Health

• Ms Sun Xueling asked about the percentage of follow-up consultations that can be moved to the telemedicine framework, the criteria for determining which ailments can be addressed via tele-consultations without lowering care standards, and the expected cost savings for hospitals and patients.
• Minister Gan Kim Yong stated that the Smart Health Video Consultation initiative was introduced in public healthcare institutions last November, with patient safety as the top priority and clinicians assessing suitability on a case-by-case basis.
• The initiative initially covers areas such as psychiatric counselling, paediatric eczema pharmacy follow-ups, lactation consultation, and post-stroke care, where it has shown success overseas.
• Early indications suggest the programme improves productivity and convenience, but it is too soon to assess the extent of adoption and cost savings.
• The government will continue to monitor the rollout and encourage greater adoption of telemedicine.

• Assoc Prof Daniel Goh asked for percentages of eligible Singaporeans who have gone for screening by gender and age, the drop-off rate for those who test positive but do not follow up, and how the need for post-screening consultation is assessed for the enhanced programme.
• Health Minister Gan Kim Yong stated that 78% of Singaporeans aged 40 to 69 had basic health screening in the past three years, an improvement from 73% in 2010, with no significant gender difference and older Singaporeans more likely to screen.
• Among those with abnormal results, a significant proportion do not follow up, and the need for post-screening consultation is assessed based on screening results and individual and family risk factors.
• The Ministry of Health is enhancing screening programmes to encourage more eligible Singaporeans to screen and to encourage those with abnormal results to follow up with a doctor.
• The minister emphasized that while the government provides support, individuals must ultimately take responsibility for their own health decisions.

• NEA reported increased enforcement actions and license suspensions for food hygiene violations between 2013 and 2016, with food courts, coffee shops, and canteens accounting for a significant portion, while maintaining a low food poisoning incidence rate.
• The government requires food handlers to undergo basic food hygiene training and has implemented schemes like the Food Hygiene Officer program, but has declined to mandate training for all eatery workers due to practicality and cost concerns.
• NEA conducts regular inspections, public outreach programs, and provides hygiene records for public access, while working with town councils and hawker associations to address cleaning coordination issues in shared spaces.

• The Ministry of Health reported that cases referred from polyclinics to public hospital A&E departments were about 55,000 in 2014, 57,000 in 2015, and 64,000 in 2016, representing a small and stable proportion of both polyclinic and A&E attendances.
• Polyclinics can perform minor procedures but refer patients to A&E for urgent cases requiring immediate specialized assessment, while non-urgent cases are directed to Specialist Outpatient Clinics, with MOH working to enhance polyclinic capabilities and ensure appropriate referrals.
• Lists of minor surgical procedures available at polyclinics are published online, though availability may vary due to constraints, and future polyclinics will have dedicated spaces for such procedures.

• The Ministry of Health is expanding dental capacity in polyclinics and new facilities while utilizing the Community Health Assist Scheme (CHAS) to provide subsidized dental care through over 700 private clinics, with most dental conditions diagnosed and treated in a single visit.
• Specialist dental care is centralized at designated centers like the National Dental Centre Singapore and NUH Dental Centre to consolidate manpower and resources, with ongoing expansions and the upcoming NUH National University Centre for Oral Health to address long waiting times.
• Only designated national dental specialty centers provide subsidized specialist treatments like root canals and crowns, and other hospital dental clinics operate as private facilities, limiting access to these services through polyclinic referrals only.

• Dr. Koh Poh Koon explained that AVA culled some of the over 100 free-roaming chickens in Sungei Api Api based on a risk assessment to manage bird flu, noting that vaccination is not fully effective due to virus mutation and unvaccinated chicks.
• Louis Ng Kok Kwang pressed for specific figures on resident complaints and chickens culled, asked if AVA would engage local community groups, whether red junglefowls were culled, and if further culling operations were planned elsewhere.
• Dr. Koh Poh Koon emphasized that AVA’s actions are pre-emptive and based on risk, not solely on complaints, citing a recent bird flu outbreak in Malaysia and stressing the need to protect public health and safety.

