Singapore

Increasing adoption of telehealth (COS – MOH)

Given the cost savings, improved outcomes and improved patient satisfaction that telehealth has the potential to bring, the Ministry should look into ways to increase its adoption in Singapore.

Parliament, 12 March 2014

Madam,

Telehealth is a mode of healthcare delivery that uses technology to enable the remote diagnosis, consultation, treatment, education and care management of patients. It includes the use of home monitoring of chronic diseases, remote consultations between patients and providers, and videoconferencing between doctors in different hospitals.

Telehealth has the potential to reduce healthcare costs, increase the level of convenience for patients, and improve patient outcomes.

One key barrier to a greater adoption of telehealth is the absence of an agreed-upon reimbursement model. If doctors cannot get paid for telehealth consultations, they are more likely ask patients to come to the clinic for a face-to-face consultation. Similarly, if patients cannot use their Medisave or receive subsidies to pay for telehealth consultations, they would be more likely to choose to make the trip down to the clinic.

Given the cost savings, improved outcomes and improved patient satisfaction that telehealth has the potential to bring, the Ministry should look into ways to increase its adoption in Singapore.

These include providing the infrastructure and support to healthcare providers and patients in acquiring telehealth technologies, reforming reimbursement models for telehealth, and revising any legislation that unduly inhibits telehealth adoption.

Use of Medisave (COS – MOH)

The restrictions on Medisave withdrawals sometimes result in patients facing financial difficulties even though they still have balances in their Medisave accounts.

Parliament, 12 March 2014

Madam,

The restrictions on Medisave withdrawals sometimes result in patients facing financial difficulties even though they still have balances in their Medisave accounts.

Medisave should be allowed for all medically necessary treatment that is of proven value and is cost effective. MOH should greatly expand the list of approved outpatient treatments under the Chronic Disease Management Programme (CDMP). While 15 chronic diseases are now in the list, there are many others which are not, but which require long-term medication and frequent consultations, which can be very costly.

The expanded Medisave withdrawal list should be updated regularly by an independent panel consisting of doctors and healthcare researchers.

In addition, patients above age 75 should be allowed to use their Medisave without being subject to annual limits. This will ensure that they are not deterred from seeking treatment because of high cash payments.

Fare increases and quality of service (COS – MOT)

The PTC chairman acknowledged that service reliability needs to improve, but said that this issue should be kept separate from fare raises, which are to cover rising costs for operators. This is quite baffling for most commuters, myself included. In most service industries, customers will demand good service before they even agree to pay. But for public transport in Singapore, we seem to be expected to pay more just to get satisfactory service.

Parliament, 11 March 2014

Madam,

In January, when the Public Transport Council (PTC) approved hikes in bus and MRT fares, many commuters asked why fares were being raised when they had yet to see satisfactory improvement in service reliability.

The PTC chairman acknowledged that service reliability needs to improve, but said that this issue should be kept separate from fare raises, which are to cover rising costs for operators.

This is quite baffling for most commuters, myself included. In most service industries, customers will demand good service before they even agree to pay. But for public transport in Singapore, we seem to be expected to pay more just to get satisfactory service.

Can the Ministry consider revising the fare review formula to incorporate service reliability as one of its components? This will create is a direct link between service quality and fare adjustments, and will better align the incentives for transport operators with the interests of commuters.

HDB flats approaching end of lease (MND – COS)

If the Government does not have any specific plans for flats when their leases expire, I think it should make this clear to the public, so that buyers can factor this in when choosing a resale flat, and they don’t pay too high a premium for older flats.

This speech today was a follow up to a Parliamentary Question I asked in January, regarding the value of HDB flats at the end of their 99-year lease. I will post the Minister’s reply next week once it is out on the Hansard.

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Madam,

Government leaders have, over the years, frequently told Singaporeans that their HDB flats are an asset which they can monetise during retirement. However, less frequent are the reminders that, as a flat approaches the end of its 99-year lease, its asset value will depreciate to zero.

While most Singaporeans know that their flats are on a limited lease, many assume that HDB will not let their assets become worth nothing, or that their flats will eventually go through an “en bloc” before their leases expire.

