Motions · 2023-05-09 · 第 14 届国会
支持后疫情时代医疗保障
Supporting Healthcare
议员Tan Yia Swam质询医疗体系在后疫情时代的可持续支持，强调医生与患者关系的复杂性及医疗资源有限。她呼吁政府采取全方位措施，关注医疗支出、慢性病管理及医疗服务质量。辩论聚焦医疗费用、患者权益与医生责任的平衡，体现对医疗系统长期发展的关切。
关键要点
- • 医生应关爱患者
- • 患者更自主质疑医生
- • 医疗支出需持续支持
推动全政府医疗支持
"Why does anyone stand up to advocate for certain causes? We want to leave behind a better world than what we were born in."
参与人员（6）
完整译文（中文）
Hansard 英文原文译文 · 翻译日期：2026-05-02
副议长女士：陈雅琛博士。
下午4时01分
陈雅琛博士（提名议员）：女士，我提议，"本院承诺支持超越新冠疫情的医疗保健工作，以及政府整体努力以提供持续且稳定的支持"。
【程序文本】*该动议亦由阿卜杜勒·萨马德先生和莎希拉·阿卜杜拉博士联署。【程序文本】
我声明本人为私人执业的乳腺外科医生，并担任新加坡医务委员会指定委员及新加坡医学会副会长等多个医疗领导职务。更重要的是，我以一名有年迈父母和岳父母的女儿身份，以及有患病子女的母亲身份发言。请允许我用普通话说几句话。
（普通话）：【请参阅方言发言】俗话说，“医生有父母心”。医生应像父母对待子女一样，关心和关注患者。医生应终身保持这种心态。然而，患者不一定愿意一辈子被当作孩子对待。孩子年幼时无知，会服从父母的指令；长大后，会开始反抗父母的指令。
三十年前，患者通常会听从医生的话。但现在，由于科技进步和信息获取便利，越来越多患者会质疑医生的诊断或指示，甚至挑战医生。
（英语）：为什么有人会站出来倡导某些事业？我们希望留下一个比我们出生时更美好的世界。
我倡导医患关系。作为患者，我希望医生关注我的最大利益，而不必担心被不公正投诉或起诉。作为医生，我希望专注于患者的病情、需求和愿望。
但生活比这复杂得多。许多其他因素影响这种关系——不同的求医行为、不同的健康信念、融资模式、对结果的期望、客户服务、社交媒体营销、寻求盈利的商业实体等。
我为何推动政府整体努力？医疗开支是国家预算中的第二大项。强调建设更多医院、综合诊所、健康新加坡计划及招聘人员——这些不能无限制持续下去。
当前热点新闻是关于癌症药物清单，我分享一些令人警醒的健康统计数据：每年26%的死亡归因于癌症；每年20%的死亡归因于肺炎；每天有20人死于心脏病发作或中风；每天有4人因糖尿病截肢；新加坡糖尿病引起的肾衰竭居世界首位；60岁以上每10人中有1人患痴呆症；每10人中有1人患精神疾病；三分之一的绝经后女性患骨质疏松——若发生髋部骨折，五分之一会在一年内死亡。
这些是我们医疗界熟知的事实。健康新闻杂志经常报道，但人们不关心，直到事情发生在自己身上。大多数人只有生病时才接触医疗，这时已为时过晚。
人类记忆短暂，这就是为何制度必须记住并传承教导。
感觉全国乃至全球在新冠疫情后都已向前迈进。但回顾疫情历史，下一次疫情终将到来——可能十年后，也可能五年后。我们需要为下一次疫情、银发浪潮、心理健康危机做好准备。医疗保健必须是全球、国家的整体政府努力，而不仅仅是卫生部的工作。
我呼吁大家改变思维方式。我呼吁每个部门、每位政府官员、每位公务员——事实上，任何正在聆听的人——都应思考如何更好地教育人民照顾健康、预防疾病。
接下来，支持医护人员——这意味着什么？不能只是一次性的快照、一次性健康活动、一次“感谢”运动或一枚奖章。定期调整薪资以匹配通胀和生活成本上涨至关重要。但更重要的是，对医护人员的支持应是深植的尊重和对我们工作的认可。
我们许多人视工作为使命。我们承诺照顾患者。这不仅仅是一份工作。就像保护国家的武装部队一样，医护人员保护人民的健康和福祉。这不仅是买卖交易。
那么医护人员想要什么样的支持？回到我关于亲子关系的比喻。我希望医患关系是相互关爱和尊重的。我们不能只在父亲节或母亲节那一天爱父母，对吧？这应是一个持续的过程。考虑我们的意见，倾听并让我们参与决策。
我已说明为何需要超越疫情支持医疗保健，及为何需要政府整体努力。现在我分享三个大策略：一、识别并承认问题；二、各级教育；三、跨部门协作。
让我讲个有趣的故事。十多年前，作为一名初级医生，我记得有一天手术室发生小骚动。我们被告知召回手术单，以清理等待手术的患者队列。我质问原因，被告知“部长要来视察”。
我当时很愤慨，告诉主管护士，“让他看看，让他看看我们多忙。”当然，我被赶走了，接待团带他参观。我是个愤怒的年轻医生，但我决心学会成为更好的变革倡导者。
领导者需要深入基层，医护人员需要学会更好地为自己发声。也许我们天性不愿承认失败或求助，因为这意味着软弱，而我们决心为患者坚强。这或许是为何许多人工作至极限。
过去两年，主流新闻和社交媒体大量关注床位短缺、初级医生和护士长时间工作、欺凌和骚扰，但我告诉你，这对我们来说并不新鲜。
走廊床、帐篷内的临时床位、将日间手术床转为急症床。另一个故事——有一次我值班，半夜接到科主任电话，紧急找出明天可出院的患者，因为急诊部有50多名患者等待床位。
有些患者适合出院，但常见的社会请求是留院至周末，因为子女无法请假接送，或需等帮佣抵新加坡。因此，我不是做手术，而是在做床位管理，还被家属骂无情。然后，当我去处理新患者时，又被骂让他们等太久。
一次值班从早上8点开始，次日早上8点结束，接着全天工作至后天下午6点。我们每月值班六到八次。80至100小时工作周并不罕见。医生、护士、实验室技术员、快递员、护理员——医疗系统中的每个人都尽力满足需求；有时，我们无法做到。
有多少人曾去厕所哭泣躲避？有多少人选择离开？
过去几十年，我们见证了问题的起伏。取消收费指导方针，加上按实际收费计划，导致成本飙升，原因多样，我们仍在多边医疗保险委员会（MHIC）努力解决。住院医培训变革，导致导师流失，培训生归属感下降。培训时间缩短，部分专科受影响。
医疗私有化和商业化是“必要之恶”。必须有人确保有资金维持可持续经营。但当医护人员被管理者视为商品时，这又是对医患关系的负面影响。
目前，我们面临新问题。私营部门因租金、人力成本及商业实体压力，经营成本上升；IT系统持续问题；经验丰富的护士、辅助医疗人员甚至医生流失。
我曾谈及健康和替代医疗服务，这些服务未受监管，有时弊大于利。谷歌使用不当导致搜索引擎优化文章质量差，进一步加剧医患脱节。
一些家庭医生表达了对健康新加坡计划的疑虑。许多医生担忧总额付费模式、药物白名单影响及实际支付给全科医生的费用，可能无法覆盖运营成本。
我并非说这些不好。我说医生对这些变化感到担忧。我们经历过带来不良后果的变革，当别人规定我们如何行医时，我们感到无助。
我们应从过去错误中学习，避免重蹈覆辙，但人类记忆短暂，少有人有时间或决心深入历史。
政治官员来来去去，但大多数医生和护士是一生的职业。任职最长的卫生部长是颜金勇先生，任期10年，我感谢他与我们行业保持的温暖支持关系，翁毅康先生也善意延续了这一关系——希望未来也如此，在我发言之后。
没有人全心全意关注医疗系统。医生做临床工作。临床科学家做研究。护士照顾患者日常需求。许多人对“系统”感到不安和不满，但没有人专责评估和改进系统。
反而，其他服务行业的专家被引入提供意见，收取咨询费——然后离开，而我们却拼命努力，痛苦不堪。即使我为私营部门、Shield计划、企业保险、礼宾服务、第三方管理员（TPA）多次游说，许多人听了却未必在意。
遗憾的是，连我自己的医生也未密切关注我的倡议，仍重复旧有抱怨。有些人知道但不敢行动，可能害怕若不遵守TPA规则会失去生计。TPA已介入医患关系。我常对同行说，企业应盈利是常识，但我们绝不应从人的痛苦中牟利。
医疗服务提供者处于两难境地——政府医院因等待时间长被投诉，私营医院被指收费过高。
患者期望极高。我们都想要完美——便宜、快速且优质。
我多次为重组医院背书。我们都曾在那里受训和工作，它们提供优质护理。有时沟通不够清晰或亲切，仅因团队规模庞大。
我认为重组医院便宜且优质，但快速难以做到。我请求公众理解。重组医院是教学医院。我们都从某处开始。我们通过导师指导学习，检查小肿块，做首次手术。
患者绝非实验对象。有主治医师领导，有专科医生负责您的医疗过程。遇到有爱心的年轻医生时，我希望您帮助医生成长。
如果经济允许，有些人会选择私立医院，因为服务更个性化，通常更快，且因团队较小更具隐私。但我请求您理解，每位医生都经营着业务，采用不同模式，承担不同成本。如果您找到信任的医生，沟通透明，我希望您也给予他所需支持。
我列举了一系列长期存在、复杂且系统性的问题，不指望任何人能解决。
请继续听我谈教育和跨部门协作的看法。
人们学习方式多样。我认为最常见的是频繁接触和重复。我们经常吃饭，对吧？一天三次，甚至五次或更多。新加坡人热爱美食。如果我问鸡饭，必有激烈辩论，比较烧鸡与蒸鸡，姜、辣椒。爱好者甚至知道不同店铺的具体收费：额外辣椒、额外饭、升级鸡腿肉的价格。
但有多少人需要大手术或因重大疾病住院？
有些复杂病患反复住院，医疗团队随着时间了解患者及家属。这类家庭通常也很清楚治疗费用。
但大多数人首次重大疾病时，是第一次必须在医院就医。那时才知道医疗费用昂贵，已非好时机。患者担忧癌症诊断、生存率、治疗副作用及并发症、工作与家庭责任。
许多人不了解新加坡治疗费用，初见账单震惊。我处理开胸手术账单时就是如此。
医疗融资极其复杂，新加坡有多重安全网——公立与私立部门。谁付钱？纳税人资金、保险池。存在多种共付和补贴层级。问题是大多数健康人不关心这些，直到遇到健康问题。
若是择期手术，有时间进行财务咨询、预授权等。但紧急情况，团队先行施救。患者及家属可能背负巨额债务。或医院冲销坏账——虽不常见，但确实发生，如无医保的外劳仅有意外险，保障不足。当地人亦可能不熟悉所购产品，无论是住院、重大疾病或早期癌症计划，可能不了解除外条款或保障限额。
我是在近三年才学会这些术语和知识，讨厌必须了解它们，因为分散了我照顾患者的精力。但这是必要的。我三月时谈过，保险公司应与医疗提供者建立更紧密合作关系，让患者更有经济保障。
人们需要学会如何导航我们的医疗系统。几年前，我开设博客，专门介绍如何进入医疗系统、不同路径及优缺点。但我无法持续，其他事务优先。此后见过几篇写得好的文章，无需重复发明轮子。收集这些，建立中央资料库，作为所有新加坡人的主要参考。
