture, Community and Youth to make volunteering more accessible, attractive, and meaningful. Details will be announced when the action plan is ready later this year.
Mr Gan also paid tribute to senior citizens such as Mr Harbhajan Singh, 74, a senior nurse manager in Tan Tock Seng Hospital.
"Because of the commitment and devotion of pioneers like Mr Singh, we have today a modern and robust health-care system," he said.
To recognise their contributions, Mr Gan added, MOH has teamed up with the Singapore Business Federation to offer special benefits to seniors.
These include dining discounts, free or discounted entry to places of attraction, as well as discounted hotel stays and travel packages.
Also included are free courses offered by the Council for Third Age's senior learning providers.
Transport subsidy extended to 1,000 more seniors
By Kash Cheong, The Straits Times, 13 Mar 2015
A TRANSPORT subsidy that is currently given out to the wheelchair-bound seniors will be extended to seniors requiring some form of mobility assistance, Senior Minister of State for Health Amy Khor said in Parliament yesterday.
The transport subsidies come under the Seniors' Mobility and Enabling Fund (SMF) and is for those attending Government-funded day rehabilitation, dementia care or dialysis services.
Starting next month, the subsidy will be extended to include those who require "some form of mobility assistance", she said. This includes, for instance, those who need to use walking sticks.
The improved scheme is also meant to encourage seniors to attend rehabilitation follow-ups.
Dr Khor said: "The fact that the elderly may not follow up with rehab could be due to other factors, such as (having) no transport to day rehab."
Dr Khor was responding to questions from Mr Low Thia Khiang (Aljunied GRC) on why some seniors do not attend rehab follow-ups, which subsequently affects their recovery.
With the enhanced scheme, an additional 1,000 seniors will benefit from transport subsidies. Currently, 2,000 seniors get transport subsidies under the SMF. "The level of funding support given will be based on mobility needs," Dr Khor said.
The Health Ministry expects to provide an additional $14 million from the fund to support eldercare operators in providing transportation.
Besides providing transport subsidies, MOH has also stepped up efforts to encourage seniors to attend rehab follow-ups by providing subsidies for home rehabilitation since April last year. With more rehab needs, the number of physiotherapists, speech therapists and occupational therapists in the public and step-down care sectors has grown by 40 per cent to more than 1,200 today. Course intakes in local institutions for speech and occupational therapy as well as physiotherapy have also been increased, said Dr Khor.
Singaporeans aged above 60 can also tap the fund to get subsidies of up to 90 per cent on hearing aids. Since 2013, close to $17 million in subsidies have been given out through the fund, she said.
Greater peace of mind on health care
But new ways must be found to encourage people to do their part
By Fiona Chan, Deputy Political Editor, The Straits Times, 13 Mar 2015
COPING with health-care costs has been a major worry for many Singaporeans, but recent measures by the Government are helping to ensure that Singaporeans have less reason to fret.
Among the moves announced by Health Minister Gan Kim Yong in Parliament yesterday were more drug subsidies for those who need continuing care after leaving the hospital, and extending the use of Medisave funds and Community Health Assist Scheme (CHAS) subsidies to cover a wider variety of chronic conditions.
Seniors aged 65 and above will also be able to use another $200 a year from their Medisave to pay for outpatient treatment, he said in response to calls by Dr Fatimah Lateef (Marine Parade GRC) and Dr Chia Shi-Lu (Tanjong Pagar GRC) for more flexibility in Medisave use. At the same time, Mr Gan reiterated that Singaporeans will be able to use Medisave to pay for premiums under the MediShield Life insurance scheme, which will cover all Singaporeans for life.
For those who want to add enhanced coverage to cover the costs of a more comfortable hospital stay, the Government is working with private insurers to develop a new standard Integrated Shield Plan. This will be rolled out in the first half of next year, Mr Gan assured Dr Chia and Mr Ang Wei Neng (Jurong GRC), who asked for a progress update during the debate on the Health Ministry's spending plans.
Together, these actions increase the Government's share of health-care spending, make Medisave more useful, and allow more risk-pooling through MediShield Life.
And there is little doubt they will help lessen Singaporeans' concerns about their medical bills. But regular reminders about the importance of staying healthy could also be useful. By the time something goes wrong with a person's health, it is often too late to do much about it.
That's why Dr Chia's suggestion yesterday for a HealthFuture scheme - borrowing from the new SkillsFuture initiative - was intriguing. He proposed a HealthFuture account for each Singaporean, to be used for healthy lifestyle programmes such as smoking cessation, weight loss, exercise classes or health screenings.
Just as the SkillsFuture account aims to help Singaporeans maintain their employability through credits that can be used for training courses, the HealthFuture account could encourage them to proactively upkeep their health.
Such an account would prompt Singaporeans to "invest in our own health, for now and for the future", Dr Chia said. He suggested that HealthFuture funds could take the form of contributions by the Government, employers and individuals, or come from Medisave, adding: "We all recognise the importance of keeping healthy and disease prevention, but walking the walk is far more difficult than talking the talk."
Responding to Dr Chia's idea, Parliamentary Secretary for Health Muhammad Faishal Ibrahim reminded the House that "Singaporeans do not necessarily have to spend money to keep healthy".
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