• Ms K Thanaletchimi asked about the pervasiveness of the Adapt and Grow initiative in the healthcare sector, and the Minister for Health, Mr Gan Kim Yong, responded that in 2016, about 300 jobseekers were placed into healthcare through this initiative, complemented by recruitment fairs that hired about 400 mid-career locals.
• The Minister outlined enhancements to the Professional Conversion Programme and other schemes to support mid-career Singaporeans in becoming nurses, administrators, and support care staff, including increased funding for training and new scholarships for nursing studies.
• The government will work with partners like MOM, WSG, e2i, healthcare employers, and unions to reach out to mid-career job seekers and facilitate their transition into the healthcare sector.
• Ms Thanaletchimi sought clarification on the Attach and Train programme's pervasiveness across all healthcare institutions, including the long-term care sector, and the Minister agreed to work with unions and employers to expand the programme.
• The overall response emphasizes collaboration and multiple initiatives to make the Adapt and Grow and related programmes more pervasive in the healthcare sector.

• The Healthcare Professional Conversion Programme (PCP) has admitted over 400 Singaporeans since 2009, with 82% of those enrolled between 2009 and 2011 completing training and being successfully placed into healthcare jobs.
• Among those successfully placed, 92% remained in their roles after the minimum service period, indicating strong retention.
• Public healthcare institutions also support non-clinical staff in converting to clinical roles, with 54 scholarships or sponsorships provided over the last three years.
• Over 750 enrolled nurses have advanced to become registered nurses through polytechnic programmes in the last three years, showing upward mobility within the sector.
• The PCP is largely standardised based on professional modules but includes institution-specific on-the-job training, with some variations across organisations.

• The government has adopted a whole-of-government approach through the Action Plan for Successful Ageing to support Singaporeans in an ageing society, overseen by a ministerial committee.
• Investments include continuing education and training infrastructure, SkillsFuture initiatives, and the WorkPro scheme to keep older workers employable and support mid-career changes.
• Infrastructure and programs for seniors’ social needs are being expanded, such as HDB’s housing options, Active Ageing Hubs, and enhanced home safety measures.
• Healthcare and aged care infrastructure has been growing since 2012, with additional hospital beds, nursing home places, and community care facilities.
• Efforts are also being made to make housing, transport, parks, and buildings senior-friendly, including barrier-free designs, accessibility funds, and therapeutic gardens.

• Leon Perera queried the estimated incremental cost of extending health subsidies to all Long-Term Visit Pass (LTVP) holders for FY2017/2018.
• Health Minister Gan Kim Yong stated that subsidies are differentiated by citizenship status, with only Singapore Citizens, Permanent Residents, and LTVP+ holders eligible for subsidies.
• The Minister explained that LTVP holders do not currently receive healthcare subsidies and that computing the incremental cost is not meaningful as there is no plan to extend subsidies to them.
• The response emphasized that any cost estimate would require assumptions about the number of LTVP holders, their healthcare needs, and subsidy levels, which are not available.
• The debate highlights the government's policy to maintain subsidy differentiation based on residency status without plans to expand eligibility to all LTVP holders.

• Assoc Prof Daniel Goh Pei Siong inquired about the severity of the space crunch for subsidised dialysis, future planning for rising patient numbers, current uptake of home dialysis options, and available subsidies for home-based treatments.
• Health Minister Gan Kim Yong reported that end-stage renal disease patients requiring dialysis have increased from 5,200 in 2012 to 6,400 in 2016, with 92% on haemodialysis and 8% on peritoneal dialysis, noting geographical mismatches in demand and supply.
• The Ministry of Health is promoting peritoneal dialysis through higher subsidies, enhanced education in public hospitals, and expanded home support programmes, while also increasing haemodialysis capacity to serve 1,300 more subsidised patients by 2020.
• Four new haemodialysis centres will open later this year to add 500 subsidised patient places, alongside upstream prevention efforts like screening and early intervention under the War on Diabetes.

• Assoc Prof Fatimah Lateef inquired if inter-professional education and practice principles will be integrated into the three strategic focus areas for developing a future-ready nursing workforce.
• Health Minister Gan Kim Yong affirmed that inter-professional education and practice are already integral to nursing training, with examples including joint learning sessions at universities and team-based care simulations at institutes.
• The Ministry plans to incorporate inter-professional principles into the three strategic areas: care (streamlining team-based processes), community (equipping nurses for inter-professional collaboration), and competency (developing broad-based skills for team-based care).

