Speech by Minister for Health Mr Gan Kim Yong at the MOH Committee of Supply Debate, 12 Mar 2015

SPEECH BY MINISTER FOR HEALTH MR GAN KIM YONG AT THE MOH COMMITTEE OF SUPPLY DEBATE, 12 MAR 2015

(A)          STATE OF OUR HEALTH

1.               Madam, as we celebrate our 50th year of nation building, let me also take this opportunity to thank our pioneering healthcare professionals, who have overcome a host of public health challenges arising from the lack of proper sanitation and poor food hygiene practices in the early years. As a result of their efforts, the average life expectancy now stands at 83 years, well above most countries, compared to just 65 years then. Infant mortality rates also improved from 26 per 1,000 live births to 2 per 1,000 live births.

2.               Our pioneers also worked tirelessly to train up the next generation of healthcare professionals and nurtured in them the spirit of service and excellence. Mr Harbhajan Singh is one such pioneer. After reaching the retirement age in 2002, he stayed on and to date has chalked up a total of 55 years of service in Tan Tock Seng Hospital (TTSH). Mr Singh was also part of the team of frontline healthcare workers involved in battling the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, and he stands ready to battle again new emerging infectious diseases such as Ebola. Because of the commitment and devotion of pioneers like Mr Singh, we all can enjoy a modern and robust healthcare system today. Let us say a big “Thank You” to all of them.

3.               Mr Gerald Giam asked about how socio-economic factors affect health outcomes in Singapore. Health outcomes have improved for all Singaporeans, as seen through the overall improvements in life expectancy and reductions in infant mortality. However, as with other countries, there are differences in health outcomes and risk factors across different socio-economic groups.

4.               Using education as an indicator and taking obesity as an example, the 2010 National Health Survey showed that women with PSLE education and below were 1.4 times more likely to be obese compared to those with GCE “A” Level education and above. However, men with lower educational qualifications were less likely to be obese. This compares favourably with a study of 22 European countries, in which less educated women and men were 2.8 and 1.9 times more likely to be obese on average.

5.               Our survey shows that the lower educated have good access to healthcare services and reasonably good outcomes for key chronic conditions, such as diabetes. Healthcare 2020 focuses on further improving access and affordability of healthcare to achieve better outcome for all Singaporeans and especially the more vulnerable. At the same time, we will also help them to have stronger awareness and better understanding of health issues so that they can take personal responsibility of their health outcomes. This is why the Health Promotion Board (HPB) has targeted its health promotion outreach and messages to ensure that these messages and outreach will reach all socio-economic groups. My Parliamentary Secretary Assoc Prof Faishal will elaborate on our health promotion efforts later.

6.               Let me update the House on the progress of Healthcare 2020, as requested by Dr Chia Shi-Lu.

(B)           BUILDING INFRASTRUCTURE AND CAPACITY

7.               First, on infrastructure developments. Over the last decade, we have added more than 1,200 acute beds, and 500 community hospital beds. From now till 2020, we target to add at least 1,700 acute beds, from our two new general hospitals. This rate of expansion of development is more than double that in the last decade. The Ng Teng Fong General Hospital is scheduled to open by July 2015. I am pleased to let Members know that we have achieved Temporary Occupancy Permits (TOP) for both the Specialist Outpatient Clinics (SOC) tower and the ward tower of the hospital.

8.               Our care model will evolve as our population ages. Mr Low Thia Khiang asked about rehabilitative care. Rehabilitation plays a pivotal role in our care of an ageing population. We are strengthening rehabilitative care by more than doubling our capacity for community hospitals. Minister of State Dr Lam Pin Min will talk more about plans on this area and my Senior Minister of State Dr Amy Khor will share how the Ministry is developing manpower to support rehabilitation, as well as strengthening home and community care.

9.               Our specialist centres are also being expanded and upgraded to better serve Singaporeans. Last year, we opened the new National Heart Centre (NHC) building. By 2019, we will open a new Centre for Oral Health (COH) at the NUH. This will allow us to expand dental services for Singaporeans and provide more training capacity for dentists and dental therapists.

10.           We are also improving Singaporeans’ access to quality primary care within their communities. Last year, I announced that we would be building two new polyclinics in Jurong West and Punggol.

11.           This year, I am pleased to announce that we will build a new polyclinic and, in answer to Mr Liang Eng Hwa, this new polyclinic will be in Bukit Panjang. This will serve residents staying in the region. This will also relieve pressure on nearby polyclinics, such as Choa Chu Kang Polyclinic. We will also be redeveloping Yishun and Marine Parade polyclinics to better serve residents there.