The Minister told me in a reply to my PQ in January that the selection of sites and the pace of SERS (the Selective En Bloc Redevelopment Scheme) will depend on factors such as their redevelopment potential, and the availability of replacement sites for rehousing, and other resources.

Can the Minister confirm whether all old flats will eventually be replaced through SERS before they reach their end of lease? If not, what proportion will be not be replaced?

Other than SERS, what are the Government’s plans for HDB flats that approach their end-of-lease? For example, will their leases get topped up, and will the topping up cost be borne by HDB, or the lessees?

There are now over 31,000 flats which are more than 40 years into their lease. I’m sure many young couples are still buying these resale flats, which would mean that the leases may end within their lifetimes.

Trans-Pacific Partnership FTA (COS/MTI)

As a major trading nation, it is important for Singapore to be part of the TPP. However, I hope the Minister can assure us that the strategic and macroeconomic benefits of the TPP to businesses will not come at the expense of ordinary Singaporeans.

6 March 2014, Parliament

The Trans-Pacific Partnership (TPP) is an ambitious free trade agreement (FTA) involving 12 Asia-Pacific countries, including the US and Japan. Its scope goes beyond removing tariffs, to tackling broader environmental, labour and intellectual property (IP) rights issues.

The IP rights chapter in the TPP has raised much concern among the negotiating countries. The US’ proposals reportedly seek a much more stringent level of IP protection than WTO (World Trade Organisation) standards, or even the US-Singapore FTA. They are said to strongly favour American industries and big corporations.

There are worries that the TPP may extend the scope of pharmaceutical patents and delay the sale of generic drugs. These could raise prices of pharmaceuticals in TPP member countries, including Singapore.

Can I ask the Minister:

1. Will the TPP directly or indirectly cause an increase in the price of medical drugs in Singapore?

2. Will our patients have to wait longer to obtain affordable, life-saving generic medicines?

3. And what are the concrete steps our negotiators are taking to protect our national interests in this area?

Use of NSmen resources (COS/MINDEF)

For most NSmen, annual in-camp training (ICT) involves long hours away from work and family. There is often a lot of waiting time in between the action, hence the adage, “hurry up and wait!”

Speech in Parliament during the Committee of Supply debate for the Ministry of Defence on 5 March 2014.

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For most NSmen, annual in-camp training (ICT) involves long hours away from work and family. There is often a lot of waiting time in between the action, hence the adage, “hurry up and wait!”

Commanders, however, are much busier throughout the ICT because they are often engaged in planning while the men wait. Yet for the sake of equity, units usually issue call-ups to all involved NSmen for the full duration of the exercise. This incurs a huge cost in terms of the NSmen’s time and Make-up Pay – which is based on the NSmen’s civilian salary.

To better utilise NSmen resources, could non-commanders be recalled for a shorter ICT duration or fewer ICTs? To address the inequality, key appointment holders and commanders could be rewarded with extra pay or benefits to compensate them for the additional sacrifices they make for our nation.

Prudence in defence spending (COS/MINDEF)

In deciding on its expenditure and choosing cutting edge defence technology, does MINDEF consider that if we leap too far ahead, there is a risk of spurring an arms race, as countries in our region may feel under pressure to keep up with us? This could lead to even greater spending in the future, which may be unsustainable.

Speech in Parliament during the Committee of Supply debate for the Ministry of Defence on 5 March 2014.

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Each year, MINDEF takes up the largest share of the budget among all ministries. This year, the defence budget is $12.6 billion dollars — more than a fifth of total expenditure.

Singapore has the highest defence spending in South East Asia by far. According to the latest data from the Stockholm International Peace Institute (SIPRI), we spend 42% more than the next highest spender in the region, and 80% more than the third highest spender.

I fully appreciate the need for us to maintain a strong and credible defence force, and to remain ahead of potential adversaries.

However, in deciding on its expenditure and choosing cutting edge defence technology, does MINDEF consider that if we leap too far ahead, there is a risk of spurring an arms race, as countries in our region may feel under pressure to keep up with us? This could lead to even greater spending in the future, which may be unsustainable.

