Debated in Parliament on 11 Nov 2013.
Mr Deputy Speaker, Sir, I beg to move, "That Parliament do now adjourn."
Question proposed.
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Thank you, Mr Deputy Speaker, for allowing me to file this Adjournment Motion and speak on social assistance and affordability for Singaporeans.
With increasing globalisation, Singapore, like many other developed countries, faces greater economic volatility, sluggish wage growth at the lower end, relatively less social mobility and a rising income gap between the haves and have-nots. While our median household incomes have risen and more have higher salaries, there still are vulnerable groups of Singaporeans who may need more than a leg up over a longer period of time before they can catch up with the rest.
The Government needs to intervene in a timely and decisive manner to provide more support to lower income Singaporeans to help them improve their lives and carve more and better opportunities for themselves and their children.
I must, however, acknowledge and state for the record that the Government has done quite a bit to help vulnerable Singaporeans, such as the elderly and low-income earners – through Government assistance schemes, such as the Community Health Assist Scheme, GST Vouchers, ComCare and Workfare Income Supplement, to name a few. The Minister for Social and Family Development shared with us in detail earlier today. Nonetheless, with the rising cost of living and inflation in the prices of food, housing and transportation, affordability remains a challenge for the low-income earners whose salaries have not quite increased in tandem with the increase in prices, and for the elderly whose current savings from years of toil and sweat have not quite amounted to much, in relation to today's prices of goods. Hence, there is still room for more to be done to help them.
For instance, our ComCare assistance scheme can be streamlined and made easier to process and disburse to the beneficiaries. Some residents I met have lamented that from the time they apply for ComCare, they would have to wait for another two to three or even four weeks before they would be given the much-awaited cheque. While they are appreciative of the financial assistance they receive, they also get frustrated with the wait, to the extent that some of them will jump with annoyance at the mere mention of ComCare! As
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MSF introduces the first 10 Social Service Offices in the heartlands, I hope that the processing and wait time can be improved.
I would also like to propose that ComCare assistance be given for a longer duration at any one time – six months instead of the current three months. For many residents whom I have met and who have sought ComCare assistance, three months of financial assistance, in the first instance, is barely enough for them to find a job, wait for the next pay cheque, and settle their arrears or debts, before having a decent amount left over for daily expenses, such as for food and transportation. Most of the time, they would have to reapply and this would incur an even longer period of wait time.
To enhance the ComCare assistance given to lower income families, specifically those with school-going children, may I propose that MSF work closely with MOE to identify the children from these families and extend transport and school breakfast vouchers to the children. These are important because the transport vouchers will help mitigate the cost of travelling to and from school and to ensure that the children continue to attend school, while the school breakfast vouchers will help to ensure that they are able to start off their school day with a good and healthy meal, despite the financial difficulties that their families are facing.
Conversely, I hope that MOE can also refer students who do not attend school regularly or who show signs of malnutrition to MSF so that a follow-up can be made to visit their families to identify those who are vulnerable and who may need further social or financial assistance; in other words, close collaboration between the Ministries and agencies would be very useful.
Another enhancement is the use of MediSave. I applaud the review of our healthcare financing but I also hope that MOH can grant greater flexibility in the use of MediSave by Singaporeans – not just for hospitalisation or surgical procedures; in other words, recuperative or reactive healthcare expenses – but for preventive healthcare expenses as well. I spoke about this in the Budget debate earlier this year, and as I did then, I would once again implore the Ministry to consider that Singaporeans be allowed to use our MediSave funds for preventive healthcare expenses, such as healthcare screenings, physiotherapy sessions, especially for the elderly, and dental checks, and also for antenatal medical consultations, in both private clinics and restructured hospitals.
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One of my residents, Uncle Robert, whom I met during one of my block visits, is one such Singaporean who can benefit from such flexibility in the use of our Medisave funds. Uncle Robert lives with his wife, just the two of them, in a spartan but cosy five-room flat. His three children are all grown up, married and live with their own families. While Uncle Robert and his wife are retirees and hence do not earn any monthly salary, they lead a simple but comfortable life with enough to get by. He insists that he does not want any financial assistance nor does he want to ask from his children. But what he wants is to be able to be independent and spend his own hard-earned money for his needs.
When I met him, Uncle Robert shared that although he was asked by his doctor to go for a detailed health screening at the hospital, he had been postponing it as he was certain one check would lead to another and the final hospital bill would be quite substantial for him for out-of-pocket cash payments. He added that he has "several thousand dollars" in his MediSave account and all he wants is to be able to finance his healthcare expenses with his own money in his MediSave account.
I am sure many of us understand how Uncle Robert thinks. He feels a sense of dignity and independence because he can pay for his own expenses – medical or otherwise. Greater flexibility in the use of MediSave will certainly help seniors such as Uncle Robert to independently take care of their health and well-being.
