Health screening (COS – MOH)

To encourage greater adoption of health screening, I propose that all Singaporeans who reach age 40 be provided with one set of free health screening tests for common chronic conditions and cancers under HPB’s Integrated Screening Programme. This should include the cost of the doctor’s consultation.

Parliament, 12 March 2014

Madam,

Age-appropriate preventive health screenings have been recognised as a cost-effective way to identify health problems before they develop further and end up being more costly to treat.

However, many are reluctant to undergo health screenings because of the inconvenience, cost or fear that it will reveal health problems, whose treatment may be beyond their ability to pay for.

More resources should be invested in promoting regular health screening on a wider scale. High risk groups should be identified and greater efforts should be made to reach out to them.

To encourage greater adoption of health screening, I propose that all Singaporeans who reach age 40 be provided with one set of free health screening tests for common chronic conditions and cancers under HPB’s Integrated Screening Programme. This should include the cost of the doctor’s consultation.

Subsequent health screenings should be provided at subsidised rates, and patients should be allowed to use their Medisave to pay for the remaining cost.

Having more Singaporeans in high risk age groups undergo regular health screenings could reduce overall health expenditure, as diseases are detected earlier, hence requiring less costly interventions.

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.

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.

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.

Adjournment motion: Easing the cost of healthcare for Singaporeans

While we are all at risk of falling ill, unaffordable medical costs are not inevitable. The Government must reform the way that healthcare is financed in Singapore, so as to ease the healthcare burden on all Singaporeans. This will give all our people peace of mind, knowing that they will be able to afford all necessary treatment if they fall ill.

I filed an adjournment motion on healthcare financing in Parliament on 12 November 2013. This was my speech.

———————-

Madam Speaker,

Thank you for the opportunity to speak on this adjournment motion.

Many Singaporeans are worried about falling ill and not being able to afford their medical expenses. A survey conducted last year by Mindshare, a global media and marketing services firm, found that 72% of Singaporeans felt they “cannot afford to get sick due to high medical costs.”[1]

This echoes the sentiments of many Singaporeans I have spoken to, many of whom are elderly or have sick family members to care for. In particular, the high out-of-pocket payments at the point of treatment are a great source of worry for many.

It is not uncommon to hear accounts of older folks ignoring health problems and delaying visits to the doctor because they fear that medical expenses will be a financial burden to themselves and their families.

Medical inflation in Singapore was almost 9% in 2011 – much higher than general inflation.[2] Our people should not have to face these increasing medical costs alone. The structure of our healthcare financing system is a critical factor in determining whether healthcare is truly affordable for all Singaporeans.

In Singapore, less than one-third of all healthcare costs are paid by the Government.[3] More than 60% of costs are paid by patients out-of-pocket, which includes cash and Medisave. This is much higher than the average of 14% in high income countries, according to data from the World Health Organization.[4]

Is it any wonder then, that Singaporeans are feeling the strain of healthcare costs? High out-of-pocket spending can create barriers to healthcare access and use, because people who have difficulties paying medical bills may delay or forgo treatment even though they need it.

It is a fundamental responsibility of the Government to ensure that all our citizens have access to high quality healthcare based on their medical needs, and regardless of their income.

The healthcare burden cannot continue to be borne so heavily by individuals and their families. Singapore’s population is ageing and healthcare costs are expected to continue rising.

The Government must be prepared to shoulder a much larger proportion of healthcare costs than it currently does. We need to shift away from seeing healthcare as primarily an individual responsibility, and emphasise more government intervention, risk sharing and fairness in financing.

We need to change the way healthcare is financed, so that Singaporeans who fall ill can focus on seeking the most appropriate medical treatment, without worrying about whether they will be able to afford it.

*****

I would like to make a few proposals on healthcare financing to reduce the financial burden on Singaporeans when they fall ill, to improve the efficiency of the healthcare system and contain medical inflation.

MediShield premiums

First, on MediShield.

MediShield is an insurance scheme intended to help cover large hospital bills. However, it does not provide full coverage. Patients need to make hefty co-payments[5], in addition to other claim limits like caps on hospital ward charges, and annual and lifetime claim limits.[6] As a result, MediShield claims covered only 2.1% of total healthcare expenditure in 2011.[7]

In August this year, the Government announced plans to provide expanded insurance coverage under a new “MediShield Life” scheme. These changes to cover all Singapore residents, without exclusions for old age or pre-existing conditions, are certainly welcome. They are consistent with what many Singaporeans and the Workers’ Party have been calling for.