International development (COS/MFA)

Speech in Parliament during the Committee of Supply debate for the Ministry of Foreign Affairs.

International development is a form of foreign aid that seeks to improve the lives of people in developing countries, while at the same time furthering a country’s foreign policy goals.

It has not traditionally played a very visible role in our foreign relations strategies, apart from technical assistance programmes that we provide to developing countries. This is unlike most other developed countries that have dedicated international development agencies and sometimes even a cabinet minister in charge.

In 2013, Singapore contributed $26.7 million in overseas development assistance (or ODA), which includes technical assistance programmes, and scholarships and tuition grants to foreign students. Can the Minister share what other forms of ODA Singapore contributes that are not captured in this amount?

Many developed countries in the United Nations have committed to target an ODA contribution of 0.7% of gross national income (GNI). What is Singapore’s ODA as a percentage of GNI?

While I don’t expect Singapore to target 0.7%, are there plans to increase our ODA contribution in the future?

Does the Government see international development as a cost-effective way of furthering our foreign policy goals?

Given the multifaceted nature of international relations today, what is the role the Government sees international development playing in the years ahead?

Budget 2014 Speech

It is important to emphasise that the Pioneer Generation Package is not a “senior citizen’s package” even though all of our pioneers are now elderly. It should not be viewed as the fulfilment of the Government’s obligations to the elderly. There is still much that needs to be done for the elderly and future elderly in Singapore, especially people with disabilities, homemakers and low income workers who will have insufficient savings when they reach retirement age.

3 March 2014

Madam Speaker,

The Workers’ Party supports the Government’s initiatives to honour the pioneer generation of Singaporeans.

In August 2011, we released a National Day statement entitled, “Honouring our First Generation”. In our statement, we said:

“(T)he Workers’ Party wishes to pay a special tribute to the first generation of Singaporeans who struggled to build our nation during the early decades of independence. They are now our parents and grandparents, uncles and aunts; the elderly cleaners; the retired civil servants and teachers; the first National Servicemen.”

“This generation embodies the true Singapore spirit—the determination to work hard, overcome the odds and carve out a better life for their children. They serve as an shining example for many future generations to follow.”

“History may only remember the kings and not the soldiers, but let us never forget the contributions of the first generation of Singaporeans. More than anyone else, they deserve to enjoy the fruits of our nation’s success.”

“The men and women in our Pioneer Generation have borne society’s burdens … They gave the best years of their lives to our nation. Our nation must now give its best in return to them.”

I think this aptly describes our respect for and gratitude to the pioneer generation of Singaporeans.

PIONEER GENERATION PACKAGE

Madam, it is important that we honour our pioneers and do so before it is too late. Last year, over 13,000 people aged 65 and over departed from us, according to the Singapore Demographic Bulletin. Last week, I met a resident who said that his 80-plus year old neighbour was very happy to learn about the Pioneer Generation Package, but sadly he passed away suddenly the next week before enjoying any of the benefits.

The subsidies for specialist outpatient clinics and polyclinic services, as well as disability assistance, will be rolled out in September 2014, and all pioneers who do not already qualify can join the Community Health Assist Scheme (CHAS) only in January 2015. The MediShield Life subsidies will be applied at the end of 2015.

The Government should expedite the roll-out of the Pioneer Generation Package benefits. For example, since CHAS is already in place, can we allow all Pioneer Generation members to immediately benefit? Although MediShield Life will only be rolled out in end-2015, the Government should start applying MediShield premium subsidies for the Pioneer Generation from this year. The elderly above age 65 are already shouldering a heavy premium burden of between $540 and $1,190 per year for just MediShield Basic.

Alternatively, the Government could consider doubling the planned additional Medisave Top-ups for Pioneer Generation members until the Pioneer Generation Package is fully rolled out, so that pioneers can start to enjoy the benefits of this package sooner. This would provide 65-year olds an additional $400 in Medisave Top-ups this year and next year, instead of $200 in each year.

The DPM said that there would be panel to assess appeals from those who marginally missed out on the precise criteria. Could the DPM share what are the guidelines the panel will be given to make their assessments? I hope the panel will err on the side of generosity, as many of those who just missed out have made significant contributions on par with pioneers. In particular, I am of the view that all those who served in the first few batches – and not just the first batch – of National Service (NS) should qualify for this package because they played an important role at a critical juncture in our nationhood.

