Health

• The Minister for Health acknowledged that the 2023 suicide data is provisional and attributed the decrease to a whole-of-society approach, including public education campaigns, trained peer supporters, and expanded crisis helplines.
• Key measures to sustain this trend focus on changing societal attitudes by normalizing conversations about mental health and reducing stigma to encourage early help-seeking.
• For youths, initiatives include promoting mental well-being, teaching emotion regulation skills, training educators and school counselors to identify challenges, and building peer support systems.
• For seniors, the Silver Generation Office proactively reaches out to those aged 60 and above to identify needs and connect them to support services like Active Ageing Centres and befriending programs.

• The Minister for Health highlighted that pharmacists play a crucial role in medication safety through tasks like medication reconciliation, which reduces risks of inappropriate medication use.
• Studies show pharmacist-led interventions in outpatient settings have decreased unplanned hospital admissions and emergency visits, and collaborative care improved chronic disease management for patients with Type 2 diabetes.
• In intensive care units, pharmacist interventions have led to reduced ICU stays and healthcare costs by correcting drug regimens and discontinuing unnecessary medications.
• The Minister noted that while some benefits are not fully quantifiable, the overall impact of pharmacists is significant in preventing adverse outcomes and optimizing patient care.

• The Ministry of Health conducts regular engagements through surveys, workshops, and consultations to assess pharmacist job roles and skills, which informed the 2020 Development Framework for Pharmacists outlining competency domains.
• Public healthcare institutions sponsor pharmacists for postgraduate training to prepare them for enhanced clinical, specialist, and leadership roles, such as in antimicrobial stewardship or specialized clinics.
• The government leverages postgraduate skills by deploying pharmacists into higher-level positions that align with their advanced competencies and institutional needs.

• Melvin Yong inquired whether the Ministry of Health tracks perinatal depression prevalence and requested statistics for the past five years.
• The Ministry of Health indicated it relies on local research studies to estimate prevalence, citing rates of 7% to 9% for antenatal depression and 6.8% to 10.4% for postnatal depression.

• Dr Lim Wee Kiak asked the Ministry of Health for annual data on MediSave claims and amounts used for elective treatments in accredited Malaysian hospitals.
• Dr Lim also asked whether MediShield Life could be expanded to cover healthcare bills in Malaysian hospitals with approved partnerships with Singaporean hospitals.
• Health Minister Ong Ye Kung responded that MediShield Life is designed for local public hospital subsidies and is not extended overseas, though MediSave can be used for overseas elective treatments, with about 250 claims annually averaging $3,400 each over the past three years.

• About 650 pre-enlistees, or 2.7% annually, have been exempted from National Service since 2010 due to severe mental health conditions to ensure safety.
• Exemptions are determined by SAF medical doctors using guidelines from public healthcare psychiatrists, with inputs from private doctors considered.
• The Minister did not provide specific data on individuals who voluntarily serve despite exemption or their completion rates.

• Ms Ng Ling Ling proposed allowing family members' MediSave to cover nursing home fees for elderlies with advanced-stage dementia after subsidies, especially for sandwich families with studying children.
• Minister Ong Ye Kung outlined existing support: means-tested subsidies of up to 75% for nursing home care and 80% for home care, MediSave Care withdrawals up to $200 per month for severe disability, and long-term care insurance like ElderShield and CareShield Life.
• For those still facing financial challenges, the Minister advised applying for financial assistance through schemes like MediFund.

• Mr Darryl David raised concerns about wrongful insurance claims by doctors and asked how patients needing legitimate claims are protected, as well as whether outpatient procedures could be made claimable to prevent unnecessary inpatient admissions.
• Health Minister Ong Ye Kung stated that the Ministry of Health (MOH) enforces a robust framework against wrongful claims, detected through whistleblowing, complaints, or analytics, and ensures that patients are not affected when errant claims are rectified.
• MOH encourages treatments in outpatient or day surgery settings when clinically appropriate and does not support admissions solely for insurance claims, while allowing MediSave and MediShield Life claims for selected outpatient treatments.
• The Ministry continues to review healthcare financing schemes to meet Singaporeans’ needs and maintain the sustainability of healthcare costs.

• Dr Tan Wu Meng asked whether a survey has been done to assess healthcare workers’ off-duty work and how such realities are recognized without undermining flexible work arrangements.
• Minister Ong Ye Kung reported that most medical residents stay within an 80-hour workweek, but some complete administrative tasks after hours when not busy with patients.
• He noted that high patient loads and aging demographics pressure the system, and balancing workloads may shift tasks to others or reduce patient care.
• The government aims to manage workload by expanding teams, fostering teamwork, enhancing efficiency, using technology, and encouraging good health.

• The Health Promotion Board will continue efforts with healthcare partners to raise awareness and address barriers to breast cancer screening, with mammograms fully subsidised for eligible Singapore Citizen enrollees under Healthier SG.
• The Ministry of Health is assessing the clinical and cost-effectiveness of selected cancer genetic tests among high-risk populations, and subsidies will be provided for tests found to be effective.
• National data shows that while 75% of women aged 50 to 69 have ever been screened, only 35% undergo regular biennial mammograms, indicating a need for increased uptake.