人们不主动关心，直到事情发生在自己身上。看看全球变暖，普通人是否担忧？即使面对气候变化证据？人们是否担忧生育和早育？直到尝试生育遇到困难？我知道大多数患者直到出现症状或听闻朋友同事确诊乳癌才担忧。人们只有在事情影响自己时才关心。
我希望我的孩子长大后能自我负责。同样，我相信我们每个人都能为自身健康负责，但需要被赋能，知道如何做。
人类是情感动物，但有思考能力。学会调节情绪、用理智思考是宝贵技能，应从小培养。我认识一些成年人仍在挣扎。我不能低估科学和逻辑框架在解决问题中的重要性。恐惧、愤怒、忧虑、喜悦都是正常情绪反应，但我们必须学会调节。太多患者因焦虑瘫痪，影响治疗过程。
某些疾病研究充分，进展清晰，例如乙型肝炎导致肝癌，乙肝疫苗有效。其他多因子疾病，如大多数癌症和心血管病。仅因我吸烟，不代表必得肺癌。同样，不吸烟也不保证永不患肺癌。事情没那么简单，没有灵丹妙药或“免死金牌”。
肥胖、中风、心脏病发作——我们称这些为“生活方式疾病”，因为每天我们都会在饮食和活动水平上做出小的决定，这些决定会积累成疾病或预防疾病。有些疾病是隐匿性的。我们是否能识别心理健康问题，还是直到出现自残等警示事件时才被发现？
可预防的创伤是我们可以改进的另一个巨大领域。提高儿童安全座椅的意识、所有道路使用者包括行人和骑行者的道路安全意识、驾驶执照的更严格规定、为紧急车辆让路、工作场所安全。
有太多东西需要教授，也有太多东西需要学习。教育不能仅仅归属于教育部（MOE），正如健康不应仅仅是卫生部（MOH）的领域。我坚信，从婴儿期开始并贯穿我们的学校和工作成年时期的教育，将是实现良好可持续健康的关键。我很高兴翁部长上个月表示，卫生部将与教育部和社会及家庭发展部（MSF）合作，为我们的年轻人奠定坚实的健康基础。
我对婴儿在看着iPad时被喂食的频率感到震惊。研究表明，屏幕时间对大脑发育有不利影响。婴儿无法很好地识别人脸并发展社交技能，导致后期执行功能和高级功能出现问题，如注意力集中、冲动控制和情绪调节。我见过越来越多20多岁的年轻成年患者有此类问题，我对未来几代人深感担忧。
教授技术的适当使用不仅针对年轻人，也针对成年人。关于日益复杂的金融诈骗新闻层出不穷。与健康相关的趋势包括声称能奇迹般治愈癌症或保证减肥的疗法。我见过患者尝试黑蒜饮食、芦荟、碱性水、负离子服装。清单无穷无尽。
我称之为伪科学，因为其中有一丝真理。有一个实验显示该物品具有杀死培养皿中少数癌细胞的某种特性。对我来说，这就像观察到“嘿，蚂蚁能用叶子漂浮在水面上！因此，如果我用大叶子，我可以用它航行穿越海洋！”我无法专业地将此类研究推断为能治愈癌症，而一些销售人员却这么做，脆弱的患者会尝试，甚至有时放弃经过验证的治疗。
在疫情期间，疫苗犹豫和大型制药阴谋论对公共健康产生了直接负面影响。互联网连接拉近了人们的距离，但也让错误信息泛滥。人们依赖口碑推荐，有些人使用谷歌评价，但有些人不知道这些评价可以被购买或伪造，或者存在恶意营销机构故意给竞争对手差评。
那么，教人们如何使用谷歌和人工智能（AI）作为工具的责任是谁的呢？感觉这不应该是政府的工作。那就由个人自己负责吧。
励志演讲家吉姆·罗恩说过，“你是你花最多时间相处的五个人的平均值”。我用这句话定期审视我的个人和职业成长。每当我感到停滞不前时，就是时候审视并做出改变，走出舒适区，学习新事物。不要过于安于现状，陷入回音室。
终身学习是一项挑战。那么我们如何培养人们这种心态呢？这引出了我的下一个观点：跨部门协作。
我认为新冠肺炎多部委工作组是一个很好的平台，领导层可以讨论并分享快速变化情况下的及时信息，并协调政策方向。当然，向下传递过程中存在问题，因为人毕竟是人，我们的反应各异。用《龙与地下城》的说法，有人是守法善良，有人是混乱邪恶。有些人严格遵守法律条文，有些人遵循法律精神。有些人利用他人的绝望牟利，有些人自私任性地按自己的规则生活，不尊重所处的社会。
新加坡政府结构复杂：分为16个部委，进一步划分为部门、司局和50多个法定机构。不同部委的人会相互交流吗？还是有非常严格的协议规定如何提出新想法？我之所以问，是因为我曾作为员工在一家重组医院内部工作，知道存在明确的层级流程。即使现在，我也只与卫生部的某些人员有过交流经验。
我知道公务员系统中各级都有非常聪明且敬业的人。我知道有热情且关怀他人的人，他们积极参与各种团体、慈善和社会企业。生态系统蓬勃发展，但我怀疑是否存在过多中小型团体。我们能否整合这些资源？
我们每个人可能都是某一领域的专家，但我们不知道自己不知道的东西。
通过参与心理健康产业委员会（MHIC），我有幸跨行业建立网络，结识保险公司、理财顾问、精算师，并从他们的角度讨论医疗问题。作为临床医生，我谦卑地意识到自己之前对医疗融资知之甚少。我再次提起盲人摸象的故事，每个人只触摸自己能触及的部分，却争论大象的样子。因为事实如此——我们不知道自己不知道的东西。
我现在挑战大家跳出常规领域，思考如何运用你的知识更好地支持医疗，无论你身处何处。你们听到了我作为医生、医疗领导者提出的问题。你们能帮我吗？
我恭敬地分享一些如何将未来政策与医疗方向对齐的想法。正式工作组显得非常结构化。我相信，当志同道合的人随意讨论时，头脑风暴和协同效应可能创造出更好的成果。
从小做起，早期儿童发展局和教育部可以与卫生部紧密合作，确定年轻新加坡人应学习的关键基础健康信息。挑战不在于死记硬背，而是如何获取信息更新，因为一些科学突破发展迅速。
我小学时学的食物金字塔现已过时，取而代之的是健康餐盘模型，当前营养和健身研究倾向于低碳水化合物饮食配合抗阻训练。谁知道未来研究会显示什么？
教孩子们如何正确饮食，培养定期锻炼的习惯以保持健康体重。小学已做了大量心理健康教育和安全、适当使用社交媒体的工作。这些也可以推广给未在互联网时代成长的成年人，让他们学习网络礼仪和安全知识。
引入并强化家庭医生的理念及优质初级护理的重要性。教授如何导航医疗系统，如何获得补贴护理以及不同类型保险的作用。
社会及家庭发展部（MSF）在建设强大家庭的使命中，也可以与教育部和卫生部合作，塑造性教育，指导家庭如何进行关于道德、宗教信仰和身份的艰难对话。可以咨询教练行业，尤其是专注于性咨询的教练。
教导年长青少年和高等教育学生关于为人父母的旅程，其诸多喜悦与困难，使年轻夫妇能够做出知情的婚姻决定，权衡生育与否的利弊，以及何时生育；是在20多岁、30多岁还是40多岁？
进入职场后，我们常常忽视自身健康以追求事业。在长时间工作或轮班中，我们养成不健康的饮食习惯和不规律的睡眠时间，不知道如何安排锻炼时间。有多少成年人在五年或十年的工作生活中注意到体重增加和疲惫？体重悄然增加。
新加坡男性每年需通过个人体能测试，但女性可能没有健身基准。存在一种“瘦胖”现象，即体重在健康范围内，但肌肉和骨量较低。
我认为这是各部委可以为健康做贡献的地方，通过持续教育饮食和锻炼、筛查和疫苗接种以及赋能成年人。
对于人力部（MOM），研究如何在工作场所培养健康习惯；咨询健身行业；让负担得起的健康食品易于获取；鼓励10至20分钟的简单办公室或椅子锻炼；让老板推行此类健康实践；教导员工屏幕时间限制和心理休息的重要性；研究弹性工作时间，以便员工优先安排个人、家庭和医疗预约时间；考虑健康激励措施；与卫生部、新加坡消费者协会、新加坡金融管理局合作，调查企业保险支付不足和第三方管理员（TPA）施加的面板限制的投诉；帮助员工获得优质护理。
文化、社区及青年部、社会及家庭发展部和通讯及新闻部（MCI）可能是促进各部委跨部门协作的理想推动者。好的想法、内容和项目可以得到所有部门的支持，而不是每个部门都试图独立开展项目。
举一个例子。如果你在谷歌搜索“新加坡如何减肥”，会出现什么？健康交流（HealthXchange）、健康中心（HealthHub）、健康促进局（HPB）的文章被美容诊所、水疗中心和健身房的广告文章淹没。一篇优质文章配上好视频，可以在不同部委和各种社交媒体平台广泛分享。重复传播相同的基本健康信息：正确饮食、每天锻炼、保护心理健康，无论你在哪个部门，是社会支持、青年还是体育。
感谢国土发展部为湖滨花园新建的滑板公园。我希望你们继续将体育融入社区。你们知道新加坡的城市景观被国际认可为跑酷天堂吗？但跑酷者经常被居民驱赶，居民认为他们在破坏环境，警方也被叫来驱赶他们。我希望新加坡能给予跑酷社区更强有力的支持。
可持续发展与环境部（MSE）供应水和安全食品的使命，也可以扩展到更实惠的新鲜农产品，因为食用全食物比加工食品更有益健康。食品安全标签由新加坡食品局（SFA）监管，隶属于MSE，但营养标签由健康促进局（HPB）监管，隶属于卫生部。我在网上找到了一本64页的手册。我认为即使饮品被评为“C”或“D”，人们仍然大量购买珍珠奶茶！
值得称赞的是城市农业的兴起，得到了新加坡土地管理局、新加坡城市重建局（URA）、农粮兽医局、新加坡食品局、动物与兽医服务局以及建屋发展局（HDB）等国家机构的支持。我希望没有遗漏任何机构。这带来了食品安全的开端，以及与自然共事、学习种植和食用有机食品的健康益处，这将是持久的。
信息技术（IT）在许多方面仍是巨大挑战。我在之前的演讲中提到，电子健康记录有时不过是微软Word文档或扫描存储的PDF文件。系统笨重且不直观。生命体征仍需手动输入。我的患者试图在HealthHub、Healthy 365和Health Buddy中查找手术组织学报告，但都找不到。
我不知道如何实现，但请通讯及新闻部（MCI）、GovTech、综合健康信息系统（iHIS）及其他IT法定机构协调，建立一个良好的国家系统？我设想使用Singpass和HealthHub，配合触发问题提醒个人重要健康检查点：身高体重、健康筛查、疫苗接种、预约。
医疗旅游是一个复杂的国际问题。贸易与工业部（MTI）会否研究这如何可能增加本地医疗成本，但仍帮助新加坡保持作为优质医疗领先地位的声誉？我仍对医疗礼宾业务深感不安，他们向医疗服务提供者收取费用以引入外国患者。
MTI会否协助卫生部吸引新加坡人从事医疗必需岗位？研究医疗人员的招聘、培训和留任。人力资源管理至关重要，不是将人视为商品，而是真正建立良好的工作关系，使他们感到被重视并长期留下。
复杂的医疗状况由多学科护理团队管理。我将类似概念应用于我们的医疗系统问题。跨部门协作；与医疗服务提供者接触；跨部委和行业走出舒适区。
适当的咨询工作报酬值得考虑，并逐步建立网络。我非常关注成本，理想情况下，如果能依靠志愿者，那很好，但我也意识到这可能导致同一批热心人被反复调用。
建立一个智囊团，所有部委都能访问并在全球问题上进行简短咨询，而非零散地向组织提出请求。
最后让我总结。我已说明为何医疗应是全政府关注的事项，而非仅卫生部的责任。我列举了医疗中的长期问题，强调了多层次教育的必要性，并呼吁大家跨部门协作。
我的老朋友曾说：“别假装你想让人们健康。你们医生想要更多病人，对吧？有生意！”