Madam, I would now like to touch on a few other aspects of Budget 2014.

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GST

First on GST (goods and services tax). For the past six years, GST has been the second-largest contributor to government revenue, after corporate income tax. In FY2013, its contribution of $9.52 billion exceeded that of personal income tax by almost $1.9 billion. In FY2014, GST’s proportion of revenue is expected to increase to 17%, up from 16.7% last year.

It is widely recognised, even by this Government, that GST is a regressive tax, because the poor fork out a higher proportion of their income to pay GST than the rich do. The permanent GST Voucher scheme is meant to correct this regressivity.

However, GST Vouchers fully offset the GST expenses for only retiree-led households and the very low income. For other lower-income households, on average the GST Vouchers offset only about half of the GST they pay each year. Therefore, many lower income earners are still net contributors to GST.

I note that Budget 2014 provides an additional, one-off GST Voucher in the form of cash for seniors and a U-Save Special Payment. However, these are only for this year, and they still do not fully offset the GST expenses for all lower income households.

Can the GST Voucher scheme be enhanced so that it fully offsets the GST expenses of all lower income households, and offsets a greater proportion of GST expenses for middle income households?

This will better ensure that the GST Voucher scheme fully corrects the regressive nature of GST and makes it more progressive.

PRODUCTIVITY-ENHANCEMENT SCHEMES

Next, on productivity enhancement schemes and their outcomes. Before I continue, I wish to declare that I work in the IT industry and in the SME sector.

I agree with the Government’s intent to raise productivity in our companies, increase technology adoption and reduce reliance on manpower.

In his 2010 budget statement, the Finance Minister said that the “key goal” of the Government was to grow productivity by 2 to 3% per year, or 30% cumulatively, over the next 10 years to 2020. He said this will allow Singapore to maintain an economic growth rate of 3-5% a year, even with slower growth in our work force. The DPM reiterated in this year’s budget statement that raising productivity is “at the centre” of the Government’s economic agenda.

How have we progressed so far in achieving this key national goal? In 2011, labour productivity growth was 2% over the year before. In 2012, it dropped by 2%. Last year, it was flat – there was no overall growth from the year before.

The DPM acknowledged that while productivity has increased by 11% since economic restructuring began four years ago, this was entirely due to the strong cyclical recovery in 2010, with little improvement since. At this rate, is the Government going to be able to meet the targeted 30% cumulative productivity growth by 2020?

In the last four years, hundreds of millions of taxpayer dollars have been transferred to businesses through various grants and tax credits for productivity-enhancing schemes. The schemes introduced in this year’s Budget are mostly enhancements or extensions of existing schemes. Given the disappointing overall productivity growth for the past 3 years, I think we need to examine these schemes to see what adjustments need to be made to produce more positive outcomes.

ICT FOR PRODUCTIVITY AND GROWTH

Budget 2014 will include a major effort to scale up the use of ICT (infocomm technologies) by SMEs. The DPM said the Government will give a stronger push to the piloting and scaling-up of ICT solutions that can help to transform whole sectors, through the ICT for Productivity and Growth (IPG) programme.

Under one of the initiatives in the IPG programme, the IDA (Infocomm Development Authority) will pre-qualify eligible vendors and their solutions. SMEs need not apply to IDA for the subsidy; they can approach the pre-qualified vendors, and IDA will reimburse the vendors directly. These apply only to sectoral solutions currently supported under IDA’s iSPRINT programme.

How will the Government ensure that IDA uses a fair and objective method, and that its officers have sufficient industry experience and competencies to select the right vendors and solutions? This is critical because SMEs will be limited to these vendors and solutions – for better or for worse – if they want to tap on the IPG fund. In this respect, wouldn’t it be more appropriate to allow SMEs to choose the best vendor and solution that meets their unique business needs, rather than restrict them to a pre-qualified list from the government?