• The Ministry of Health regularly reviews and adjusts MediSave withdrawal limits, with recent updates including a $700 limit in 2021 and full MediSave use for HealthierSG chronic disease program copayments in 2023.
• MediSave is designed to support significant healthcare expenses over a lifetime, particularly in old age, but current schemes like MediSave 500/700 and Flexi-MediSave allow for more flexible outpatient use.
• The government receives about 1,500 annual appeals for exceeding MediSave limits, approving around 40% of these based on genuine affordability concerns, out of roughly 1.4 million Singaporeans using MediSave yearly.

• The MediShield Life Council is conducting a comprehensive review to ensure coverage keeps pace with rising medical costs and evolving healthcare needs, with details expected later this year.
• The government is enhancing advisory support to help Singaporeans make informed choices about Integrated Shield Plans, including publishing premium comparisons and working with agencies to improve consumer education.
• Efforts are underway to address public hospital capacity constraints, such as increasing beds and manpower, while also studying the potential portability of Integrated Shield Plans, with findings to be shared by year-end.

• The Minister outlined that mpox Clade I has not yet reached Singapore but is expected to arrive, with characteristics including transmission mainly through close physical contact, a low reproduction number (R~1.3), and a case fatality rate of about 3–4% in Africa—though likely lower in Singapore due to better healthcare and past smallpox vaccination providing some immunity.
• Singapore’s response plan includes digital health declarations and screening for travelers from high-risk areas, enhanced surveillance and isolation protocols for suspected cases, contact tracing and quarantine of close contacts, and contingency measures for schools and preschools similar to those used for hand-foot-and-mouth disease.
• Vaccination will be targeted rather than population-wide, focusing on healthcare workers and close contacts of infected persons using the existing JYNNEOS vaccine supply, with plans to procure more doses, while masks are not currently recommended for the general public unless evidence of significant respiratory transmission emerges.
• The Minister emphasized that mpox is not expected to require broad safe management measures like those during COVID-19, stressing personal responsibility and hygiene, and noted that enhanced surveillance will be implemented in settings like foreign worker dormitories, eldercare homes, and camps.
• In response to supplementary questions, the Ministry will provide public information on symptoms, encourage early medical attention, use the GP network for community monitoring, and acknowledged that undetected cases may enter Singapore due to the long incubation period, but the virus’s low transmissibility reduces the risk of widespread community spread.

Nadia Ahmad Samdin asked about the top symptoms leading to referrals at the Menopause Centre and the possibility of screening for perimenopausal and menopausal symptoms under the Healthier SG movement. Ong Ye Kung responded that the most common symptoms for referrals include hot flushes, poor sleep, mood disorders, vaginal dryness, and sexual problems. He emphasized the importance of the primary care doctor-patient relationship under Healthier SG, stating that women experiencing menopausal symptoms should consult their doctors for appropriate assessment and management.

Assoc Prof Jamus Jerome Lim raised questions about the role of the Health Sciences Authority in the importation of generic medicines into Singapore, including whether guidance is provided and the criteria used for approval. Ong Ye Kung responded that the import of generic medicines is encouraged after original patents expire, but all medicines must undergo evaluation and approval by the Health Sciences Authority to ensure safety, quality, efficacy, and compliance with Good Distribution Practice standards before they can be supplied in Singapore.

Gerald Giam Yean Song asked the Minister for Health about the measurable public health benefits of the SG Arrival Card system, including traveler health reports and follow-up actions. Ong Ye Kung explained that the system is essential for monitoring infectious diseases like Yellow Fever and Ebola, enabling early detection and risk reduction for Singapore. Approximately 240 travelers with reported symptoms are assessed monthly, with quarantines for those lacking valid vaccination certificates from endemic areas. The Ministry will update the health declaration process as new infectious diseases emerge, emphasizing the continued need for such measures while risks exist.

Syed Harun Alhabsyi asked the Minister for Health about the five-year trend and current waiting times for entry into nursing homes for respite care services. He also inquired about differences in waiting times for patients with general needs, psychiatric care needs, and intellectual disabilities. Ong Ye Kung stated that this question has been answered in writing in the Official Report dated 6 August 2024.

Leong Mun Wai asked the Minister for Health about the proportion of Singaporean nursing graduates employed in public hospitals and their median salaries since 2020. Ong Ye Kung responded that approximately 70% of registered nurses were working in the public healthcare sector between 2020 and 2022. Fresh nursing graduates in public hospitals can expect starting salaries ranging from $2,050 to $4,050 per month, depending on qualifications, excluding additional allowances and bonuses. The Ministry of Health does not gather salary data from the private healthcare sector.

Hazel Poa questioned the Minister for Health about the median waiting times for new specialist outpatient appointments in oncology and for cancer treatments. Ong Ye Kung provided the median waiting times for 2023 but noted that the Ministry of Health does not track waiting times for cancer treatments, as they are not considered meaningful indicators. He explained that waiting times for chemotherapy, radiotherapy, and surgery vary based on cancer type, stage, and other patient-specific factors, including potential delays chosen by patients.

Gan Thiam Poh queried about the percentage of citizens converting to CareShield Life, the potential extension of participation incentives beyond 2024, and ways to simplify the conversion process. Ong Ye Kung reported that over 304,000 Singaporeans born before 1980 have enrolled, with about three-quarters upgrading from ElderShield. The government has opted to provide a time-limited participation incentive to encourage early sign-ups, offering up to $3,000 over ten years for those who enroll by December 31, 2024. A final extension of the incentives was introduced last year to further promote enrollment.