不！理想情况下，我想照顾那些尽力而为仍然生病的患者，而不是那些因缺乏知识、资源或自我照顾而忽视自身健康的人。让我们共同努力减少可预防疾病的数量。这才是真正的成本节约。保持健康是我们每个人的责任。要有教育并保持信息更新。
作为社会，我们应当友善且有公民意识。那些在新冠疫情期间囤积医疗物资并试图牟利的人，羞愧吧！作为医生，我平等照顾所有患者。但当重症监护病床满员时，谁更应得到照顾？
疫情让每个人都深刻意识到资源有限——口罩、抗原快速检测包、氧气。这是生活的现实。资源有限，谁来做守门人决定谁最需要？
医疗工作者需要政府帮助制定这些政策。我们需要每个人优先考虑健康。不要逼我们进行分诊决定救谁。我期待一场激烈的辩论。[掌声]
[(程序文本) 提出问题。 (程序文本)]
副议长女士：沙希拉·阿卜杜拉博士。
下午4时31分
沙希拉·阿卜杜拉博士（提名议员）：在开始之前，我想声明我是就职于邱德拔医院的正畸医生。
副议长女士，我们目前处于疾病爆发应对系统绿色状态，这是自新冠疫情开始以来的最低健康警戒级别。新冠疫情对世界产生了深远影响，医疗工作者在为需要者提供关键护理方面发挥了重要作用。随着我们开始走出疫情，显然我们需要继续优先支持医疗工作。
本动议承认医疗在社会中的重要性，旨在确保医疗工作者和患者都能获得他们茁壮成长所需的支持和资源。它建议采取全政府方法，建设一个更健康、更有韧性的社会。
超越疫情，展望未来，我想谈三个需要我们持续关注和支持的领域：首先，医疗人员短缺，这与医疗工作者的倦怠和心理健康有关；其次，为我们的外来劳工提供牙科护理；第三，支持特殊护理和老年牙科领域。
首先，医疗人员短缺。医疗工作者一直面临巨大压力、情绪挑战和艰难的工作环境，工作时间长且不可预测，存在受伤和疾病暴露风险。这些因素可能导致倦怠和心理健康问题，即使在疫情之前也是如此。
虽然短期措施如咨询和心理健康项目至关重要，但必须解决倦怠和心理健康问题的根本原因。
这需要解决系统性问题，如工作量、工作与生活平衡、支持、培训和职场文化。其核心实际上是人力短缺，卫生部已在努力解决。
然而，即使在全球范围内，医疗人力资源也存在竞争。新加坡外籍护士的流失率显著上升，从2019年的9.5%增至2022年的14.5%。
在今年的供应委员会（COS）演讲中，高级议会秘书拉哈尤·马哈赞女士提到：“本地和外籍护士流失到竞争国家，是导致护士压力大和工作量高的关键原因。我们需要替代流失到其他国家的人力，保障护士福利，并满足日益增长的需求。”如果我们更进一步，我们需要确保我们的医疗工作者得到支持，并拥有提供最佳护理所需的资源，我们需要在系统中建立“缓冲”或余地。
我有一些关于如何留住和吸引医疗人力的建议。
第一：给予表现良好的医疗工作者的直系亲属永久居民身份。卫生部支持提名议员陈雅森博士提出的建议，即给予表现良好的外籍医疗工作者永久居民身份。对于这些表现良好者，我们能否更进一步，自动给予他们的直系亲属，即配偶和子女永久居民身份？
我知道我工作场所的几位牙科护士因这个原因离开。经过多次申请后，她们最终放弃，选择带着全家移居加拿大、新西兰和澳大利亚等地。如果我们给予她们家属永久居民身份，她们将在新加坡扎根，失去她们的可能性将降低。当我们失去表现良好者，尤其是资深者时，我们不仅失去一名员工，还失去他们在医疗系统中的多年经验。
第二：确保薪酬在本地和国际上具有竞争力。新加坡公共医疗部门已于2022年将护士基本工资提高了5%至14%，并提供留任奖金。我知道卫生部定期监测我们薪酬的本地和国际竞争力。薪资可能不是医疗工作者唯一的决定因素，但对于许多人选择职业路径时仍是重要考虑，尤其是在护理工作需求巨大的情况下。它也能激励外籍医疗工作者继续在新加坡工作。坦率地说，更高的薪酬待遇总是有帮助的。
第三：灵活工作安排（FWA）。这是陈武明议员在COS辩论中详细谈及的，我无法过分强调其重要性。医疗工作者也是母亲、父亲、女儿和儿子。他们可能有年迈的父母或年幼的子女。是的，医疗工作者已有灵活工作安排。然而，卫生部和人力部可以合作，提出更多创造性的灵活且家庭友好的人力资源工作实践，适合医疗工作者不同人生阶段及各医疗环境的独特需求。例如，除了错峰班次外，我们可以考虑灵活的班次长度，将班次分割为更短的安排时间，或为医疗工作者提供更多带薪假期。
第四：提升公众对医疗工作者的尊重。公众应理解医疗工作者不仅是需要顺从患者要求的交易性服务提供者。对虐待或威胁应零容忍。因此，我对我们在这方面取得的巨大进展以及三方工作组防止虐待和骚扰医疗工作者的建议感到鼓舞。我的提名议员同事拉杰·约书亚·托马斯先生将进一步就此话题发言。
第五：通过提供更广泛的支持和帮助改善家庭护理环境。为减轻医疗部门压力，照顾者是居家养老的基础。然而，我从亲属处目睹了这条路的艰难。
我们可以考虑的一个简单措施是实施更多包含照顾者的人力资源工作实践，并增加长者护理假，这一建议此前已有提出。另一个是各部委如何协作，确保已感到压力山大的家庭能顺利了解不同的护理选项和可用补贴，确保每个即将开始这段旅程的家庭都能联系到医疗社工，进行需求评估并提供指导。这样，在照顾长者需求的同时，我们也应关注照顾者自身的需求评估，避免忽视他们的心理健康自我照顾或他们自己年老时的经济保障。
其次，我想谈谈为弱势群体，特别是外籍劳工、老年人和特殊需求人群提供牙科护理的重要性和服务。牙齿健康是一个容易被忽视但非常重要的健康方面，现代研究显示口腔健康与全身健康及生活质量有关。例如，牙龈疾病可增加糖尿病、感染性心内膜炎及其他血管疾病的风险。因忽视导致的牙痛也可能使人虚弱。我们不能忽视口腔健康及其对整体健康和生活质量的影响。
然而，对于外籍劳工，即使牙科治疗被认为必要，雇主也必须承担治疗费用，而牙科治疗费用可能很高。
目前，初级保健计划确保符合条件的外籍劳工能获得可负担的医疗服务。我建议将牙科护理也纳入外籍劳工服务范围。护理不必涵盖所有牙科服务，如常规洗牙和抛光，但应针对紧急需求，即可能非常疼痛的牙科病例，以及感染和肿胀病例，若不治疗可能危及生命。
我现在想谈谈支持老年人和特殊需求群体。随着我们朝着“更健康的新加坡”目标努力，我们希望确保口腔健康在成功老龄化和包容性医疗中得到关注。
在开始之前，我想讲述一位同事的案例。一名严重智力障碍女性到老年及特殊护理牙科诊所接受治疗。她的行为挑战使得局部麻醉（即清醒状态下）治疗不可行。然而，全身麻醉（即睡眠状态）治疗也存在问题。风险大于收益，尤其是单颗牙齿拔除。
此外，医院政策要求对精神无行为能力成年人进行法律代理同意，获得法院指定代理人可能需数月且费用高昂。更糟的是，该女性曾在医院环境中经历过创伤。其家属权衡后选择了椅旁管理。
经过三次适应性访问尝试准备后，牙医尝试用身体约束进行拔牙，但因困难重重未能成功，治疗被终止。
这一经历凸显了患者家属在系统中导航的困难，也反映了牙医和医疗团队在治疗复杂需求个体时面临的挑战。
我想触及几个方面。
第一：与老年及特殊护理患者及其社区互动。这些群体缺乏口腔健康知识和健康目标，凸显了倡导和观念转变的必要。患者和照顾者常难以了解各种服务，不知道向谁寻求经济援助及其他支持服务。
为此，可能需要加强相关护理人员之间的跨部门合作；牙医、病房护士和照顾者等专业人员需掌握基本口腔健康知识及可靠治疗信息来源。我们可考虑审视护理实践指南，确保为住户提供的口腔护理既更新又实用。
第二：为复杂需求患者预留容量。牙医尽力协助，但缺乏护理标准指导。需要临床实践指南及护理路径，确保提供优质且适当的护理。多重健康及行为问题的复杂病例可在医院处理，较轻病例可转介至全科诊所的牙医网络。稳定后复杂病例也可转回全科医生。
第三：老年及特殊需求设施缺乏牙科护理服务。部分社区及服务弱势群体的机构已主动发展自身牙科能力。在新加坡所有护理院中，只有部分通过Unity Denticare巴士或志愿团体及机构的流动团队获得现场牙科服务。更少有护理院设有固定的实体诊所，由志愿牙医在有人力时运营。
例如，临终关怀协会在其最新的日间临终关怀中心Oasis@Outram设立了牙科诊所。
在特殊需求方面，新加坡智障人士运动（MINDS）发展及残疾医疗诊所去年成立，已开始为患者提供牙科筛查及转介服务。随着MINDS开放跨学科健康中心，该服务有潜力扩大。
然而，志愿团体间缺乏协调也是主要问题。综合护理署（AIC）协调照顾者及长者护理，但不包括牙科服务。这导致资源配置效率低下，如人力浪费，以及尚未服务的护理院需求未被满足。
虽然我们应赞扬志愿精神，但几乎所有这些服务均无成本回收机制，令此模式难以持续。若服务为长期提供，消耗品、材料及人力成本需纳入考虑。
因此，为解决这些问题，我呼吁卫生部和社会及家庭发展部更多支持不同社会服务机构发展其个性化牙科能力。现场牙科服务有多种优势。对自闭症谱系障碍者而言，去陌生场所接受牙科护理可能是困难体验。注射令人害怕，拔牙也令人恐惧。
无现场服务，患者需被送往初级保健服务，有时需昂贵的私人救护车。外部诊所治疗受限于跨机构数据共享限制、专科服务费用高昂及等待时间长等问题。因此，老年人及特殊需求者的牙科需求“就地”管理更为有利。此类诊所也能避免将资源用于选修治疗如牙齿美学，而专注于基本需求，提高效率并节省成本。
资金是支持的重要方面，牙科服务资本成本高。其他支持方面可包括行政及许可灵活性。例如，我们尝试将手持便携式牙科X光作为家庭护理拔牙的护理标准，但至今仍未获批准。
第四：利用牙科官员资源。我们仍缺乏志愿为该群体服务的牙医。为培养志愿服务精神，可安排牙科官员在履行合约期间短期派驻，服务老年及特殊需求患者。此举也可扩展至其他弱势群体如外籍劳工。希望他们合约期满后也能继续志愿服务。
总之，在我们承诺支持疫情后医疗工作并确保持续稳定支持时，不能忘记牙齿健康是实现整体健康和生活质量的关键组成部分。弱势群体如外籍劳工及老年和特殊需求人群的牙科医疗需求不应被忽视。副议长女士，我支持本动议。
副议长女士：阿卜杜勒·萨马德先生。
下午4时45分
阿卜杜勒·萨马德先生（提名议员）：副议长女士，在两位领域专家医生之后发言确实不易。不过，我感谢提名议员陈雅森博士让我参与提出本动议的团队。
作为工人阶层的代言人，我的发言将聚焦两个主要领域，即医疗工作者福利及吸引年轻新加坡人投身医疗行业的挑战——他们是我们医疗劳动力的未来。
首先，我想向本院分享，医疗服务员工工会（HSEU）和新加坡手工业及商业工人工会（SMMWU）代表护士、辅助医疗专业人员及支持人员，合计拥有超过35,000名会员。
我们呼吁尚未加入工会者尽快加入。原因很简单。工会不仅代表你们在工作场所的声音，也会为你们发声。
虽然医疗行业不在我的职责范围内，但我已联系HSEU和SMMWU的领导，了解他们成员近期及长期的关切、挑战和愿望。
