Health

• Assoc Prof Fatimah Lateef questioned how the Emergency Ambulance Services are handling the rising number of calls and what plans exist to manage future increases, as well as how public education on proper ambulance usage will be promoted.
• Teo Chee Hean reported that ambulance call volumes have risen by 8.4% in the first half of 2013, with SCDF expanding its fleet by engaging more private ambulance operators and cross-training firefighters as first responders.
• SCDF emphasized that emergency ambulances are for life-threatening situations only, urging the public to use 995 for emergencies and 1777 for non-emergencies, and plans to enhance public education through community events and hospital posters.

• Gerald Giam questioned why certain mandatory vaccinations for Primary 1 registration are chargeable for Singaporeans at polyclinics and asked if all such vaccinations could be made free.
• Gan Kim Yong explained that Medisave can be used for all NCIS vaccinations with an annual cap of $400 per account and a $3,000 MediSave Grant is provided for newborn Singaporeans to cover these costs.
• Vaccinations that provide strong herd immunity are already offered free at polyclinics to encourage uptake, while all required vaccinations for Primary 1 registration are free for citizens at polyclinics.
• The Ministry of Health stated it will continue to review the financing framework to ensure the affordability and relevance of the National Childhood Immunisation Schedule for Singaporeans.

• The Minister for Health reported that attempted suicides increased from 1,009 in 2011 to 1,090 in 2012, while suicide deaths rose from 8.1 to 10.3 per 100,000 population, noting that yearly changes may not reflect long-term trends.
• Underlying causes for suicide are complex, including family, social, economic, and mental health issues, with relationship problems and financial/employment difficulties each linked to about one-third of suicides based on a 2000-2004 study.
• A multi-pronged prevention strategy involves building resilience (e.g., school programs, peer support training), targeted interventions (e.g., Family Service Centres, hospital crisis care), and public awareness campaigns to promote mental well-being across all age groups.

• Png Eng Huat asked for data on Singaporeans who exhausted their annual Medisave withdrawal limit for chronic disease treatment from 2009 and their age profile.
• Gan Kim Yong explained that the annual Medisave limit for chronic disease management was raised to $400 in 2012, with 149,000 patients benefiting that year and about 26,000 fully using the limit.
• The proportion of patients fully utilising the limit was similar across ages, with most incurring average bills of $200, and options like family Medisave accounts or Medifund available for those with higher costs or financial difficulties.

• Dr Janil Puthucheary asked whether healthcare information is affected by the Personal Data Protection Act (PDPA) and if citizens' access to their own healthcare data would be impacted.
• The Minister for Communications and Information clarified that the healthcare sector remains regulated by existing laws like the Private Hospitals and Medical Clinics Act, with the PDPA applying concurrently but not overriding these specific regulations.
• It was confirmed that medical professionals and institutions must continue to uphold patient confidentiality, and patients can still request their medical reports as usual.
• Regarding third-party providers not covered by healthcare laws, the Minister stated that such data collection would generally be covered by the PDPA based on usage, with exceptions evaluated case by case.
• The PDPA serves as a baseline law to protect personal data across sectors, ensuring a common standard while allowing sector-specific laws to prevail in case of inconsistency.

• The Ministry of Health is studying enhanced MediShield coverage, including lifelong protection for all Singaporeans and Permanent Residents, with details and costs under review ahead of a public consultation later this year.
• The Minister acknowledged that higher payouts from expanded coverage would lead to increased premiums, but assured that government subsidies and existing MediSave top-ups will ensure affordability, especially for the elderly and low-income.
• A Pioneer Generation Package is being developed with details to be announced later, while MediShield Life aims for implementation by 2015, pending further consultations and policy finalization.