However, I remain concerned about the rising premiums. The Government has already warned that premiums will go up.[8] While I accept that increased coverage will come at a cost, there are two questions we must consider: Should all of these cost increases be borne by policyholders? And will some groups of Singaporeans find the premiums unaffordable?

MediShield premiums rise with age. An 86-year old pays a premium rate that is more than 23 times that of a 20-year old.[9] The elderly shoulder a disproportionate premium burden. Policyholders over age 60 contribute about 36% of total premiums, even though they make up just over 12% of policyholders.[10]

Most of the elderly are retired with little or no income. It is unfortunate that many of those who are least able to afford the premiums are paying the most.

Many of our senior citizens have exhausted their Medisave accounts and have difficulty coming up with money to pay their premiums. Every year, an average of 650 elderly policyholders opt out of MediShield coverage completely.[11] This leaves them vulnerable and without insurance protection, putting them at risk of financial catastrophe if they fall ill.

The Government does not directly subsidise MediShield premiums, although it does give ad hoc Medisave top-ups to the elderly and a Medisave grant to newborns.

I would like to propose that the Government introduce a MediShield premium subsidy programme for all vulnerable groups of Singaporeans. These would include elderly persons with no income and limited savings; people with disabilities; patients who have exhausted their Medisave; low income families; and those who already qualify for Medifund, Public Assistance, ComCare and the Community Health Assist Scheme (CHAS).

The appropriate level of premium subsidies should be automatically extended to them, without a need for them to apply separately. This could help many more Singaporeans to cope with the rising premiums, while ensuring that the MediShield Fund remains solvent.

Annual cap on out-of-pocket payments

While MediShield is intended to help cover the costs of large medical bills, policyholders still have to make co-payments in the form of deductibles and up to 20% in co-insurance. Last year, over 2,400 MediShield policyholders made co-payments of over $10,000 each.[12]

These co-payments can be financially crippling on their own. Would MOH explore the introduction of an annual cap on out-of-pocket co-payments made by each patient. Any medical bills above the cap would be borne by the Government.

Such schemes are a feature in most developed countries, including Japan, South Korea and New Zealand.[13] It is also one of the key consumer protections in the Affordable Care Act in the US.

An annual cap on out-of-pocket payments will limit the financial risk that individual patients are exposed to, and help allay the anxiety of many Singaporeans about uncertain medical expenses.

Co-payments

From the Government’s perspective, co-payments are necessary to discourage over-consumption. The Government’s fear is that “free” healthcare will escalate costs, and become fiscally unsustainable.

However, people do not consume healthcare like they do other goods and services. Most people visit doctors rather grudgingly – usually when they fall sick and have obvious symptoms. Demand for healthcare is therefore not unlimited.

A health insurance experiment conducted by the RAND Corporation, involving over 7,000 patients in the US, found that indeed, higher co-payments reduced the consumption of healthcare. However, the experiment also found that co-payments caused patients, especially the poorer ones, to reduce the use of medically necessary care. The experiment found that poor patients with hypertension tended to avoid treatment, leading to significantly higher mortality rates.

High co-payments have also been shown to have an effect on patients adhering to their prescriptions. In another experiment by researchers from Harvard Medical School, nearly 6,000 patients who had just suffered a heart attack were prescribed drugs that reduced the chance of another attack. Half of them had their co-payments for these drugs waived, while the other half paid the usual fee. The result showed that more patients in the zero co-pay group took their medication regularly. They saw their health improve, with lower incidences of stroke and repeat heart attacks than the patients who had to co-pay. Interestingly, the elimination of co-payments did not increase total spending by patients and insurers, and even reduced spending in some areas.[14]

The lesson from these two experiments, is that if co-payments are too high, poorer patients may be deterred from seeking necessary treatment. Similarly, it is difficult enough to get patients to adhere to their prescriptions, and high co-payments could make it even harder. This could have knock on effects like higher rates of hospital re-admissions, which will cost both the patient and the system more in the long run.

Means-testing

The Government’s claim that no one will be denied healthcare because of inability to pay is cold comfort for some Singaporeans who regularly forego medical appointments or cut back on prescribed medication because of the high costs and the difficulty in obtaining financial assistance.

A few weeks ago, I met an elderly resident at his home in Bedok, who suffers from COPD[15], a chronic lung disease. He is unable to work and has no children to support him. When I asked him how he was coping with his medical expenses, he told me that he was using his Medisave but had almost exhausted it. I was disturbed to learn that he often skipped medical appointments and cut back on his medication just to save money. I told him that there was financial assistance available, and that he should not compromise on his health. But he told me that he had given up applying for assistance because of all the documents that he had to submit, and interviews he had to attend, for the purpose of means-testing.