• Assoc Prof Fatimah Lateef asked the Minister for Health for the number of applicants and successful approvals under the Flexi MediSave scheme since its implementation.
• Gan Kim Yong explained that the Flexi-MediSave scheme allows Singaporeans aged 65 and older to use up to $200 of MediSave annually for outpatient treatments at public clinics without needing to apply.
• In 2016, over 260,000 Singaporeans, or about half of those aged 65 or older, benefited from the scheme.
• The scheme was introduced in April 2015 to cover outpatient care at public sector clinics and those under the Community Health Assist Scheme.
• Eligibility is automatic for all Singaporeans aged 65 and older, with no separate application required for approval.

• HealthHub is a one-stop portal and mobile app developed by the Health Promotion Board, offering health-related content, e-services, and incentives, with over 84,000 app downloads and 530,000 monthly page views as of January 2017.
• A new Caregiver Access module introduced in 2016 allows authorised caregivers to access medical appointments and records of those they care for, with users controlling the level of access.
• In April 2017, a new Personal Health Management module called HealthHub Track will provide digital tools and action plans for health monitoring, along with personalised content for pregnant women.
• A Diabetes Risk Assessment tool for adults aged 18 to 39 will be introduced in September 2017 to help assess the risk of undiagnosed diabetes.

• Miss Cheng Li Hui sought an update on the participation of private healthcare institutions in the National Electronic Health Record (NEHR) system.
• Minister Gan Kim Yong reported that over 21,000 healthcare professionals from more than 1,000 providers now access NEHR, with high adoption rates among GP clinics and long-term care facilities.
• The Minister highlighted recent growth in private sector participation, including specialist clinics, dental clinics, and x-ray labs, and affirmed continued efforts to encourage broader NEHR adoption.

• The Minister of State for Health moved the third reading of the Kwong-Wai-Shiu Free Hospital (Transfer of Undertaking and Dissolution) Bill, noting its referral to a Select Committee which made only minor textual updates.
• The Select Committee received one written representation deemed unrelated to the Bill’s subject matter, and the hospital itself expressed support for the legislation.
• Passing the Bill will allow the hospital to modernize its corporate structure, enhance flexibility, and strengthen transparency and accountability in providing healthcare services to Singaporeans.

• Assoc Prof Daniel Goh asked the Ministry of Health about its powers to ensure good governance at private clinic groups and whether the payment of medical claims by third-party administrators should be regulated to protect clinics' financial viability.
• The Minister of State for Health responded that the Ministry regulates clinics under the Private Hospitals and Medical Clinics Act to ensure safety and continuity of care, requiring clinics to notify MOH and transfer patient records if ceasing operations.
• He added that third-party administrator arrangements are private contracts not directly intervened in by MOH, though the Singapore Medical Council provides ethical guidance to doctors on fee arrangements to protect patient well-being.

• Er Dr Lee Bee Wah asked about the number of CHAS Blue Card holders who used up their maximum subsidies and whether the $480 annual cap for chronic conditions would be increased.
• The Minister of State replied that about 2% of the 550,000 annual CHAS Blue Cardholders used the maximum subsidies, noting additional support through MediSave and other healthcare initiatives.
• Dr Lee followed up by asking if there are other ways to assist residents whose children’s MediSave accounts are inadequate.
• The Minister responded that patients can seek help from medical social workers in public healthcare institutions if family MediSave is insufficient.
• The debate concluded without a direct answer on raising the subsidy cap, focusing instead on existing support mechanisms.

• Er Dr Lee Bee Wah raised concerns about the frequency and approval rate of requests for MediSave withdrawals above the capped limit and asked if the cap would be reviewed in light of rising medical costs.
• The Minister of State for Health responded that about 200 such appeals are received annually, with roughly half approved based on case-by-case assessments, and highlighted existing safeguards like government subsidies, MediShield Life, and Flexi-MediSave for those aged 65 and above.
• Er Dr Lee gave an example of a resident with a rejected MRI request and asked for advice, to which the Minister suggested submitting the case for review and noted that MediSave limits are periodically assessed for affordability.

The Ministry of Health outlined its strategy to future-proof Singapore's healthcare system through three key shifts: moving care beyond hospitals to the community, focusing on value beyond just quality, and promoting health beyond healthcare. Key initiatives include a major reorganisation of healthcare into three integrated clusters, a significant expansion of capacity and manpower to meet ageing population demands, and a strengthened focus on preventive health, notably the "War on Diabetes" through public education, screening, and community programmes. The debate also highlighted ongoing reviews to enhance support for the elderly, including improving ElderShield and long-term care financing, while addressing challenges in healthcare affordability, manpower sustainability, and the integration of technology and innovation across the system.