通过近期疫情，我们意识到医疗工作者为新加坡默默付出多少。确实，工作时间长，且时常遭遇患者家属的辱骂。问题是，为什么只有在疫情期间我们才意识到医疗工作者的重要性？为什么必须经历疫情才能学会感激他们？
遗憾的是，这就是现实。只有在危机时期，我们才知道这些前线工作者的重要性。
就像我在电力行业一样，只有在电费上涨或停电时，我们才开始意识到稳定可靠电力供应的重要性，而这在日常生活中被视为理所当然。不要羞于承认现实。
女士，去年本院就“更健康的新加坡”议题进行了相当长时间的辩论。各位提出了许多良好建议和想法，提醒我们过更健康的生活方式。虽然重点是发展健康生活方式，但我们不应忘记那些帮助我们实现健康生活方式的人，即我们的医疗工作者。
让我们关注医疗工作者面临的挑战，包括行政和支持人员，而不仅仅是直接面对患者的医生和护士。也不要忘记放射科、病理科等其他部门支持人员同样关键的角色。
这让我聚焦于医疗工作者的福利及培养未来一代服务于此行业。
本次会议前，我不仅联系了两个工会，还联系了我网络中的朋友及亲眼见证医疗工作者辛勤工作的新加坡人。我们认可卫生部通过医院管理层已做出支持，但仍有如轮班、薪资等方面可进一步改进。
我想谈谈轮班安排，事实上，卫生部多次声明不监管此类安排，交由医院管理团队负责。因此，我呼吁卫生部设立专门团队独立监督医疗工作者的轮班安排。不要等到意外发生才开始调查。
我们需确保轮班安排充分考虑休息时间，因为我们需要时刻保持身体警觉的工作人员照顾患者和支持医生。
我对此感受深刻，因为我女儿是成千上万医疗工作者之一。我亲眼见证她过去十年在盛港医院经历的长时间工作。有时，我觉得问题不在于企业轮班政策，而是排班的直线经理可能偏向自己喜欢的员工。她最近离职，也告诉我她团队约半数同事早已离开。她现在开始新的工作旅程。
讽刺的是，她曾于2020年作为实习生在同一家医院实习，当时是共和理工学院最后一年学习。我当时震惊地得知她实习期间没有任何津贴。我之前未提出此问题，是因为我还在与行业内亲友核实。核实过程中，我回忆起多年前在某些对话会上也曾提出此问题，巧合的是，我女儿也经历了同样的情况。
我想问卫生部是否知道有实习生没有获得劳动报酬的情况。我们不要把实习描绘成像在学校上课的另一种形式。学术经历和工作经历永远不会相同。我不认为给这些学生发放津贴会让医院或卫生部的财政陷入困境，因为他们是在真实的工作环境中，而不是在学校。
我呼吁卫生部或医院立即审查此事，不要让我们的学生沦为免费劳动力。我们不要让我们的孩子，未来的劳动力，成为今天的免费劳动力来源。我们不应延续这种做法。
女士，随着新加坡在全岛建设更多重组医院，这意味着会有更多的就业机会。这将使医疗工作者能够迁移到离家更近的首选医院，或者获得更好的薪酬，甚至两者兼得。
我们是否准备好迎接希望进入医疗行业的新加坡人，尤其是年轻人？
虽然我们仍然欢迎外国医疗工作者来补充本地劳动力，但有哪些措施确保有足够的新加坡人作为医疗工作的核心？上述关切也是我工会兄弟姐妹们与我分享的众多关切之一。
虽然医院工作人员的情况被广泛讨论，但我们不要忘记社区诊所的医疗工作者。他们面临的工作压力与医院工作人员相当。根据我的交流，有人指出他们希望社区诊所严格实行预约制度，因为即使预约已满，仍有许多未预约的病人前来。这极大地增加了他们和医生的负担。另外，有人希望社区诊所经过运营时间审查后，能尽快实行五天工作制。
轻松一点，我理解目前三方正在努力保护和防止对我们医疗工作者的虐待和骚扰。无论程度如何，对医疗工作者的任何虐待都必须采取更严厉的措施。请允许我用马来语发言。
（马来语）：[请参阅本地语演讲。] 在为应对人口老龄化做准备的过程中，我们加强了包括医疗工作者在内的医疗计划。鉴于工作需求和劳动力短缺，装备现有医疗工作者掌握新知识和技能至关重要。我们需要受过培训且富有爱心的医疗工作者照顾我们的老龄新加坡人，无论是在医院还是社区养老院。这项工作不仅需要体力，还需要在面对困难病人和挑战性照护者时具备心理韧性。
正如我之前英文演讲中提到的，我们都面临过、正在面临并将继续面临挑战。请注意，有两个工会，卫生服务员工联盟（HSEU）和社会及医疗支持工作人员联盟（SMMWU），是你们的声音，倾听并为你们在工作场所的挑战发声。如果你还没加入，请加入他们！
你们的工会了解你们的工作挑战，并将尽最大努力为你们争取利益，从工作场所事务到其他福利待遇。不要害羞提供反馈，因为我知道我的工会兄弟姐妹们永远支持你们。
挑战之一是轮班人员的长时间工作、长时间工作带来的疲劳、苛刻的病人和照护者，以及薪资应反映工作量，而不仅仅是在危机期间。
我呼吁卫生部认真审视医院的轮班工作时间，不要等到发生不幸事件才采取行动。议员们已多次提出此呼吁，我希望这次不会被轻视。
另一个令人担忧的问题是医院实习生没有获得任何津贴，却做着与正式员工类似的工作，这可被视为免费劳动力。过去听说此类做法时我曾怀疑，但当我女儿2020年在盛港医院实习时亲身经历后，我深刻体会到现实。因此，我呼吁高等院校和卫生部审查此做法，禁止在新加坡实行此类免费劳动力。
如果不停止上述做法，可能会阻碍年轻新加坡人加入这一有意义的行业。随着人口老龄化，我们需要更多年轻新加坡人加入医疗行业。新医院正在建设中，我感谢卫生服务员工联盟和社会及医疗支持工作人员联盟的工会兄弟姐妹们与管理层合作，提升会员和员工技能，以适应当今先进的工作模式并为未来做准备。
请确保接受培训的员工获得更好的薪资和更好的工作前景。
（英文）：我再次呼吁相关各方提醒自己关注这群医疗工作者和医生的重要性，访问重组医院、私立医院、社区诊所甚至邻里诊所时，永远不要害羞表达感谢。代表劳工运动的所有领导者，我们感谢你们为照顾我们的家庭、朋友和新加坡同胞所做的努力。
再次提醒大家不要忘记加入工会，因为工会——始终以会员为先，永远支持工人。副议长女士，我支持该动议。[掌声]
副议长女士：黄玲玲女士。
下午4时58分
黄玲玲女士（宏茂桥）：副议长女士，我支持三位被提名议员提出的动议。事实上，我毫不怀疑政府致力于在新冠疫情后继续支持医疗保健。回顾本议院最近在财政预算委员会会议上支持的2023年国家预算，卫生预算预计总支出为125.9亿新元，仅次于国防预算134.1亿新元。
我认为政府需要继续警惕的是预算的使用情况，更重要的是是否转化为我们老龄人口更好的健康成果。此外，我完全同意被提名议员的观点，认为新加坡人的健康必须是全政府的努力。我还要进一步强调，这必须是全社会的努力。
让我通过三点详细说明：一是通过“更健康的新加坡”计划支持我们的家庭医生；二是关心我们的前线工作人员，尤其是急诊科的工作人员；三是赋能新加坡人，提供更多知识和支持，以更好地管理自身健康。
首先，支持全科医生（GP）诊所的家庭医生。我坚定支持“更健康的新加坡”计划，几年前曾访问荷兰、英国和美国的多个地区，了解他们如何管理老龄化人口中日益增加的慢性病负担。
然而，新加坡的全科医生，作为“更健康的新加坡”运动的核心，直到近年来才成为政府确保优质医疗服务的重心。
举个例子，我宏茂桥选区有一位非常勤奋的全科医生。他的诊所位于组屋大厦地下室的防空洞内，组屋发展局（HDB）多年来将该防空洞租给诊所使用。疫情期间，作为公共卫生预备诊所，他在空置的组屋底层公共空间设立了临时摊位，协助进行新冠检测和疫苗接种。事实证明，老年居民更容易进入底层公共空间，而非只能通过楼梯进入的地下防空洞。
新加坡民防部队（SCDF）未批准诊所在楼梯处安装轮椅升降机。扩建电梯至地下诊所需等待组屋发展局的电梯升级计划，目前无明确计划或时间表。
我与该全科医生一起向组屋发展局申请永久提供空置的底层公共空间给诊所使用。虽然原则上获得批准，但从概念设计到临时占用许可证的流程还需6至12个月。该医生刚收到约20万新元的装修报价，正苦恼是否放弃。即使筹集到资金，审批还需获得城市重建局（URA）、建筑与建设局（BCA）和民防部队的同意。
帮助医生更多地帮助病人，减少行政负担。我举的这个例子只是我在动员选区内全科诊所支持“更健康的新加坡”计划时遇到的几个例子之一，目的是让居民能早日与可信赖的家庭医生开始预防健康之旅。若要让全科医生拥抱“更健康的新加坡”，推动这一多部门战略成功，必须以全政府思维加强各部门间的协调，减少繁琐耗时的工作流程。
其次，关心我们的前线医疗工作者，尤其是急诊科人员。上周，我们有人获悉新加坡西部某公立医院向社区团体发出的求助信息。该医院过去两周急诊负荷极高，床位100%满员。急诊医生尽力工作，但入院等待时间延长，约有100名病人等待床位。医院呼吁基层志愿者帮助传播信息，劝导居民非必要时不要前往急诊科，若病情稳定应先咨询全科诊所。
感谢政府在本议院宣布的多项临时策略，缓解医院床位紧张的压力，以及通过“更健康的新加坡”计划提升全科诊所能力和容量。与此同时，必须加大人力资源力度支持前线医疗工作者。我再次建议考虑在公立医院采用超编制聘用机制，为应对突发需求提供缓冲，更重要的是保障医生、护士和前线医疗工作者的身心健康。
最后，我强调不仅需要全政府承诺，还需全社会行动，共同维护老龄人口的健康。
我提出具体建议，加快利用远程医疗技术，不仅是视频咨询，还包括端到端的远程生命体征监测系统，用于管理高血压、糖尿病和高脂血症等常见慢性病。
政府资助的临床试验应加快并扩展至私人全科诊所。慢性病是无声的疾病，心脏病发作和中风等并发症往往让新加坡人措手不及。
许多远程生命体征监测技术已被临床证明能改善特定慢性病患者的健康结果，但我看到两大制约因素阻碍其在新加坡的普及。一是需要进行操作试验，确保患者与初级医疗团队之间数据传输顺畅，以及护理团队对异常生命体征的响应流程；二是个人同意程序，决定向其信任的医生（公立或私立）及支持团队（包括积极老龄中心等社区组织）开放个人生命体征数据的范围。
这两项制约因素需要政府建立信任、制定协议甚至立法，并由公私医疗服务提供者（包括全科诊所和非营利社区医疗服务机构）促进和支持，以赋能更多新加坡人获得正确的健康知识，并在护理团队的协助下以知情方式管理自身健康。
副议长女士，最后，我在本议院多次引用“健康就是财富”这句话。为了避免这句话沦为空洞口号，而我们身边的人却不断因心脏病发作或突发中风等慢性病并发症失去健康，随着人口老龄化，让我们以临床知识为基础、行政高效且协调一致的方式，全力以赴，确保这句话在未来多年成为大多数新加坡人的真实写照。副议长女士，我支持该动议。
副议长女士：严彦松先生。
下午5时06分
严彦松先生（阿裕尼）：副议长女士，全球正面临医疗和社会护理领域严重的人力短缺。国际护士理事会（ICN）首席执行官去年表示，“全球护士短缺的规模是全球健康面临的最大威胁之一。”ICN估计，由于现有护士短缺、护士队伍老龄化及新冠疫情影响，未来全球需要多达1300万名护士来填补缺口。根据世界卫生组织（WHO），东南亚地区单独面临190万名护士的短缺。