Similarly, greater flexibility in the use of our MediSave funds will help expectant mothers mitigate their antenatal medical expenses – be it at the restructured hospitals or private clinics. Many expectant Singaporeans can benefit from this, such as Mdm Rahimah, one of my residents. She was expecting her second child when she came to see me for financial assistance. She relied on her husband, the sole breadwinner, who worked as a security guard and earned about $1,200 a month, but who also had to pay alimony to his ex-wife and two other children. There was barely enough for Mdm Rahimah and her two-year-old child each month. She did not go for her monthly antenatal checks as she could not afford it. However, having worked before, she had some funds in her MediSave account and was hoping she could draw down from her MediSave for her antenatal consultations.
At the moment, under the MediSave Maternity Package, up to $450 can be withdrawn from an individual's MediSave account for pre-delivery expenses, such as consultations, ultrasound scans and tests, but only if these were done at the same hospital that they deliver their baby in. The claim for these pre-delivery expenses is made only after delivery at the same hospital – in other
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words, a reimbursement claim structure that requires upfront cash payment first. So, for someone such as Mdm Rahimah, this is difficult.
I hope MOH would consider granting greater flexibility for our expectant mothers to draw from their MediSave account to pay for their antenatal medical expenses after each consultation, visit or test, whether at polyclinics, private clinics, or hospitals which may be different from the one they would eventually deliver their baby in, instead of the current reimbursement claim structure that requires upfront cash payment.
In addition, I would like to suggest that the withdrawal limit for antenatal or outpatient consultations or treatments by expectant mothers be increased to at least $600. In the spirit of encouraging and helping Singaporeans to have more children, I hope the Ministry will seriously consider making these proposed changes. A higher quantum would be appreciated for sure.
The introduction of MediShield Life for all Singaporeans is very much welcomed. Residents I spoke to have expressed their support for it as this would help ensure all Singaporeans have a medical safety net to fall back on should medical expenses be more than what their MediSave or out-of-pocket cash payments can cover. Even younger and more affluent Singaporean residents I met have expressed their willingness and support for pre-payment of premiums while they are still young or while they can afford it. So, this is good news.
However, one concern raised by specifically older residents and those with lower income, is whether they can afford the premiums for MediShield Life. This concern does not just come from older Singaporeans or those with relatively lower income, but several middle income earners who have more dependants to support – such as young children, ageing parents or family members with special needs.
The Pioneer Generation Package is a good start to help older Singaporeans pay the MediShield Life premiums, but I would like to urge the Government to consider providing premium subsidies to these other groups of Singaporeans – the lower income earners and the middle income earners with more dependants to support.
It is heartening to hear that the Government will convene a committee to look into the premium and payout structure of MediShield Life. But in order to help Singaporeans adjust in the initial period when MediShield Life is introduced, the Government can consider providing some form of financial
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support to those who need it. Yet, another consideration is to increase the Medisave withdrawal limits for each Singaporean so that the premiums for MediShield Life can be paid fully from our Medisave funds.
While it is recognised that the Government has improved policies and programmes with regard to social and financial assistance, the implementation and delivery of such assistance can be enhanced further.
For one, accessibility, as spoken by Members earlier today, of such assistance can be improved, where barriers to seeking assistance can be kept to a minimum or eliminated altogether. Easy access to such assistance will make it less frustrating for those who need it and, at the same time, help to preserve their dignity and sense of hope.
Next, the Government can do more to ensure affordability for Singaporeans. Social and financial assistance schemes can be reviewed regularly, to take into account current income and cost-of-living trends. And for low-income families who are plagued by illnesses or extenuating circumstances, or those with young, school-going, or elderly dependants, additional support can be provided. Managing the cost of living and continued affordability of services is important to such families, and any additional help by the Government will certainly be needed.
Third, the Government can provide greater flexibility in assessing the merits of each case applying for social or financial assistance, taking special circumstances into account when determining eligibility and the level of support to be rendered. This is so that families in genuine need can receive appropriate help even if they do not fit the criteria that have been set or only qualify for minimal help. Frontline staff can also be trained to assess such needs and exercise flexibility at the point of application for assistance.
In addition, greater flexibility in the use of one's social security savings, in this case, the use of Medisave for preventive healthcare, will develop a sense of independence and self-worth among our people. For all we know, it may just pave the way for better healthcare in the long run.
Finally, there can be better coordination among the Ministries, Government agencies and organisations that extend social and financial assistance to those in need and who are more vulnerable in our society. Better coordination will not just lead to greater efficiency but also ensuring that the assistance rendered is more effective and targeted and, at the same time, reduce frustration and
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anxiety among the beneficiaries.