(C) DOING THINGS DIFFERENTLY

12.           Madam Chair, even as we build more facilities, we also need to continue to find new ways to give better care to our patients.

13.           Our healthcare Clusters have been working with community partners to provide more holistic care for our patients in the community setting. For example, the Eastern Health Alliance (EHA) and its community partners have been deploying professionals together with neighbourhood volunteers to reach out to at-risk residents, through their Neighbours for Active Living programme.

14.           Take Mr Sim, for instance. He is an 82-year-old resident living in Tampines, suffering from multiple chronic conditions. He has difficulties walking after a fall and is currently being cared for by his 75-year-old wife, Mdm Liew. The EHA team checks on Mr Sim to make sure he takes his medication, and applies for the various medical and transport subsidies for the couple. They also bought a walking frame and guided Mr Sim on how to use it. Today, the team regularly calls and visits the elderly couple to make sure that they are well.

(D)     IMPROVING AFFORDABILITY

15.           Let me now move on to healthcare financing. The Ministry of Health has made three major policy shifts to give patients and their families greater peace of mind about healthcare costs. First, the Government would shoulder a higher share of national healthcare spending. Second, we expanded the use of Medisave and helped Singaporeans to save more in their Medisave accounts. Third, we will increase the role of risk-pooling through MediShield Life.

Providing Support through Subsidies

16.           We have significantly enhanced subsidies, especially for the lower- and middle-income families in the subsidised SOCs and for outpatient drugs. To date, about 360,000 patients have benefited from the higher subsidies. Pioneers also receive additional subsidies. Since September last year, about 340,000 or about three-quarters of all Pioneers have enjoyed the benefits.

17.           One such patient is 70-year-old Mdm Lee Soon Meng. She visits the National Neuroscience Institute four times a year. She used to pay a subsidised rate of $50 for tests and consultation a visit. In September last year, her bill was reduced to $30 due to the enhanced subsidy, then further halved to $15 as she is a Pioneer. For medication, she can expect to pay only $20 a visit this year instead of the usual $80, after taking into account both the enhanced subsidies and her Pioneer benefits.

18.           For those requiring longer term care, we have progressively extended subsidies to drugs prescribed by Intermediate and Long Term Care (ILTC) providers since 1 January this year. Mrs Lina Chiam asked about pensioners’ eligibility for pensions coverage in approved community hospitals. Pensioners are eligible to claim for their stay if they stay in Ang Mo Kio-Thye Hua Kuan Community Hospital. Mrs Chiam also suggested that we extend Medisave limits for pensioners in community hospitals. The current withdrawal limit is generally sufficient as it covers eight out of 10 bills. With MediShield Life which covers community hospital stays, almost all patients would see their community hospital bills fully covered by MediShield Life and Medisave. Those who still need help can appeal and we will exercise some flexibility on a case-by-case basis.

Increasing Medisave Flexibility

19.           Assoc Prof Fatimah Lateef and Dr Chia Shi-Lu have asked about further flexibility for outpatient Medisave usage. We have made steady progress on this second front. Recent Medisave changes include extending Medisave use to outpatient scans. From 1 April this year, under the new outpatient Flexi-Medisave scheme, the elderly aged 65 and above can use another $200 per year from Medisave to pay for outpatient medical treatment at SOCs, polyclinics and participating Community Health Assist Scheme (CHAS) clinics.

20.           We just expanded the list of chronic diseases covered under Medisave and CHAS last year. I am glad to announce that four more chronic conditions – epilepsy, osteoporosis, psoriasis and rheumatoid arthritis – will be covered under CHAS and Medisave use from 1 June this year. This brings the total number of chronic conditions covered to 19, which covers the most common chronic conditions.

21.           Mrs Chiam has proposed for the Chronic Disease Management Programme (CDMP) to cover eczema. CDMP conditions are selected based on professional inputs, taking into consideration various factors, such as disease prevalence and the effectiveness of early intervention to reduce complications. There is currently no plan to include eczema in the CDMP but we will take note of Mrs Chiam’s request. We regularly review this programme from time to time. But, meanwhile, Singaporeans can enjoy subsidised treatment for eczema at the polyclinics, SOCs and CHAS GP clinics, a point that Mrs Chiam asked. Those with difficulties can also approach the Medical Social Workers at our public healthcare institutions for assistance.