新加坡到2030年需要再增加2.4万名护士、辅助医疗专业人员和支持护理人员，以运营医院、诊所和养老中心。我们快速老龄化的人口导致医疗和社会护理需求大幅增加。然而，新加坡护士流失率高。护士报告辞职的原因之一是工作量大和压力大，这在很大程度上是由人力短缺引起的。
迫切需要采取措施解决人力短缺问题。没有快速解决方案。我们需要鼓励更多新加坡人选择医疗和社会护理作为职业，以增强未来专业人才的储备。
我在三月关于新加坡抗疫的演讲中指出，新加坡护士常被视为医生的助理，而非独立的专业人士。我们需要提升该职业形象，增强社会对护士和辅助医疗工作者的尊重。护士应获得更多自主权，承担更高级别的职责。
学校应及早向学生介绍医疗和社会护理职业。专业协会应制作相关材料和视频，介绍该领域职业，并与学校分享以传播给学生。我赞同谭雅琛议员刚才提出建立医疗系统导航文章库的建议——希望她能重新开设博客，让我们继续借鉴她的知识。职业指导应从中一开始，以激发学生对医疗和社会护理职业的兴趣，并让他们在升至中三时开始选择合适科目。
正如我四月关于教育系统的演讲中提到，学校应摒弃按成绩分流学生，转而允许学生根据兴趣选择科目组合。这样我们才能培养出热爱并热情从事医疗工作的未来专业人才。
高等院校可编写指南，帮助本地学生为申请这些院校做好准备。指南可包括所需科目、成绩要求以及参与的课外和课内活动，帮助学生为入读理想院校和专业做好准备。例如，指南可建议学生选择特定科目组合，加入科学俱乐部，寻找科学研究机会，撰写和发表研究论文，或在学校假期期间在医疗或社会护理机构实习。
指南还应指导如何寻找这些机会，并与专业医疗和社会护理协会合作，为学生创造机会。这些措施有助学生早期专注于医疗和社会护理领域的兴趣，更好地为未来职业做准备。临近申请大学或理工时才匆忙准备作品集为时已晚，但许多学生正是如此，因为他们在中学阶段对兴趣缺乏明确认识，未参与为未来职业做准备的活动。
相反，资源较丰富家庭的学生通常从父母那里获得指导，并通过父母的职业关系获得实践机会。为了提升社会整体水平，发掘更广泛的人才，我们需要让每位学生都能获得这些信息。
然而，改变公众对健康和社会护理职业的看法并提高公众意识需要时间，并且需要包括政府、媒体、学校和家长在内的各方利益相关者共同努力。我们必须继续制定有针对性的举措，解决医护人员关心的问题，如工作与生活的平衡、薪酬和职业发展。
尽管如此，仅依靠增加人力供应来满足我国的健康和社会护理需求是不可持续的。考虑到新加坡自身的人口老龄化，这将带来更大的护理需求，如果我们要为所有健康和社会护理机构配备足够的医生、护士、辅助医疗专业人员和护理人员，以达到理想的医护人员与患者比例，健康和社会护理部门可能会占用新加坡人力资源的过大份额，从而使其他经济部门的人才和技能短缺。
技术在提升生产力和增强人力方面可以发挥重要作用。在我2013年于本院提出的关于降低医疗成本的休会动议中，我曾表示，在医疗系统人力有限的情况下，应将技术作为倍增力量来使用。如今这一点比十年前更为重要。
医疗技术（HealthTech）是一个快速发展且前景广阔的领域，必须在新加坡进一步发展。当前正在开发的变革性技术将彻底改变未来医疗服务的提供方式。这些技术包括基于人工智能的诊断，能够比传统方法更早发现疾病并更快速地做出更准确的诊断。例如，麻省理工学院的研究人员开发了一种名为Sybil的人工智能模型，能够利用低剂量计算机断层扫描预测患者未来六年内患肺癌的风险。
新兴的精准医疗领域有潜力改变医疗服务，已被用于癌症、心血管疾病和遗传疾病等疾病的治疗。它能够通过提供更有针对性和更有效的治疗，减少药物不良反应，并优化疾病预防策略，从而潜在地改善患者的治疗效果。我注意到，目前新加坡有一项精准医疗计划，旨在生成多达一百万人的精准医疗数据，整合基因组、生活方式、健康、社会和环境数据。这是一个非常积极的发展。
还有一些医疗技术虽然不像前述的“深度技术”那样先进，但已进入市场，能够提升医护人员的生产力，增强患者体验并改善健康结果。
国家电子健康记录（NEHR）系统是一项重要的多年期医疗技术计划。根据卫生部网站，截至2023年5月5日，有2231家医疗机构参与NEHR。该名单似乎每天都在增长，我注意到自今年年初以来，参与的医疗服务提供者数量显著增加。
《海峡时报》于5月2日报道，“自2011年NEHR启动以来，私营部门参与缓慢”。根据2023年3月卫生部长王乙康对议员Leon Perera的议会质询回复，只有约30%的持牌私营门诊医疗机构拥有NEHR的查看权限，且不到4%的机构在贡献数据。
樟宜综合医院临床助理教授施庆勇于2020年发表的题为《新加坡全科医生对NEHR的态度和看法》的调查和论文发现，年龄超过40岁且执业超过15年的独立执业全科医生较少查看和贡献NEHR数据。自认为计算机技能较差以及认为技术或财政支持不足的医生也较少使用NEHR。
《健康信息法案》原计划于2018年提交议会，规定持牌医疗集团在宽限期后必须强制向NEHR贡献数据。但由于当年7月SingHealth系统遭受网络攻击和数据泄露，该法案被推迟，以便先实施技术和流程改进，提升NEHR的安全防护水平。
根据卫生部高级国务部长詹尼尔·普图切里所述，这些安全改进大部分应于去年完成。我想请问高级国务部长，NEHR的所有安全改进是否已全部实施？
我了解到卫生部计划今年下半年提交《健康信息法案》。卫生部是否正在与医生沟通，解决他们对必须向NEHR贡献患者数据安全性的担忧？卫生部如何协助剩余的全科医生和牙医加入NEHR？
前卫生部长颜金勇于2017年表示，“只有数据全面，患者才能充分发挥NEHR的潜力。”他补充说，“为了使NEHR数据全面，每个医疗服务提供者和医疗专业人员都需要贡献相关数据。”
鉴于NEHR的目标以及迄今为止已投入6.6亿新元的系统建设，必须在解决医生合理关切的同时，毫不拖延地全面推广该系统。
我们需要利用多年执业的全科医生的知识和经验，尤其是在推进“更健康的新加坡”计划时，全科医生将在促进健康生活方式和预防医疗中发挥关键作用。
技术可以帮助全科医生专注于他们最擅长的工作。许多私人诊所发现管理各种IT系统是一大挑战，这些系统需要连接社区健康援助计划（CHAS）、“更健康的新加坡”以及NEHR。
我注意到有一项技术补贴计划，帮助全科医生实施与“更健康的新加坡”兼容的诊所管理系统。然而，实施这些系统仍需全科医生及其诊所助理投入大量时间和精力——而他们若想专注于直接患者护理，根本没有这些时间。
卫生部应探索为全科医生和牙科诊所提供IT经理服务的可能性。这样，他们可以受益于IT专业人员的专业知识，协助解决医疗IT相关问题。
通过提供IT事务的联络点，全科医生及其诊所助理便能专注于为患者提供高质量的临床护理。这一方案不仅能提升全科医生的效率和生产力，还能帮助他们跟上最新技术进展。
副议长女士，迫切需要采取行动解决健康和社会护理机构的人力短缺问题，并培养更多新加坡人进入该领域。我在发言中提出了一些建议，希望卫生部和教育部予以考虑。
为了提升健康和社会护理部门的生产力并增强人力，我们需要加大力度利用技术作为倍增力量，并协助服务提供者实施和使用这些技术。
本周五，即5月12日，是国际护士节，也是弗洛伦斯·南丁格尔的诞辰纪念日，我借此机会向新加坡公私营医疗机构的所有护士致以衷心感谢。我们感谢你们无私的奉献、牺牲和对人民的关怀。女士，我支持该动议。
副议长女士：梁文韬先生发言。
下午5时20分
梁文韬先生（非选区议员）：副议长女士，进步新加坡党（PSP）支持该动议，呼吁议会支持疫情后医疗保健及政府整体努力，持续稳定支持新加坡医疗体系。
PSP再次感谢所有医护人员的牺牲和奉献，特别是在过去三年的疫情期间为新加坡人服务。
我们欢迎政府通过“更健康的新加坡”计划支持医疗保健，该计划从以反应性照顾已患病者的交易型系统转向以预防新加坡人患病为目标的结果导向型系统。
谭雅珊医生、莎希拉·阿卜杜拉医生和阿卜杜勒·萨马德先生热情谈及了涉及医生、医护人员、患者及社会各界的自下而上的改进。
我们支持他们提到的改进，但也认为应首先着眼于改革医疗融资和控制医疗成本，以更好实现这些改进。
PSP将医疗可持续性定义为为所有新加坡人提供最有效、可负担且公平的医疗服务。重点不应仅是保护政府财政，而应建立具备适当激励机制的医疗体系，鼓励健康生活，同时保障新加坡人在其一生中所有医疗状况下的保障。
目前，新加坡人通过其医疗储蓄（MediSave）、子女的医疗储蓄、医疗保险（MediShield Life）、私人保险及现金支付承担了大部分医疗费用。
我承认过去十年政府在医疗方面的支出增加，推出了先驱一代和独立一代计划以及社区健康援助计划（CHAS）。但这些计划的实际支出相较于部分先驱和独立一代新加坡人医疗储蓄不足的需求而言仍然较小。实际支出也相较于先驱一代基金和独立一代基金的总资产而言较少。
总体而言，政府对医疗支出的贡献不足。
根据世界卫生组织数据，政府承担的医疗支出比例从2011年的33%增加到2019年的43%，但仍远低于经济合作与发展组织（OECD）75%的平均水平。
新加坡人享受的是一流的医疗服务，但政府提供的财政支持远远不足。
过去二十年医疗支出翻了一番多。新加坡人继续承担自己及父母、子女的医疗账单已不可持续。
为减少社会不平等，政府必须加大力度帮助新加坡人应对不断上涨的医疗费用，增强其财务保障。
无论贫富，人们都不会选择生病。富裕家庭能更好应对医疗灾难，而类似灾难可能轻易耗尽低收入家庭的医疗储蓄和现金储备，即使有医疗保险赔付。
因此，女士，我提出三项建议，以减轻新加坡人的医疗财务负担。
第一，政府应为所有新加坡公民支付医疗保险（MediShield）和护理保险（CareShield Life）保费。
新加坡人的退休保障是长期问题。首先，住房成本耗尽了他们的大部分中央公积金（CPF）储蓄。因此，许多新加坡人必须在退休年龄后继续工作才能生存，而不出售组屋。
保险保费占用了他们另一部分CPF储蓄，这些储蓄本可用于退休。
我在2021年预算演讲中估算，一个四口之家为父母支付至65岁、两个子女支付至25岁的医疗保险和护理保险总保费至少会耗费11万新元的CPF储蓄，且未计复利损失。
如果保费每五年上涨10%，这笔财务负担可能超过25万新元。换言之，如果该家庭无需支付医疗保险和护理保险保费，父母在65岁时将多出25万新元以上的CPF储蓄用于退休。
因此，我重申2021年预算辩论中的呼吁，敦促政府为所有新加坡公民支付医疗保险和护理保险保费。
这将使政府每年支出增加约30亿新元，但同时意味着新加坡人的CPF余额将相应增加。这将使普通新加坡人的医疗储蓄余额享受更长时间的CPF利息复利效应，更好地应对医疗事件。