• The Minister announced that from January 2014, the Community Health Assist Scheme (CHAS) will remove the age qualification, allowing all Singaporeans in lower and middle-income households to access subsidized care, with automatic inclusion for existing cardholders' younger family members.
• If a CHAS-eligible household experiences a drop in income during the validity period, the subsidy level can be upgraded from orange to blue upon application and case-by-case review.
• The Ministry is actively encouraging more private GPs and dental clinics to join CHAS by explaining the scheme’s benefits through the Agency for Integrated Care and outreach efforts.
• CHAS subsidies primarily cover chronic diseases under the Chronic Disease Management Programme (CDMP), which is being expanded from 10 to 15 conditions, and acute outpatient care for blue cardholders, but not all procedures at participating clinics.

• David Ong questioned the number of MediSave withdrawal requests from seniors aged 60 and above for parents' medical bills and suggested a review to promote shared family responsibility in elder care.
• Gan Kim Yong noted that in 2012, about 4,600 CPF members aged 60 and above withdrew an average of $2,000 from their MediSave for parents' treatment, representing 2% of that age group's total withdrawals.
• He explained that using MediSave for family healthcare supports children caring for parents but must be balanced to ensure sufficient savings for their own needs, with top-ups via GST Voucher and financial assistance options available.

• As of July 2013, 645 patients have stayed in restructured hospitals for more than 21 days, occupying about 10% of beds; 364 require continued acute care, while the rest are awaiting placement or caregiver arrangements.
• The Ministry of Health is implementing initiatives like interim caregiver services, transitional care home visits, and care coordinators to support timely discharges and reduce long stays.
• There has been progress in placing patients in intermediate and long-term care facilities, with nursing home placements nearly doubling from 1,185 in 2010 to 2,100 in 2012.
• To meet growing demand, 700 more nursing home beds will be added by the end of the year, with about 3,000 more by 2016, and community hospital beds are set to increase by 1,900 by 2020.

• Er Dr Lee Bee Wah inquired whether any MediShield policyholders exceed the MediSave withdrawal limits for basic premiums and how many such cases exist.
• Minister Gan Kim Yong confirmed that MediShield premiums for all age groups can be fully covered under current MediSave withdrawal limits.
• The Ministry of Health will continue regular reviews of MediShield and MediSave to ensure healthcare affordability for Singaporeans.

• MediShield coverage has increased from 78% in 2007 to 92% (3.5 million members) by end-2012, due to auto-cover points like at birth and recent enhancements covering congenital conditions and extending age limits.
• The remaining 8% are mostly uncovered due to opting out, lapsed coverage, or never applying; less than 0.5% were denied due to serious pre-existing illnesses, though those with conditions can be covered for unrelated treatments.
• The Ministry of Health is reviewing feedback from parliamentary committees and public engagements to consider extending MediShield coverage to Singaporeans with pre-existing illnesses.

• The Ministry emphasizes a comprehensive strategy combining surveillance, elimination of breeding sites, public education, community involvement, and enforcement, supplemented by research on new control methods like gravitraps and the "Mozzie Zap" aerosol spray.
• Annual exercises such as the Intensive Source Reduction Exercise are conducted ahead of the dengue peak season, with heightened inspections, indoor spraying, and distribution of insect repellents in high-risk areas.
• Since the "Do The Mozzie Wipe-out" campaign started in April 2013, there has been a decrease in summonses issued to households and repeat offenders, alongside a reduction in reported breeding habitats.

• The Ministry of Health monitors the global MERS situation and assesses the risk of a serious public health impact in Singapore as low, while implementing precautionary measures such as health advisories at airports and for travelers from affected regions.
• MOH has ensured hospitals maintain sufficient N95 mask stocks for MERS preparedness while replenishing the national stockpile, which was recently drawn down during the haze period.
• For Singaporeans performing Haj in Mecca, MOH works with MUIS to issue health advisories, require medical check-ups and vaccinations, and monitor pilgrims' health through an accompanying medical team.

