Clarification by Senior Minister of State for Manpower and Sustainability and the Environment

Mr Deputy Speaker, thank you for the opportunity to update this House on the clarification I sought from Ms He Ting Ru sometime back.

Sir, on 4 April 2002, I sought clarification from Ms He Ting Ru on an anecdote she shared in her speech during the debate on the Budget Statement on 28 February 2022, in which she said and I quote, "After all, what does it say about us as a society that our senior residents come to us and tell us as a matter of course that they have requested for their medication dosages to be cut down because they cannot afford to pay for the full dosages that doctors have prescribed to them to treat their medical ailments?"

She clarified on the same day after checking her records that a resident sought her assistance at her Meet-the-People Session to appeal for an increase in his MediSave claimable limits because he was, I quote, "prescribed various medications for these chronic conditions, which despite the various subsidies and claims of MediSave available to him, he was unable to avoid paying in full as there remained a residual cash payment that he was required to make."

I asked Ms He to forward the details of this resident to me so that I could check and ensure that the necessary support and assistance were rendered to him.

On 5 April 2022, the day after the clarification in Parliament, Ms He sent me a copy of the Meet-the-People Session letter dated 24 February 2022 which she sent to CPF Board, requesting for the MediSave claimable limit to be raised by a further $500 a year. It must be noted that Ms He submitted the appeal to CPF Board on 24 February 2022 but she made her speech in Parliament on 28 February 2022, just two working days later before the CPF Board had a chance to consider the appeal and furnish a reply.

She said in her speech on 28 February 2022 and I quote, "While these systems are in place to prevent abuse – and quite rightly so – we must also ask ourselves and continue to ask ourselves important questions: who we are as a people and what values do we stand for?"

This seems to suggest that the system has failed the patient and left him to struggle, such that he even asked for a reduction of the dosages of medication – something that would not be in line with what doctors professionally would do.

Having checked the facts with MOH colleagues, I felt that I should update this House to close the matter. For medical confidentiality reasons, I will use the initials of this patient and refer to this resident as Mr H.

I understand that her resident, Mr H is receiving medical treatment at Sengkang Polyclinic to manage multiple chronic medical conditions and currently, has no outstanding bills with Sengkang Polyclinic.

On 8 September 2021, Mr H had visited Sengkang Polyclinic where he declined his doctor's recommendation to increase the dosage of his medication to manage his chronic condition due to affordability concerns. I want to confirm with Ms He that at no time was there a suggestion to cut the dosage of his medication and his medication dosage has not been reduced.

His doctor had done the right thing and referred him to see a medical social worker to assess his financial ability and eligibility to receive Medication Assistance Fund (MAF) subsidies for three Mr H's drugs. However, Mr H did not follow up with the medical social worker.

Following Ms He's appeal to CPF Board on behalf of Mr H on 24 February 2022, his MediSave withdrawal limits for the Chronic Disease Management Programme (CDMP) has been raised from the current $700 per year to $800 per year with effect from March 2022. And this higher limit would apply for his entire lifetime. In addition, he can utilise a further $300 a year from his MediSave under the Flexi-MediSave scheme. The CPF Board had, in fact, replied to Mr H on 16 March 2022, with a copy forwarded to Ms He.

So, Ms He Ting Ru should already know that CPF Board had accorded flexibility to her resident when she gave a clarification in Parliament on 4 April 2022 and subsequently sent the details of this resident to me via an email on 5 April 2022.

Hence, there is flexibility in our system to meet the needs of this resident.

Sengkang Polyclinic also reached out to Mr H to arrange for him to see a MSW on 14 April 2022 and has since accorded Mr H MAF subsidies of 62.5% for the three non-standard drugs. His next medical appointment at Sengkang Polyclinic is in August 2022, next month. Should his doctor assess then that he requires other MAF drugs to manage his condition, he will automatically receive 62.5% subsidies for these drugs as well. If he still has difficulties paying for his medical bills, the medical social worker is able to further assist him to apply for MediFund assistance.

I should emphasise that while the drugs are non-standard, he would have been eligible for MAF if he had gone to see the medical social worker in September 2021 as arranged.

Mr Deputy Speaker, having provided these factual clarifications, may I just make a few more additional observations.

It is unfortunate that when Ms He raised this issue in Parliament, she phrased it in the following way, and I quote, "After all, what does it say about us as a society that our seniors come and tell us as a matter of course that they have requested for their medication dosages to be cut down because they cannot afford to pay in full for dosages that doctors have prescribed to them to treat their medical ailments?"

Her statement was cast as an indictment on our society and the picture painted was one of a society where seniors are forced to cut down on their necessary and essential medication dosages, simply because they cannot afford it. Implicit is also the suggestion that this state of affairs is due to a government that is not in touch with the ground or is uncaring.

However, as seen from the facts which I have outlined above, this is not the case. In fact, the opposite is true.