This will require the seamless sharing of information, knowledge and experience, and a collective belief, that by working together, we are able to do our best in helping those who are vulnerable and in need. The MSF's introduction of the Social Service Offices in our heartlands is a welcomed move, which, I hope, will help realise this belief.
At this juncture, please allow me to speak in Malay, Sir.
(In Malay): [Please refer to Vernacular Speech.] The ability to manage the cost of living is a concern shared by many Singaporeans, especially among the low-income group and the elderly. For the low-income group, increases to the cost of daily necessities, housing and transportation will continue to pose challenges because their salaries do not increase in tandem with the increase in the price of goods. For the elderly, the savings that they accumulated over the years through all their hard work and toil will now not amount to much, compared to the increase in the daily expenses and medical costs.
While I concur that the Government provided many assistance schemes for these groups, there is still room to enhance the assistance given to ensure that those who really need help will be given help. One example is the recently introduced MediShield Life. Many of my residents support the MediShield Life Scheme but some are worried whether they will be able to afford the premiums to this scheme, especially those from the low-income group, the elderly and those from the middle income but have many dependants, like small children, elderly parents or family members with special needs. I hope that the Government will help these groups whether through a Pioneer Generation Package, premium subsidies or by increasing the MediSave withdrawal limits so that the MediShield Life premiums can be paid fully from the MediSave funds.
Another way would be to provide flexibility to Singaporeans when they utilise their MediSave accounts, especially for our elderly, in order to pay for the costs of health screenings, dental checks or physiotherapy sessions and for antenatal checks for expectant mothers. This flexibility will help Singaporeans to manage the cost of living in terms of medical and health needs. Please allow me to end my speech in English.
(In English): While I urge the Government to do more, I would also like to make a similar call to each and every one of us here in this House and out there
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to do our part as well. Extending the necessary social and financial assistance to those in need and who are vulnerable in our society is not just the responsibility of the Government alone. Each and every one of us has a part to play in making a positive difference in our society.
We cannot simply stand by, criticise the Government on what it has done, spew mere rhetoric on what it has not done or showcase some form of intellectual snobbery on what more it can do; but in reality, we have yet to do the real work of helping others and making that positive difference in the lives of those in need.
While words matter, actions speak louder, but not nearly as often, as said by Mark Twain.
Mr Deputy Speaker, Sir, let me first thank Dr Intan for speaking up on behalf of many Singaporeans, especially the poor and the vulnerable. She has spoken on many issues that are close to our hearts and, indeed, we will try our best to do more and do better for all Singaporeans, especially for the vulnerable ones amongst us.
As Dr Intan has said, the challenges are not unique to us – a widening income gap, healthcare costs going up faster than the income of some of the members of our society. But having said that, we do start from a better base than many other countries and we are committed to do more within our means to take care of all Singaporeans, especially the vulnerable.
Dr Intan touched on four themes which I think are most appropriate – flexibility, affordability, coordination and timeliness.
Let me first talk about flexibility. In order to achieve flexibility, we need to adopt a two-pronged strategy. First, we need to design our schemes to be flexible and we review them regularly to make sure that they are relevant.
In this, I give an example of the Public Assistance scheme which we reviewed recently. Instead of a one-size-fits-all scheme, we now have different tiers to meet different needs. Likewise, for ComCare, we do have different periods of help extended to families in need, ranging from three months and even beyond six months. Indeed, I have told my officers that they should feel
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confident that they can make the judgement to extend assistance to families in need beyond six months.
It is always a fine balance that requires the judgement of the officers to balance between premature termination of support and prolonged assistance that may inadvertently discourage independence. But it is something that we must equip our officers with to make the judgement and to call the shots.
In order to do this, we have to do the second thing which is to make sure that we strengthen the training of our frontline officers so that there is a certain consistency in their responses and yet at the same time they have the flexibility and the confidence to make the call when the call requires them to deviate from what the guidelines may be.
On the second issue of affordability, we adopt a multi-pronged strategy to ensure or manage our healthcare costs. The first strategy, as the Member mentioned correctly, is to make sure that we spend much more upfront on preventive measures and staying healthy. If all of us can do this, it would reduce our overall healthcare costs.
We have good news that for the CHAS scheme, we are going to expand it to cover diabetes, hypertension, high cholesterol, cervical cancer and colorectal cancer. We will also look into covering some vaccinations, pre-natal checkups and more complex dental procedures. Through many of these schemes, we will help people like Uncle Robert that the Member had mentioned.
Another strategy that we have adopted to manage healthcare costs is risk pooling, which is why we are going to look into the details of implementing the scheme for MediShield Life.
Yet another strategy is to make sure that we are disciplined in our treatment and right-site our services so that we can target our resources to those who need them most. In all these efforts that we do, we are going to pay particular attention to the Pioneer Generation and the lower- and middle-income groups.