Recently, a colleague sent me a photo of a large banner at the counter of a pharmacy at a government restructured hospital that read: “Please inform our staff if you do not want to take the full supply and/or if you need to know the total cost of your medication”.

These two situations illustrate how many Singaporeans find themselves making hard choices between getting the necessary treatment and saving money, and how the onerous process of means-testing may be deterring some needy patients from obtaining financial assistance, and therefore treatment.

I have spoken in this House before about how all means-testing should be done without the need for patients to physically submit income documents. The patients and their families should only need to give their consent for the provider to assess their income records with the relevant government agencies like CPF Board and IRAS.

This facility should be available at all institutions, whether private or public. The providers of all assistance schemes, including Medifund, hospital endowment funds and other charity schemes, should be able to access these records. This will better ensure that patients receive all the financial assistance that they qualify for.

Better still, can vulnerable groups of patients be pre-qualified so that they don’t even have to submit any applications before receiving financial assistance? Currently this is already being done for the CHAS cardholders receiving outpatient treatment. MOH should consider extending the same for inpatient financial assistance schemes.

*****

Containing healthcare costs

As I call for an expansion of the role of the Government in easing the healthcare burden on Singaporeans, I am also aware of the many challenges that our healthcare system faces in containing ever-increasing costs. We need to look into ways to contain healthcare costs while still improving patient outcomes.

Integrated healthcare

Many of the current measures to contain healthcare costs focus on curbing consumption by patients. However, most patients do not have sufficient knowledge to decide on the type of treatment they need. These decisions are usually entrusted to healthcare providers, which include doctors and hospitals.

Providers therefore drive the bulk of healthcare spending through their decisions to admit patients to hospital, order medical tests, prescribe drugs and charge fees.[16] Therefore, if we seek to control costs, we need to actively engage providers.

To achieve this, all providers – including GPs, hospitals and preventive care providers – must be made collectively responsible for providing a full spectrum of care for patients. These providers should cooperate and share patient information with each other, in order to make more accurate diagnoses and coordinate patient care.

They should focus on keeping patients healthy and ensuring they take their medication regularly. This will minimise hospital re-admissions, investigations and treatment, all of which are much more expensive. Providers should be paid based on their achievement of measured quality improvements, not simply the volume of patients they see or the level of fees their patients pay.

All this could lead to healthier patients and lower costs for both patients and the system.

Health technology

Technology should be used as a “force multiplier” in the face of limited manpower in our healthcare system. While Singapore is no laggard in healthcare technology, its potential is not being fully realised. Often, the problem lies not with the lack of technical expertise, but a lack of adoption.

One example of this is the National Electronic Health Records system (NEHR). The NEHR enables patient health records to be shared across the healthcare system. It can reduce medical errors, and improve productivity and coordination between providers. This will lead to better diagnoses and treatment, and reduced medical costs.

The NEHR has been rolled out to all public hospitals, polyclinics and long-term care providers. However, while over 5,000 clinical users have access to the system[17], what percentage of these users are fully utilising the functionality of the system? Is usage lower than it should be, due to usability issues or some providers still preferring to use handwritten clinical notes? How is MOH ironing out these issues to increase usage of the system?

The usage of NEHR in the primary care sector is lagging even further behind. As at March this year, it had been rolled out to only about 50 out of the 2,000 private GP and dental clinics.[18]

The Government has already invested $172 million to develop Phase 1 of the NEHR, and is paying about $20 million each year in maintenance costs.[19] The subsequent phases are expected to cost more. While the Government deems it important to recover the cost of developing and maintaining the NEHR, the goal of cost-recovery must not impose a roadblock to the full adoption of the system by all healthcare providers in Singapore. It is important to ensure that all providers, including GPs and specialist outpatient clinics, enter the necessary clinical data into the system, so that the full benefits of having electronic health records can be realised.

*****

Madam, healthcare is an issue that is close to the heart of every Singaporean. While we are all at risk of falling ill, unaffordable medical costs are not inevitable. The Government must reform the way that healthcare is financed in Singapore, so as to ease the healthcare burden on all Singaporeans. This will give all our people peace of mind, knowing that they will be able to afford all necessary treatment if they fall ill.


*****

[1] Mindshare “3D” Survey 2012, quoted in Hooi, Joyce, “Singapore’s emigration conundrum”, Business Times, 6 October 2012.

[2] Towers Watson, “2012 Global Medical Trends Survey”.

[3] Singapore Parliament Reports (Hansard), 13 May 2013, “Healthcare spending and funding sources”.

[4] World Health Organization, “World Health Statistics 2013”, p.138 (“Health Expenditure”).