• Dr Lam Pin Min asked whether paramedic services need regulation and how the standards of paramedic training are determined and maintained, to which the Minister for Health, represented by Dr Amy Khor, responded that the Singapore Civil Defence Force (SCDF) provides emergency ambulance services with paramedics trained for all emergencies, and maintains standards through audits, protocol reviews, and oversight by an independent committee.
• The government has implemented a public-private partnership with private ambulance operators that must meet SCDF standards, and is developing a Pre-hospital Emergency Care Transformation Plan with MOH and MHA to upgrade paramedic capabilities, including frameworks for continuing education and professional development for paramedics, emergency medical technicians, and medical transporters.
• In response to a supplementary question, Dr Amy Khor clarified that SCDF’s 995 emergency ambulance service is free for emergency cases as determined by a doctor, but charges $198 for non-emergency cases, while private ambulance charges are not regulated but must be disclosed upfront and are listed on the SCDF website to guide patient decisions.

• Er Dr Lee Bee Wah asked whether the healthcare financing review would consider expanding MediSave use for outpatient CT and MRI scans and ensuring retirees can use the system for outpatient services without cash.
• Minister Gan Kim Yong noted current MediSave limits for outpatient scans related to cancer and chronic diseases, and said the review is exploring ways to reduce cash outlay for outpatient treatments, especially for the elderly, while balancing affordability and preservation of MediSave for hospitalisation bills.
• Er Dr Lee Bee Wah pressed for a timeline on the review completion, citing residents' concern over high scan costs.
• Minister Gan Kim Yong explained the review is complex, covering MediFund, MediShield, MediSave, and subsidies, and aims to balance affordability, prudent use, and incentives for healthy living; he assured that measures will be announced progressively when ready.

• Over the past two years, an average of two preschools per month have been mandatorily closed due to HFMD outbreaks, with each closure lasting a minimum of 10 days to control disease transmission.
• Parents of affected children are advised to arrange alternative childcare, such as using their childcare leave or seeking support from family, friends, or neighbours.
• Preschools may also be mandatorily closed for other communicable disease outbreaks, such as SARS, following guidelines from MOH and the Early Childhood Development Agency.

• The Ministry of Health reported that median waiting times for non-life-threatening emergency cases across public hospitals were between 14 to 49 minutes in 2008 and improved to 15 to 29 minutes in 2012.
• Measures to reduce waiting times include calibrating doctor and nurse shifts based on patient load, deploying staff from less busy areas to emergency departments, and improving support services like laboratory and radiological investigations.
• To address bed availability and waiting times for admission, hospitals are renovating spaces to add bed capacity, deploying more staff, and working to discharge medically stable patients to free up beds, especially in response to the dengue situation.
• Hospitals have been instructed to prioritize suspect and confirmed dengue cases returning to emergency departments within 24 to 48 hours for timely attention.

• The Minister reported that children aged six and under accounted for over 70% of HFMD cases and about 1.5-2% of dengue cases from 2010-2012, but could not provide a detailed age breakdown or data for chickenpox as it is not a notifiable disease.
• It is not possible to determine the specific source of infections like HFMD or dengue for children, whether from siblings or childcare centres, though about half of HFMD cases in children under six were in preschools.
• The number of days a child must stay away from childcare due to HFMD, chickenpox, or dengue varies based on clinical assessment, typically ranging from one to two weeks until symptoms resolve and medical leave expires.

The request was rejected because it was considered high risk

• The Ministry of Health expressed condolences for two dengue deaths at Tan Tock Seng Hospital, noting that while most cases are mild, a small fraction develop severe forms like Dengue Shock Syndrome, with 46 severe cases out of 10,959 reported in 2013.
• An independent review confirmed that the clinical management of the two fatal cases followed standard practice, with patients initially stable but later deteriorating despite supportive care like blood transfusions.
• MOH issues regular circulars to hospitals to reinforce dengue management, including close monitoring of patients, prioritizing returning dengue cases at emergency departments, and ensuring outpatient follow-up for those not admitted.
• Hospitals are advised to watch for warning signs and refer patients for further evaluation, with MOH continuously sharing best practices to improve dengue care across public hospitals.
• The response highlights that there is no specific antiviral for dengue, so treatment focuses on rest, hydration, and supportive therapy, with expediency in emergency departments maintained through triage prioritization.