Improving the Medisave Scheme

22.           We will continue to review Medisave use, but this has to be balanced against the need to ensure that our Medisave savings are adequate for our retirement healthcare expenses. In January this year, we increased the Medisave contribution rate from employers to help Singaporeans save more. I hear Dr Chia’s call to fine-tune and simplify our Medisave rules, and so we will do that.

23.           Today, let me just explain. There are two limits on the Medisave account. One is the Medisave Minimum Sum (MMS). This is the minimum amount you need to have in your Medisave before you can withdraw your other CPF monies from age 55. The other is the Medisave Contribution Ceiling (MCC). This is the upper limit on your Medisave savings. Any additional Medisave contributions beyond this amount will flow to your Retirement or Special Accounts. Dr Chia has asked if we can consider adjustment to these limits and we will do so.

24.           To simplify the rules, we will remove the Medisave Minimum Sum (MMS). This means that you will no longer be required to use your CPF monies to first top up your Medisave account to the MMS when you apply to withdraw your CPF monies from the other accounts at the age of 55. You only need to follow the withdrawal rules as explained by the Minister for Manpower earlier.

25.           Second, from January 2016, the Medisave Contribution Ceiling (MCC) will be renamed as the Basic Healthcare Sum. This is line with CPF terminology and reflects more accurately that the sum is estimated based on what is needed for basic subsidised healthcare needs in our old age. So, MMS will be removed; MCC will be renamed Basic Healthcare Sum.

26.           Any additional Medisave contributions beyond the Basic Healthcare Sum will continue to be channelled to your Retirement and Special Accounts, and, eventually, will help to increase your CPF LIFE payouts.

27.           The new Basic Healthcare Sum will be set at $49,800 on 1 January 2016. This is a 2.7% increase over the current MCC of $48,500 set last year. Beyond 2016, we will need to adjust the Basic Healthcare Sum annually to keep pace with the growth in Medisave use by the elderly. This is necessary given rising life expectancy and healthcare expenditure, and given the expanding use of Medisave.

28.           Currently, the annual MMS adjustments are applied to all cohorts, including older Singaporeans who are well into retirement. From 2016, we will fix the Basic Healthcare Sum for each cohort when they turn 65 years, with no subsequent changes in their lifetime, so that members can have more certainty on the amount of Medisave that they should keep for their retirement healthcare needs. This cohort-based approach for the Basic Healthcare Sum is also similar to the approach that has been taken for Retirement Sum. We hope that this will make it easier for members to understand and to plan their retirement.

MediShield Life

29.           Mr Ang Wei Neng asked for an update on the implementation details of MediShield Life. I thank Members for their unanimous support of the MediShield Life Scheme Bill which was passed in Parliament in January.

30.           There is much for MOH and CPF Board to do before MediShield Life coverage kicks in at the end of 2015. Singaporeans need not apply to join MediShield Life. You will automatically be included. You will be notified of the new premiums and the subsidies you will receive as and when your existing MediShield policy is due for renewal during the one-year period starting end of 2015, when MediShield Life coverage starts. Let me just clarify: the coverage for MediShield Life will start by the end of this year for all Singaporeans, but premium payments will only be due when your existing policy is due over the course of next year.

31.           I want to assure Singaporeans once again that MediShield Life premiums will be affordable. Singaporeans will be able to pay for the premiums using their Medisave. The Government will also help through various forms of subsidies.

32.           The Pioneer Package and the Transitional Subsidies will be given independent of income and wealth. For Premium Subsidies targeted at the lower and middle-income, there is also no need for individuals to apply. Government will use information available in our records to identify those who are eligible and the amount that you are eligible for. But you can help by doing a simple check to ensure that your household information is up-to-date and accurate. In a few months’ time, Ministry of Health will be sending out a letter with more details on what Singaporeans need to do. We will guide you along step by step so there is no need to worry.

Integrated Shield Plans (IPs)

33.           Mr Ang and Dr Chia also asked about the progress of the development of the Standard Integrated Shield Plan, or Standard IP.

34.           Let me first talk about Integrated Shield Plans or IPs. IPs comprise two parts. The first part is a basic MediShield portion run by the CPF Board. This portion is the same for those without IPs and for those with IPs. They are the same. When MediShield Life is implemented at the end of this year, it will automatically replace the MediShield component.

