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MediShield Life

I would like reiterate my call for premium subsidies to be extended to all vulnerable groups of Singaporeans, including elderly persons with low savings and not only members of the Pioneer Generation; people with disabilities; those who have exhausted their Medisave; and those who already qualify for government financial assistance schemes like Medifund, Public Assistance, ComCare and CHAS (Community Health Assist Scheme).

Parliament, 12 March 2014

Madam,

I would like to make a few proposals regarding MediShield Life before it is introduced next year.

First, I would like reiterate my call for premium subsidies to be extended to all vulnerable groups of Singaporeans, including elderly persons with low savings and not only members of the Pioneer Generation; people with disabilities; those who have exhausted their Medisave; and those who already qualify for government financial assistance schemes like Medifund, Public Assistance, ComCare and CHAS (Community Health Assist Scheme).

Second, can the $70,000 annual claim limit be removed for MediShield Life? For the affected policyholders, it would be financially crippling if their insurance cover were removed when they reach the claim limit, since they would already have spent a lot of their savings on the co-payments. Fewer than 0.1% of policyholders reach the policy year limits each year. Continuing to cover them should not result in significantly higher claims or premium burdens, but would provide tremendous peace of mind for them.

Third, MOH should ensure that MediShield Life does not follow the practice of some private insurers, which sometimes reduce coverage after policyholders are diagnosed with the an illness, to prevent them from claiming again if they suffer a relapse. This should also apply to the Integrated Shield Plans that ride on MediShield Life.

Fourth, can we have better coordination of MediShield Life with private and company health insurance to ensure that they do not overlap? This will avoid unnecessary premium payments, which benefit no one but the insurers.

Properly incentivising providers (COS – MOH)

Can MOH explore alternatives to the current fee-for-service payment approach? Fee-for-service payment tends to give providers a perverse incentive to boost revenue by increasing patient throughput, rather than keeping patients healthy and out of hospital.

Parliament, 12 March 2014

Madam,

Traditionally, we contain healthcare costs by curbing patients’ demand for healthcare. We do this by making patients co-pay, so that they think twice before seeing the doctor or requesting for more diagnostic tests.

However, most times it is the doctors who decide on the course of treatment for the patients. Therefore healthcare providers, not patients, drive the bulk of healthcare spending. If we want to control costs, we need more focus on the providers.

Instead, MOH should better incentivise providers to contain the overall growth of healthcare costs across the continuum of care – from primary to acute to step down care.

Doctors and healthcare providers should be given greater financial flexibility to redesign care delivery, so that proven and cost effective services can be reimbursed. For example, we could reward providers for efforts to enhance patients’ medication compliance, monitor patients’ weight gain or blood sugar levels in their homes, or perform follow-up consultations using web conferencing.

Second, different providers should be better integrated and made collectively responsible for providing coordinated care for patients. GPs, acute hospital specialists and step down care professionals should be rewarded for cooperating and sharing information to improve quality and control costs, not simply by the volume or class of patients they treat.

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?