更健康的医疗储蓄余额最终将增强新加坡人的退休保障，因为他们需要转入医疗储蓄账户的CPF储蓄将减少。
第二，我建议政府增加医疗储蓄账户的注资和使用范围，增加对有需要新加坡人的医疗基金（MediFund）支持，并提高先驱一代和独立一代基金对老年人的支持。
截至2020年，医疗储蓄账户持有人累计余额达1100亿新元。然而，当年仅提取了10亿新元，约占不足1%，用于直接医疗费用。这一比例很小，且较2015年（当时从760亿余额中提取了9.05亿，占1.2%）有所下降。鉴于新加坡人口老龄化和医疗需求增加，这种情况不合理。
医疗储蓄账户的提款规则是否过于严格？政府一直限制医疗储蓄账户的提款。但总体来看，新加坡人甚至未充分利用其医疗储蓄余额每年获得的利息用于医疗费用，更不用说本金了。
限制医疗储蓄资金使用比要求维持退休账户最低储蓄额更难以辩解。因此，我再次呼吁放宽医疗储蓄提款限制。
我也赞同同僚Poa女士在2021年预算中提出的扩大医疗储蓄用于门诊治疗的建议。
对于医疗储蓄余额低于平均水平、难以支付医疗费用的低收入新加坡人，政府应通过增加医疗储蓄账户注资或大幅增加医疗基金援助来提供更多帮助。
目前，医疗基金每年仅发放约1亿新元，仅覆盖新加坡人约250亿新元医疗支出的0.4%。
先驱一代基金和独立一代基金也应增加对老年人的支付。自2018年以来，先驱一代基金余额约70亿新元，但每年仅支付约4亿新元，占总资产的5%至7%。独立一代基金余额约60亿新元，但每年仅支付约2亿新元，占总资产的3%至5%。
第三，我建议政府统一公共和私人医疗机构的药品采购。
目前，新加坡三大公共医疗集团实行集中采购，但私人医疗机构未实行。因此，私人诊所通常支付比公共部门更高的药品价格，而公共部门能谈判获得优惠价格。这推高了整个医疗链的成本。保险必须收取更高保费以覆盖更高药价，导致国家医疗支出不可持续地上升。
PSP呼吁政府统一公共和私人医疗机构的药品采购，并以非营利方式向公私营医疗设施分发药品。这样，作为一个小国，我们可以最大化与大型制药公司的议价能力，降低整体药品成本。
在公共部门，政府应确保向所有新加坡患者收取的药品价格（无论是否补贴）接近药品成本价。政府可以为补贴患者提供额外补贴以降低药品费用。但不应对非补贴患者的药品价格进行不合理加价以交叉补贴补贴患者。对非补贴患者收取更高价格以换取更好服务是合理的，但药品本身应保持一致。
国家级集中药品采购系统将消除为控制医疗成本而突然改变政策的需要，为新加坡人提供确定性，并增强他们的退休保障。
总之，副议长女士，我呼吁政府加大努力解决新加坡医疗体系中的不平等问题。这将放大“更健康的新加坡”等举措带来的益处。
对许多新加坡人来说，高昂的生活成本带来的财务压力是其健康状况不佳的主要原因，包括日益严重的心理疾病问题。如果能进一步改善新加坡医疗体系的可负担性和公平性，我们可以期待新加坡人整体健康状况的改善。这应成为支持疫情后医疗保健的国家优先事项之一。新加坡人值得拥有更好的医疗保障。为了国家，为了人民。
英文原文
SPRS Hansard 原始记录 · 抓取日期：2026-05-02
Mdm Deputy Speaker : Dr Tan Yia Swam.
4.01 pm
Dr Tan Yia Swam (Nominated Member) : Madam, I beg to move*, "That this House commits to supporting healthcare beyond the COVID-19 pandemic and the whole-of-Government efforts for consistent and sustainable support".
[(proc text) * The Motion also stood in the name of Mr Abdul Samad and Dr Shahira Abdullah. (proc text)]
I declare my interest as a breast surgeon in private practice and my various medical leadership roles as an appointed member of the Singapore Medical Council and the Vice President of the Singapore Medical Association. More importantly, I speak as a daughter to elderly parents and parents-in-law and as a mother to children with medical conditions. Allow me to say a few words in Mandarin.
( In Mandarin ) : [ Please refer to Vernacular Speech .] As the saying goes "Doctors have the heart of a parent". Doctors should be caring and concerned towards their patients, just like parents to their children. Doctors should have this mentality throughout their life. However, patients are not necessarily willing to be treated like a child all their lives. When a child is young, he is ignorant and will obey the instructions of his parents. As he grows up, he will start to rebel against the instructions of his parents.
Thirty years ago, patients would generally listen to the doctor's words. But now, due to advanced technology and easy access to information, more and more patients will question doctors' diagnoses or instructions, or even challenge them.
( In English ): Why does anyone stand up to advocate for certain causes? We want to leave behind a better world than what we were born in.
I advocate for the doctor-patient relationship. As a patient, I want my doctor to look after my best interests and not be worried about being complained or sued unfairly. As a doctor, I want to focus on my patient's medical conditions, her needs and wants.
But life is more complicated than that. So many other factors influence this relationship – different kinds of health-seeking behaviours, different health beliefs, financing models, expectations of outcomes, customer service, social media marketing, business entities seeking to profit in the healthcare sector.
Why am I pushing for a whole-of-Government effort? Healthcare spending is the second highest in the national budget. The emphasis on building more hospitals, polyclinics, Healthier SG and recruiting staff – this cannot go on indefinitely.
While the current hot news is about the Cancer Drug List, I share a list of sobering health statistics: yearly, 26% of deaths are due to cancer; yearly, 20% of deaths are due to pneumonia; every day, 20 people die from heart attacks or strokes; every day, four people undergo leg amputations due to diabetes; Singapore ranks first in the world for diabetes-induced kidney failure; one in 10 people over 60 years old have dementia; one in 10 people have a mental illness; one-third of post-menopausal women have osteoporosis – and if they ever have a hip fracture, one in five will die within the year.
These are some well-known facts in our medical community. Health news magazines frequently report these, but people do not care until it happens to them. Most people have a healthcare encounter only when they are sick and that is too late.