35.           The second portion is the additional private insurance coverage run by private insurers, typically to cover Classes A and B1 in public hospitals, or private hospitals. In other words, all IP policyholders are already covered by MediShield today and they will be covered by MediShield Life in time to come. Similarly, IP premiums also include MediShield premiums. There is therefore no double coverage, and no double premium.

36.           Many Singaporeans also shared that it was difficult to compare IPs, and wanted a standardised option with enhanced coverage beyond Class B2 and C. Ministry of Health has been working with the Integrated Plan insurers to develop a Standard IP, based on coverage at Class B1 wards. Benefits will be aligned across all insurers, so that the plan can be easily understood. Those looking for enhanced coverage that is more affordable than Class A or private hospital plans can consider this plan, Standard IP. We aim to introduce the new Standard IP in the first half of 2016, soon after the rollout of the MediShield Life this year. This will give time for Singaporeans to focus on MediShield Life, and better understand and adjust to the changes resulting from MediShield Life before the changes to the IPs are made.

37.           To help policy holders to make informed decisions about buying IPs, MOH is working with Monetary Authority of Singapore (MAS) to ensure that insurers present their products more transparently and more accurately. This will also address Dr Chia’s concern on IPs.

38.           Most Singaporeans use Medisave to pay for MediShield and IPs. Since every IP policy comprises two parts, it is also timely to consider restructuring the Medisave Withdrawal Limits, or MWLs, for health insurance premiums also into two components. Today, the Medisave Withdrawal Limits, or MWLs apply to the total IP premium, combining premiums for MediShield and the additional private insurance coverage.

39.           Singaporeans are not aware of how much Medisave is being used for MediShield and how much is directed towards the additional private insurance component. With MediShield Life, we will give Singaporeans more certainty, by ensuring that Medisave will always be allowed to cover the net MediShield Life premiums including additional premiums if any, and after subsidies. There is therefore really no need to set a withdrawal limit for this component that applies to the MediShield Life premium. But beyond this, there will be an Additional Withdrawal Limit, or AWL, that will apply to the premium for additional private insurance coverage only.

40.           Today, the withdrawal limit applies to the entire premium of the IP, which comprises two components – the MediShield and the additional private insurance coverage. Going forward, we will restructure this withdrawal limit. Medisave will cover the entire premium that is applicable for MediShield Life for everyone. Therefore there is no need to set a limit for the withdrawal to pay for MediShield Life premiums. But we do need to set a limit for the private insurance coverage component, and that limit will be called the Additional Withdrawal Limit. The details of that limit, will be shared with Singaporeans later.

41.           In setting the new Additional Withdrawal Limits, we will have to balance between helping Singaporeans pay for their IP premiums using Medisave, and ensuring that they have enough Medisave for their other healthcare needs.

42.           Mr Heng Chee How suggested that the introduction of MediShield Life might offer a fresh chance to revisit the concept of portable medical benefits to better protect our workers. I shared last year that a tripartite work group has been formed to look into this. Tripartite partners will be engaging employers to discuss how adoption of portable medical benefits can be further encouraged and I will be very happy to support the work group, if necessary, to ensure that we make progress on this portable medical benefit front.

Making Better Healthcare Decisions

43.           We also need to help patients navigate their healthcare journey and make more informed decisions. Since 1 September last year, we have expanded our regular hospital bill publications to include “Total Operation Fees” for the public sector.

44.           Mr Pritam Singh asked if the Ministry of Health can look into publishing drug prices. In the public hospitals, charges and subsidies that patients receive for their drugs are reflected in the patient’s pharmacy bills in an itemised manner. Treatment and drugs used for different patients will vary, even for the same condition, and drugs constitute only one aspect of the overall treatment. This is further complicated by the subsidies for different groups. Private GPs also adopt different pricing structures for drugs and consultation. Hence, it is more useful to reflect the total bill, as a comparison to help patients make decisions.

(E)    Successful Ageing

45.           Let me now come to the issue of ageing as raised by Dr Chia and Ms Ellen Lee. As noted by Ms Lee, our future seniors will have different aspirations from the current generation. Last year, the Ministerial Committee on Ageing (MCA) announced plans to develop an Action Plan for Successful Ageing.

46.           Since then, we have gone on to engage more than 1,300 Singaporeans through many focus group discussions. Many participants shared with us what successful ageing meant to them, at the individual, community, and at the city-level. At the individual level, many seniors told us that they aspire to have opportunities for learning and employment so as to remain active. Seniors are also keen to volunteer their time and expertise and in doing so, find new meaning and fulfilment in their lives.