At the end of the day, how much more flexible we can be with MediSave also has to be balanced with the consideration to make sure that we can provide enough and adequate savings for old age and retirement.
In the area of coordination, yes, we agree we can do much more and we will want to do much better. It is not just between MSF and MOE, but we will
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also want to expand this coordination from MSF and MOE to MND, MOH and many other agencies, including for those looking for jobs. MSF and MOE coming together to take care of young children who may come from disadvantaged backgrounds to make sure that they have proper breakfasts is one such example. Another example will be the after-care school services that we would like to provide for many latch-key kids.
We would also like to better integrate between MSF's social assistance and MOH's healthcare assistance. It is a continuum of assistance when it comes to taking care of our elderly. The recently launched programme of Caring for our Neighbours (CAN) launched between AIC and MSF is one such example, where we want to provide a continuum of care from social to medical.
We do not want to medicalise everything but, where we can, we will try to intervene early upstream from the social dimension first. Other work that we are doing to make sure that coordination between the various agencies is done better is, first, to make sure that we have an integrated database which I have launched recently.
We also want to put in place the network of Social Service Offices across the entire island so that people have access to services in their respective towns without having to travel further than necessary.
We recognise that we cannot help people in only one dimension and neglect the other dimensions. In fact, that would detract and subtract from all our efforts. We must make sure that the sum of our parts is more than the individual and that is where we need to deliver that integrated package of help required to everybody.
The Social Service Office will also strengthen the local planning function to make sure that we have the system to mobilise the local community resources to come together to do this better. Very often, it is the frontline grassroots community leaders who will help us to identify the people in need of help.
There are also some other things that we need to do, that is, the training and exposure of our social work professionals. In order to do the coordination across different agencies, they must know the capabilities across different agencies and what each agency is capable of, to draw on their strengths to
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overcome each other's weaknesses and deliver the integrated package required for help.
Last but not least, Dr Intan talked about the timeliness of intervention. Indeed, that is something that is close to our hearts. The first dimension of timeliness is to make sure that we detect the problem and prevent the problem upstream.
Much of this has to do with the community efforts. Many of the CDCs have many programmes to make sure that families are socially integrated into the community and the community plays an important role in picking up the problems and challenges that these vulnerable families may have.
In the example that the Member had used, a young child going to school undernourished, or without breakfast, the first line of defence is to be able to pick up the case. Someone from the school, be it a teacher or somebody else from the school, must be able to pick it up and highlight the case so that we can follow up. Very often, when we follow up on the case, we realise that it is not just about breakfast but that there are other issues related to the family that may need intervention.
The second thing about the timeliness of the intervention has to do with our staying power. Many of the cases that we come across are complex cases. It does not require us just to provide a solution at the point in time. It requires us to have the staying power to provide the help across a prolonged period of time. For many of the complex cases that we are handling now, we need volunteers and mentors, much more than even financial assistance, so that we can handhold the people to walk through the dark valleys of life.
It is on that note that I will urge members of the public and community to come together to help their fellow Singaporeans in the community in need of help. Very often, more than money, we need volunteers. We need mentors to handhold them and guide them and give them the sense of confidence to do this.
Finally, let me say that while we do not start from a very negative position, we know our challenges. And our challenges will continue to grow. Going forward, this Government is committed to do as much as we can, in partnership with the community and like-minded individuals, to take care of our elderly, our vulnerable, and to give Singaporeans a sense of assurance that they can age
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and grow old in their community with dignity.
We will try to do our best to muster the resources. As Member of the House, Mr Zaqy Mohamad, mentioned just now, it is not easy because, going forward, our challenges will grow. Our demographics and our ageing population might restrict our ability to fund many of these things and this is where we must really make sure that we target our assistance to those who really, really need it.
Nothing can replace action, as the Member has rightly pointed out, because we can all talk about this issue, but, at the end of the day, we need to act on it. We need to act on it because we want to take care of fellow Singaporeans and do our best for them. The only way we can do that is we have the help from everyone in the community, in partnership with the Government and like-minded agencies.
If I may just end off with a short saying in Malay.
(In Malay): [Please refer to Vernacular Speech.] We understand that there are people who are concerned about this issue, but please do not worry because this Government understands these issues and we will work hard to raise the standards for all Singaporeans. Do not worry. If you have problems, let us know and we will do our best to assist.
(In English): Do not worry. My assurance to all Singaporeans is not to worry. Like what Uncle Robert says, "Don't worry, because if there is a need, we will find a way." We have the resources. We are much better than what we were 30 years ago. We will definitely do our best mobilising the resources of the community and fellow Singaporeans to come and take care of our fellow Singaporeans.
*Question put, and agreed to.*
*Resolved, "That Parliament do now adjourn."*
Adjourned accordingly at 7.16 pm.
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