Humans have short memories. That is why the institution has to remember and pass on the teaching.
It feels like the whole country, even the whole world, has moved on after COVID-19. But if you look back at the history of pandemics, the next one will be here – maybe in 10 years, maybe in five. We need to be ready for the next pandemic, for the silver tsunami, for the mental health crisis. Healthcare must be a global, national whole-of-Government effort and not only a Ministry of Health (MOH) effort.
I urge for all of you to adopt a mindset change. I urge every Ministry, every Government official, every public servant – in fact, anyone listening right now – to think in terms of how to better teach our people to look after their health and prevent illness.
Next, support for healthcare workers – what does it mean? It cannot be just a one-time snapshot, a once-off wellness event, a "thank you" campaign, a medal. Regular salary revisions to match inflation and the rising cost of living are essential. But beyond that, support for healthcare workers should be a deeply rooted respect and acknowledgement of the nature of our work.
Many of us see our work as a calling. We commit to looking after patients. It is more than just a job. Much like those in our armed forces who protect our nation, healthcare workers protect the health and well-being of our people. It is not just business transactions selling remedies.
What kind of support do healthcare workers want then? Back to my analogy about the parent-child relationship. I hope the doctor-patient relationship will be mutually loving and respectful. We cannot be just using that one day of Father's or Mother's Day to love our parents, right? It should be an ongoing process. Take into account what we say, listen and involve us in decision-making.
I have explained why we need to support healthcare beyond the pandemic and why we need a whole-of-Government effort. I will now share three broad strategies on how this can be done: one, identify and acknowledge problems; two, education at all levels; and three, cross-collaboration.
Let me tell a funny story. More than a decade ago, as a junior doctor, I remember there was one day when there was a mini commotion in the operating theatre. We were told to recall our chits so that the queue of patients waiting for surgery is cleared up. I demanded to know why and I was told, "Minister is visiting."
I remember being indignant and told the sister-in-charge, "Let him see. Let him see how swamped we are." Of course, I was chased away while the welcoming party walked him around. I was an angry young doctor, but I resolved to learn to be a better advocate for change.
Leaders need to walk the ground and healthcare workers need to learn to speak up better for ourselves. Maybe it is not in our nature to ever admit defeat or ask for help, because it implies weakness and we are determined to stay strong for our patients. Maybe that is why so many of us work until breaking point.
In the past two years, mainstream news and social media gave much attention to bed shortages, long working hours of junior doctors and nurses, bullying and harassment, but I tell you this is nothing new to us.
Corridor beds, lodgers in tentage, conversion of day surgery beds to acute care beds. Another story – once, when I was on call, I was called by my head of department in the middle of the night to urgently identify patients who may be fit for discharged in the morning, because there were 50-over patients waiting for a bed in the Emergency Department (ED).
There were patients fit for discharge but the common social request was to keep the patient until the weekend because the children cannot take leave to bring him home or the need to wait until the helper arrives in Singapore. So, instead of operating, I was there doing bed management and being scolded by family members for being heartless. Then, when I go down to finally attend to the new patients waiting, I get scolded for making them wait very long.
A call starts at 8.00 am and ends at 8.00 am the next day, followed by a full day's work until 6.00 pm the following day. We did six to eight calls a month. Eighty to 100 work hour weeks are not unusual. Doctors, nurses, lab technicians, couriers, healthcare attendants – everyone in the healthcare system is trying our best to meet demands; and sometimes, we cannot deliver.