Under the current iSprint scheme, SMEs need to wait for several months for grant approval from IDA, and I am told that IDA asks SMEs many questions before approving the grant. I presume this is to ensure that SMEs and vendors do not abuse the grants. There is also a lengthy business proposal that must be submitted to justify the funding. After evaluation, IDA may decide that the “qualifying costs” for the grant will be lower than the actual implementation cost of the system, hence lowering the overall grant disbursed.

As a result, many SMEs may find that it is not worth the time and effort to apply for such funding, and this will result in a lower adoption of productivity-enhancing technology in SMEs. Only 500 SMEs have benefited from funding for sector-specific proven solutions so far under the iSprint scheme, out of over 154,000 SMEs in Singapore. This stands in great contrast to the Productivity and Innovation Credit (PIC) scheme, which does not require such a lengthy and onerous application process to obtain funding. Is it no wonder that the PIC has proven to be much more popular with SMEs? Over 80,400s SMEs tapped on the PIC scheme in the last two years.

I hope agencies can adopt a more streamlined approach when evaluating and approving technology grants for productivity enhancement. This will be a key success factor for IDA if it is to reach its target of another 10,000 SMEs over the next three years.

If the concern is that some SMEs and IT vendors will abuse the grants, then audits could be conducted after project implementation and penalties could be put in place to deter such behaviour, rather than to weigh down all SMEs because of the actions of a few black sheep.

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Madam Speaker, I have more to say on other aspects of Budget 2014, including defence expenditure, the prudent use of NSmen resources, MediShield Life, healthcare financing, and helping more Singaporeans to enter work force. I will elaborate further on these during the COS (Committee of Supply) debate later this week and next week.

Value of HDB flats at end of 99-year lease

All HDB flats are sold to Singaporeans on a 99-year lease. We are technically not home owners, but lessees. I asked the Minister for National Development, during the 20 January 2014 Parliament sitting, what the value of HDB flats would be once their leases expire. I also asked whether the pace of SERS — the Selective En Bloc Redevelopment Scheme — will be fast enough to replace the flats reaching the end of their lease.

All HDB flats are sold to Singaporeans on a 99-year lease. We are technically not home owners, but lessees.

I asked the Minister for National Development, during the 20 January 2014 Parliament sitting, what the value of HDB flats would be once their leases expire. I also asked whether the pace of SERS — the Selective En Bloc Redevelopment Scheme — will be fast enough to replace the flats reaching the end of their lease.

The Minister confirmed that the value of the flats will be zero at the end of their 99-year lease. He also indicated that the selection of sites and pace of SERS depended on factors including the site’s redevelopment potential. Implicit in what he said was that SERS is not a scheme intended solely to replace old flats reaching the end of their lease.

He revealed that there are about 31,000 flats which are more than 40 years into their 99-year leases. This number will grow larger each year. It remains to be seen what the Government’s plans are for lessees whose flats approach the end of their lease.

The full transcript of the question and answer are below.

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Mr Gerald Giam Yean Song asked the Minister for National Development (a) how many HDB blocks are more than 40 years into their 99-year lease; (b) what will be the value of an HDB flat once it reaches the end of its 99-year lease; (c) what is the average number of flats undergoing redevelopment under the Selective En Bloc Redevelopment Scheme (SERS) each year for the past 10 years; and (d) whether the pace of SERS is fast enough to redevelop all HDB blocks before they reach the end of their lease.

Mr Khaw Boon Wan (The Minister for National Development): The Selective En bloc Redevelopment Scheme (SERS) is part of the Government’s estate renewal strategy for older estates. It allows intensification of land use and revitalises such estates through new developments. At the same time, it offers an opportunity for flat owners to buy a new replacement flat with a fresh 99 year lease.

In the last 10 years, SERS has benefitted the owners of about 18,000 flats. As the name suggests, the identification of suitable precincts for SERS is selective. The selection of sites and pace of SERS will depend on factors such as their redevelopment potential, and the availability of replacement sites for rehousing and other resources.

Currently, there are about 300 HDB blocks with 31,000 flats which are more than 40 years into their 99-year flat leases.

Like all leasehold properties, HDB flats will revert to HDB, the landowner, upon expiry of their leases. HDB will in turn surrender the land to the State.

[Source: Singapore Parliament Reports]