[5] The MediShield deductible is $1,500 for Class C wards and $2,000 for Class B2 and above wards. Co-insurance is between 10% and 20% of bills.

[6] Claim limits include a cap on normal hospital ward charges of $450 per day, a lifetime claim limit of $300,000 and a maximum coverage age of 90 years.

[7] Singapore Parliament Reports (Hansard), 13 May 2013, “Healthcare spending and funding sources”.

[8] AsiaOne, 26 September 2013, “’We have made significant progress’: PM Lee”.

[9] Ministry of Health, MediShield Premiums. A 20-year old pays a premium rate of $50 per year, while an 86-year old pays $1,190 per year.

[10] Singapore Parliament Reports (Hansard), 21 October 2013, “Age Profile of MediShield Policyholders”; and MediShield Premiums (Ministry of Health).

[11] From 2010 to 2012, an average of 650 MediShield policyholders aged 60 and above opted out of MediShield coverage each year. Source: Singapore Parliament Reports (Hansard), 13 May 2013.

[12] Singapore Parliament Reports (Hansard), 21 October 2013, “Payments made by MediShield policyholders for cumulative MediShield Basic co-insurance”.

[13] Paris, Valérie, et. al (2010), “Health Systems Institutional Characteristics: A Survey of 29 OECD Countries”, Table 10 (Exemptions from copayments), p.24.

[14] Niteesh K. Choudhry (2011), “Full Coverage for Preventive Medications after Myocardial Infarction”, New England Journal of Medicine, 1 December 2011. Mentioned in Mullianathan, Sendhil, “When a Co-Pay Gets in the Way of Health”, New York Times, 10 August 2013.

[15] Chronic obstructive pulmonary disease.

[16] Rand Corporation (2013). “Solving the Health Care Cost Challenge: Leveraging RAND Expertise”. Retrieved from: http://www.rand.org/health/feature/health-care-cost.html.

[17] Singapore Parliament Reports (Hansard), 12 March 2013.

[18] Ibid.

[19] Singapore Parliament Reports (Hansard), 13 May 2013.

Health screening

We know that health screening is useful for early detection of chronic diseases and other illnesses like cancer. This can enable early treatment which means a better chance of recovery. The Health Promotion Board has been sending out letters to all Singapore residents aged 40 and older to attend health screening, yet from the Minister’s reply to my parliamentary question on 21 October 2013, it appears that the participation rate is quite low, and even MOH agrees that there is room for improvement. Here is my PQ and the Minister’s answer.

We know that health screening is useful for early detection of chronic diseases and other illnesses like cancer. This can enable early treatment which means a better chance of recovery. The Health Promotion Board has been sending out letters to all Singapore residents aged 40 and older to attend health screening, yet from the Minister’s reply to my parliamentary question on 21 October 2013, it appears that the participation rate is quite low, and even MOH agrees that there is room for improvement. Here is my PQ and the Minister’s answer.

What can we do to increase the participation rate?

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Mr Gerald Giam Yean Song asked the Minister for Health from 2011 to 2013 to-date (a) how many invitations have been sent annually to residents of 40 years old and older to go for health screening under HPB’s Integrated Screening Programme (ISP); (b) how many residents took up those invitations in each of those years; (c) what are the charges for such screenings; (d) what is the rationale for charging such screenings; (e) what are the KPIs the Ministry uses to measure the success of the ISP; and (f) how does the Ministry rate the success of the ISP.

Mr Gan Kim Yong (Minister for Health):

The nationwide Integrated Screening Programme (ISP) offers affordable and convenient screening for high blood pressure, high blood cholesterol and diabetes, as well as breast, cervical and colorectal cancers to Singapore residents for the recommended age-groups. Under the ISP, Singapore residents who reach 40 years of age receive invitation letters to go for the various ISP screening tests at GP clinics. Those who are screened receive rescreen invitations according to the recommended intervals in subsequent years for the various screening tests. To enhance accessibility, the Health Promotion Board (HPB) collaborates with partners such as People’s Association as well as companies, to bring subsidised health screening to residents in the community and workplaces.

The total number of residents aged 40 years and older who received 1st invitation letters and rescreen invitations were 490,000 in 2011 and 200,000 in 2012. In 2011, 36,000 people attended health screening under the ISP and 19,000 people in 2012. The total number of invitations and residents who attended health screening was higher in 2011 because 365,000 invitation letters were sent to women aged 50 and above who were due for their mammogram screening in conjunction with the launch of the Celebrate Wellness (CW) programme, a HPB partnership initiative with WINGS and Toteboard.