As a government, we are very much concerned and look out for those who have difficulties with medical costs and the system is designed to cater for the needs of those who are in need: the elderly, the low income and the vulnerable.

In this case, had the resident gone to see the medical social worker in September 2021 as originally arranged, it would have been determined that he is eligible for MAF assistance and he would have received the 62.5% subsidies much earlier.

We do not know the reason why he did not go to see the medical social worker at that time, but the key point to note here is that there is a system in place to help patients like Mr H. And the system is operating as it should have and the agencies did their part.

The other observation I wish to make is that when Ms He made her statement lamenting where we stood as a society, it was before the agencies even had a chance to consider the appeal. Ms He submitted the appeal to the CPF Board on 24 February 2022. She made her speech two working days later on 28 February 2022 before CPF Board even had a chance to look at the appeal or furnish a response.

For avoidance of doubt, let me clarify that I have no issues at all with Ms He raising the issue of costs of medications. Members of Parliament can and should raise the concerns important to their residents here in Parliament. The part that is of concern to me is that Ms He cited Mr H's case in support of a statement characterising our society as one that does not look after seniors, even before the facts of the case were determined and established, and before the agencies have had a chance to respond.

Having regard to the facts outlined above, that is not a fair characterisation and it is also not fair to the agencies on the ground.

It is understandable that members of the public may sometimes not be aware of the many different avenues and means in which Government agencies render assistance to them. However, as Members of Parliament, we can give them the assurance that in our society, those in need will always be provided for. As this case has shown, this Government has made provisions and set in place systems of appeal so that residents that like Ms He's resident, Mr H, need not worry.

We will continue to review and update our system and processes as the needs evolve. Thank you, Mr Deputy Speaker.

Thank you, Mr Deputy Speaker. It is good to hear the assurance that the Government will take care of people.

But I think the point I was trying to make was that things like these are still happening on the ground. And even though these avenues are available, our residents sometimes come to us and say that they really feel that they have to jump through many hoops, they feel very demoralised. Some of them tell us that they feel a bit humiliated going through the process.

The sense that Mr H came to me with, was that he could not afford it. And, in fact, he brought down his invoice, his bill, where he actually struck out the item in question; and he wrote down "delete". I have a copy of that bill. From memory, he said that he went down to the polyclinic and they actually told him that he had to come to his Member of Parliament in order to put an appeal.

And the point there was, is there any way where, yes, if the systems are working, if the systems are flexible, do our residents know that they are there? How do we get that message out to our residents, rather than have them feel that we are uncaring, that the system does not work for them, that they had to really work for it, that they have to really be humiliated? This is how they feel.

So, this is the point that I was really making here. Again, I was not casting any aspersions on the doctors, on the system. I never said that the doctors told him to cut down his usage or his dosage. Again, like I said earlier, he asked for these medications. Again, we would not go into details because of confidentiality. But he actually asked for these to be deleted because he felt that he could not afford it.

And as for the timeline, if I am not wrong, on 4 April, I said I had to check my records because the letter that the CPF Board wrote back to me was a physical one. It took a couple of days but in the meantime, I found the copy of the letter that I sent to CPF Board. I forwarded it to you. You acknowledged it to say that you would look further into this. So, that that was that. And that is just an explanation of on the timeline. Thank you.

Mr Deputy Speaker, I think it is not impossible for us to encounter residents or even patients who sometimes are not really aware of how they can seek help. This case does illustrate that this patient could not quite understand why he needs to go and see the medical social worker and perhaps that could be the reason why he did not turn up for his appointment. As a result of that, he did not get the subsidies much earlier than he would have.

But the point that is at stake here is that it is not wrong for Ms He to actually appeal for her resident and also, to speak up on behalf of the resident who needs help. And through that process, the resident gets connected to CPF Board and is able then to receive more subsidies and subsequently through the intervention of the medical social worker, get more subsidies than he would have otherwise.

But the issue here is that Ms He used this case as an example in her speech and made broad sweeping statements about how we behave as a society when this case has not actually been dealt with by the agency concerned because she made the speech two working days after the appeal was given to the agency. If she had waited for the appropriate response by CPF Board, which reached her on 16 March, she would have known that this patient has received adequate help, that the system actually works, instead of saying so in her speech, that as a society, we had failed this resident. That is the point I was trying to make.

As regard to her point about the fact that she did not say that the doctors had to cut down the medication dosages, I think I have quoted her in a speech before that that the patient has requested for their medication dosages to be cut down because they cannot afford to pay for their dosages in full. That may well be an issue of communication and how she understood what the resident has said to her.

The point I want to make here is that as parliamentarians making speeches here, let us be clear about the facts before we make statements in Parliament and not to tarnish the reputation or the efforts of agencies on the ground who work very hard to make sure that the gaps are closed, to make sure that the system actually addresses the needs of our residents and patients. Thank you, Sir.