47.           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. At the city-level, seniors also provided useful feedback on how our built environment can be enhanced to make it easier and safer for seniors to move around and stay active, creating a city for all ages.

48.           Respective Ministries will study these ideas and develop specific programmes under the Action Plan. For instance, we are working with Ministry of Education to study how to further expand the scope and scale of learning opportunities for seniors to enrich and empower them.

49.           We are also working with MCCY to make volunteering more accessible, attractive and meaningful for our seniors. Ministry of Manpower and Ministry of Transport have also taken into account the feedback from focus groups and are exploring ways to enhance the employability of older workers, and make our public transportation network more senior-friendly.

50.           Over the next few months, we will be studying and seeking inputs, such as how to promote senior learning and volunteerism, how to support seniors living in our heartlands with assisted living services, and how to promote research and innovation to transform the lives of seniors in the future. These initiatives will help equip our current seniors as well as prepare our future generations of seniors for meaningful ageing. More details will be announced when the Action Plan is ready later this year.

Celebrating our Seniors

51.           Madam, we are celebrating SG50 this year. Singapore has made good progress over the last 50 years as a young nation. To recognise the contributions of our seniors and to celebrate SG50 with them, we will be introducing the SG50 Seniors' package. Over the past year, MOH and the Singapore Business Federation have partnered more than 100 organisations to develop special benefits to our seniors. These benefits will be available to seniors for a time-limited period in 2015, to recognise their contribution to Singapore and to celebrate SG50 with them. Some of the benefits in the SG50 Seniors package include: i) dining discounts at more than 50 F&B establishments island-wide;  ii) discounted or free entry to places of attraction as well as discounts off hotels and travel packages; and iii) complimentary courses offered by Council for Third Age’s senior learning providers.

52.           This is one way of bringing the whole society together to celebrate SG50 with our seniors and to honour them with special privileges and benefits.

(F)     Beyond Healthcare 2020

53.           Dr Chia asked about the progress on our plans to meet the long-term needs for healthcare services. What is next after Healthcare 2020? Even as we continue to work hard on implementing Healthcare 2020, the journey to transform our healthcare system is a continuous one. We have started work to look beyond 2020, to prepare for Singapore’s long term healthcare needs.

Sustainability

54.           As Assoc Prof Fatimah has pointed out, the Government and all stakeholders have important parts to play in ensuring the long term sustainability of our healthcare system. At an individual level, enhancing Government subsidies, MediShield Life, Medisave and Medifund will help to ensure healthcare remains affordable to individual patients. But such measures are insufficient on their own – we must also ensure that overall healthcare bill grows at an affordable pace, so that we – as individual patients and as a society – can continue to afford it. We need to ensure that we make the best use of all our available healthcare resources.

Encouraging Appropriate Care

55.           Longer-term sustainability also requires that our healthcare providers play their part in delivering cost-effective services. Patients rely on healthcare providers to advise and act in their best interests, and provide treatments that are appropriate and necessary.

56.           My Ministry will be placing more emphasis on developing capabilities in assessing new health technologies, including devices and drugs, to ensure that they are both clinically-effective and cost-effective. This will ensure that patients get the most bang for their buck for the treatment and medications that they receive.

Integrated Care

57.           Our long-term healthcare strategy will involve further and deeper transformative changes to both the way care is organised, as well as the way it is delivered. We have been taking steps towards this by developing community care and setting up Regional Health Systems. We will go further in the next phase to integrate our healthcare system.

58.           In particular, we will also study how to bring together the public, people and private sectors, and explore more ways to strengthen partnerships among various stakeholders to optimise the use of scarce healthcare manpower and infrastructure. Over time, the aim is for one integrated national healthcare system where everyone works together as a team to serve the needs of all Singaporeans.

Smart Nation, Smart Healthcare

59.           Mr Alex Yam and Dr Chia asked about our efforts in IT productivity. IT plays an important role in healthcare delivery and we will be launching a new Community Hospital Common System (CHCS) to all community hospitals by end of this year to link up their IT systems with partnering public healthcare institutions. This will help healthcare professionals across acute and community hospitals share information on their patients and improve the patient’s care experience.

(G)     Conclusion

60.           Madam Chair, under Healthcare 2020, we have made progress towards making our healthcare system a better one. We will press on with our plans, but we must also look ahead into the future. We have started our planning processes to prepare for the future. We must continue on this journey to innovate and transform our healthcare system to ensure that it is a quality, affordable and sustainable one to keep Singaporeans healthy beyond 2020.