Costs for screening services under the ISP have been kept affordable. For example, the cost of the blood tests in the GP clinics to screen for diabetes and high blood cholesterol is $8, the cost of Pap smear to screen for cervical cancer is $15, and the cost of the Faecal Immunochemical Test (FIT) which screens for colorectal cancer is $30. This is in addition to the GP consultation fees. Lower-income Singaporeans receive all these tests for free and only need to pay GP consultation fees. For community based screening, the cost of blood tests to screen for chronic diseases is $2 to $5.

Under the ISP, GPs can refer women for mammography for breast cancer screening at Breast Screen Singapore (BSS) centres at 16 polyclinics, at a subsidised cost of $50 for citizens. Women aged 50 and above can use Medisave to pay for mammograms at all Medisave-approved screening centres, including the BSS centres.

Patients are charged for screening under the ISP as the health of an individual is a shared responsibility. We have also targeted government subsidies at those who need help most. To make screening even more affordable and accessible, the Community Health Assist Scheme (CHAS) has been enhanced to increase the coverage of subsidies for screening tests under the ISP. From 1 January 2014, the recommended tests will be fully subsidised by the government for CHAS patients at accredited GP clinics. They will also enjoy subsidies for GP consultation charges of up to $18.50 per visit, for their screening and subsequent follow-up consultations, up to two times a year.

The results have been encouraging. In the National Health Survey 2010, among Singaporeans aged 40 to 69 years, 71% had been screened for high blood pressure in the past year; and 61% and 64% had been screened for high blood cholesterol and diabetes respectively in the past three years, in accordance with the recommended frequency of screening. In terms of cancer screening, 48% of women aged 25-69 years had undergone the Pap smear test within the past three years; and 10.3% of Singapore residents aged 50-69 years had a Faecal Occult Blood Test (FOBT) within the past one year.

Nevertheless, there is room to further improve the screening participation rate. My Ministry will continue to look into how we can encourage more Singaporeans to undergo appropriate screening, and make screening even more convenient and affordable.

Age profile of MediShield policyholders

I asked the Minister for Health on 21 October 2013 for the number of MediShield policyholders in each age group. Here was his written reply to my parliamentary question.

I asked the Minister for Health on 21 October 2013 for the number of MediShield policyholders in each age group. Here was his written reply to my parliamentary question.

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Mr Gerald Giam Yean Song asked the Minister for Health how many MediShield policyholders are currently in age ranges of (i) 0-20 years (ii) 21-30 years (iii) 31-40 years (iv) 41-50 years (v) 51-60 years (vi) 61-65 years (vii) 66-70 years (viii) 71-73 years (ix) 74-75 years (x) 76-80 years (xi) 81-83 years (xii) 84-85 years and (xiii) 86-90 years.

Mr Gan Kim Yong (Minister for Health):

As at June 2013, 3.6 million members, or 93% of the resident population, were covered under MediShield. The breakdown of MediShield policyholders by age group is presented below.

Age Group

MediShield Policyholders

0-20

881,800

21-30

505,100

31-40

598,500

41-50

598,200

51-60

537,800

61-65

189,200

66-70

106,300

71-73

51,500

74-75

29,700

76-80

46,800

81-83

16,500

84-85

6,300

86-90

2,600

Total

3,570,200

The maximum coverage age for MediShield was recently raised from 85 to 90 years in March 2013, in view of the increasing life expectancy of Singaporeans. As a next step, with the proposed move to MediShield Life, we will be studying enhancements to provide universal, lifetime coverage for all Singaporeans, including the most elderly.

Food contamination alert system is possible

Firstly, a correction to my previous post: The authorities took not 2 days, but 3 days, to shut down the stall. It was revealed in TODAY on Thursday that the first reports of food poisoning from that stall appeared on a Wed 1 Apr. The stall was not ordered closed by NEA until Sat 4 Apr morning.

I’ve received some useful feedback from friends regarding my previous post, where I questioned why NEA officers took so long to shut down the Geylang Serai rojak stall that was allegedly responsible for three deaths and over 150 cases of food poisoning.

Some felt that I was being unfair by expecting NEA to react faster than it did, and that I appeared to be pinning the blame on NEA for the food poisoning.

While I don’t think NEA is completely blameless, I never said that they are entirely to blame. The NEA, Ministry of Health (MOH), the stall holder, doctors and even some of stall patrons could have played a part to avert this tragedy, or at least prevent it from ballooning into this nightmare involving over 150 people. Most of all, I feel it is “the system” which is to blame, and not any individual person or agency. I am not interested in playing any finger-pointing games at this point, but to suggest how the system can be improved to avert future mass outbreaks of food poisoning.

Continue reading “Food contamination alert system is possible”