How many of us have just gone to cry and hide in the toilet for a while? How many have walked away?
We have seen the ups and downs of problems in the past decades. The removal of the guideline of fees, coupled with as-charged plans, leading to escalating costs, due to multiple factors that we are still trying to address now in the Multilateral Healthcare Insurance Committee (MHIC). Changes to residency training, leading to the loss of mentorship, loss of a sense of belonging by the trainees. Shorter training periods with consequences in some specialties.
The privatisation and commercialisation of healthcare is a "necessary evil". Someone has to ensure there is money to run a sustainable business. But when healthcare workers are treated as a commodity by administrators, it is yet another bad influence on the doctor-patient relationship.
Currently, we face new concerns. In the private sector, business costs are increasing due to rental, manpower costs and pressure from business entities; perpetual problems with poor IT systems; a brain drain of experienced nurses, allied health and even doctors.
I have previously spoken on wellness and alternative health services, which are not regulated and which sometimes do more harm than good. Poor use of Google leading to badly written search engine optimisation articles that further increases the disconnect between doctors and patients.
Some family physicians have expressed their perceived difficulties to onboard Healthier SG. Many doctors are concerned over the capitation model, about the impact of the drug whitelist and actual payments to general practitioners (GPs), which may not cover their running costs.
I am not saying it is bad. I am saying doctors are worried about these changes. We have lived through changes with adverse outcomes and we feel really helpless when others dictate how we should practise medicine.
We should learn from the mistakes of the past so that we do not repeat it, but humans have short memories and few people have the time or commitment to dig into history.
Political office bearers come and go, but for most doctors and nurses, we are here for a lifetime. The longest serving Minister for Health is Mr Gan Kim Yong for 10 years and for that, I thank him for the warm and supportive relationship he had with our profession, which Mr Ong Ye Kung has kindly continued – hopefully, for the future, after my speech.
There is no one who is giving the healthcare system his full attention and thought. Doctors do clinical work. Clinician scientists do research. Nurses care for patients' daily needs. Many feel unease and unhappiness at "the system", but there is no one whose job is to really evaluate and improve the system.
Instead, experts from other service industries are imported to provide opinions, get paid consultancy fees – and they leave, while we care so hard and so badly, that it hurts. Even with all my lobbying for the private sector, for reviews into Shield plans, corporate insurance, concierge services, third-party administrators (TPAs), many have heard but might not be listening.
Sadly, even my own doctors do not pay close attention to my advocacy efforts and keep repeating the same old grouses. Some are aware but do not dare to take action. They might be afraid of losing their livelihoods if they do not play by the rules of TPAs who have come between doctors and patients. I have frequently said to my peers that it is common sense that a business should be profitable, but we should never profiteer here from people's suffering.
Healthcare providers are in a no-win situation – getting complaints for long waiting times in Government hospitals, getting accused of overcharging in private.
Patients have very high expectations now. We all want perfection – cheap, fast and good.
I have repeatedly vouched for our restructured hospitals. We have all trained and worked there at some point and they provide good quality care. Sometimes, the communications may not be as clear or personable, simply because it is a very large team-based practice.
I think restructured hospitals are cheap and good, and it is hard to be fast. I ask the public to be understanding. Restructured hospitals are teaching hospitals. We all start somewhere. We all learn through mentorship, by examining small lumps, do our first operations.
Patients are never used as an experiment. There is consultant lead practice and there is a specialist in charge of your medical journey. When you meet a young doctor with a heart, I hope you help the doctor to train and grow.
Some of you will choose to go private if you can afford it because you get personal service, it is generally faster, there is more privacy because it is a much smaller team attending to you. But then I ask for your understanding that every doctor runs a business and there are various models that are used with various business costs. If you find a doctor that you trust and there is clear communication and transparency, I hope you will also give him the support he needs.
I have listed a string of perennial problems, which are complex and systemic, and that I do not expect any one person to solve.
Stay with me as I share my views on education and cross-collaboration.
There are many ways how people learn. I think the commonest method is by frequent exposure and repetition. We eat frequently, right? Three times a day, maybe five times or even more. Singaporeans are passionate about our food. So, if I ask about chicken rice, there will be a very hot-blooded robust debate on which store is the best, comparing roast chicken versus steamed chicken, the ginger, the chilli. Enthusiasts will even know the exact cost breakdown from different stores: how much you charge for extra chilli, extra rice, an upgrade to thigh meat.
But how many of us need major surgery or admission for a major illness?
There are some patients with complex medical issues who have been in and out of hospitals. The healthcare team ends up knowing the patients and families very well over time. Such families will likely also be very aware of how treatment costs are like.
For most people though, the first major illness is the first time ever that we have to seek medical care in the hospital. That is not a good time to find out how expensive healthcare is. One is already worried about their cancer diagnosis and the impact on survival, side effects and potential complications of treatment, responsibilities of work versus family.
Not many people know the cost of treatments in Singapore and many are stunned when they first see the numbers. I know I was when I had to handle the bills for an open heart surgery.
Healthcare financing is very complex and there are actually many safety nets for Singaporeans – public sector versus private sector. Who pays? Taxpayers' monies, insurance pooling. Various combinations of co-payments and tiers of subsidies exist. The problem is most healthy people do not bother to check these until they encounter health issues.
If it is an elective surgery, there is time for financial counselling, pre-authorisation and so on. But in an emergency, the team would deliver the necessary life-threatening treatments first. The patient and their family may be saddled with a big debt. Or the hospital writes off bad debt – not often, I believe, but I know that this happens when we have a foreign worker with no health insurance, just an accident policy and there is no or inadequate cover. Same for locals who are not familiar with the product they bought, whether it is a plan for hospitalisation, critical illness or early cancer plan. Maybe they did not know about exclusion terms or coverage limits.
I picked up this lingo and knowledge only in these recent three years and I hate that I have to know it. It distracts from my real work in caring for patients. But it is necessary. This is what I talked about in March, for insurers to build closer working relationships with healthcare providers so that patients have more assurance of affordability.
People need to learn how to navigate our healthcare system. Some years ago, I started a blog specifically on how to enter the healthcare system, the different paths available and the pros and cons of each. But I could not maintain it. Other commitments took priority. Since then, I have seen several well-written articles. There is no need to keep re-inventing the wheel. Collect these, have a good library of such articles in the central repository and let it be the main reference for all Singaporeans.
People do not actively care until it happens to them. Look at global warming, does the average person worry about global warming, even when faced with evidence of changing microclimates? Does a person worry about fertility and starting a family young, until they are actually trying and come across difficulties? I know most of my patients never worried about breast cancer until they have a symptom or heard that a friend or colleague is recently diagnosed with breast cancer. Then, it triggers fear and worry. People care, only when things affect them.
I want my children to grow up and take responsibility for themselves. Likewise, I believe that everyone of us can take responsibility for our own health, but we need to be empowered on how to do this.
Humans are emotional creatures, but we have the capacity to think. Learning how to regulate emotions and using our brains to think is an invaluable skill that can be taught from childhood. I know some adults who still struggle with this. I cannot underestimate the importance of having a scientific and logical framework in approach to all problems. Fear, anger, worry, joy are all emotional responses that are normal but we must learn to regulate them. Too often, I see my patients so paralysed by anxiety that it interferes with the treatment process.
Some diseases are well-studied and the progression is clearly understood, for example, Hepatitis B leads to liver cancer and Hepatitis B vaccination is effective. Some others are multifactorial, such as most cancers and cardiovascular diseases. So, just because I smoke, it does not mean I will get lung cancer for sure. Likewise, just because I do not smoke, it does not mean that I will never get lung cancer. It is not so simple; there is no magic bullet or "免死金牌".
Obesity, strokes, heart attacks – we call these "lifestyle diseases" because every day, we make small decisions on food and activity level that will build up to or prevent these. Some illnesses are insidious. Do we recognise mental health issues or is it unseen until there is a sentinel event with self-harm?
Preventable trauma is another huge area we can improve on. Awareness on child safety seats, road safety awareness by all users including pedestrians and cyclists, stricter regulations for driving licenses, giving way to emergency vehicles, workplace safety.
There is so much to teach, so much to learn. Education cannot be assigned to just the Ministry of Education (MOE), just as health should not be the domain of the MOH only. I firmly believe that education starting from as young as infancy and carrying on throughout our schooling and working adult years will be the key to good sustainable health. I am glad that Minister Ong stated last month that MOH will partner MOE and the Ministry of Social and Family Development (MSF) to lay a strong foundation of health for our young.
I am alarmed at how often I notice infants being spoon-fed while they are looking at an iPad. Studies have shown that screen time adversely affects brain development. Babies are not able to read faces as well and develop social skills, leading to later problems in executive and higher order functioning, such as the ability to focus, impulse control and emotional regulation. I have seen increasing numbers of young adult patients in their 20s with such problems and I am deeply concerned for the future generations.
Teaching the appropriate use of technology is not just for the young, but for the adults as well. News abound of increasingly elaborate financial scams. In relation to health, there are trends of miracle cures to fight cancer or guarantee weight loss. I have seen patients trying the black garlic diet, aloe vera, alkaline water, negative ion clothing. The list is endless.
I call this pseudoscience because there is a hint of truth in it. There is one experiment to show that the item has one property that has killed a few cancer cells in a petri dish. To me, this is like an observation that, "Hey, the ant can use a leaf to float on water! Therefore, if I use a big leaf, I can use it to sail across the ocean!" I cannot professionally extrapolate such studies to claim that it can cure cancer, which is what some salespeople do and vulnerable patients will try it and sometimes even forgo proven treatments.
During the pandemic, vaccine hesitancy and big pharma conspiracies had direct negative impacts on public health. Internet connectivity has brought people closer together but has also allowed misinformation to flourish. People rely on word-of-mouth recommendations, some use Google reviews and some people do not know that these can be bought or faked, or that there are malicious marketing agencies who deliberately downvote rival companies.
Whose role is it then to teach people how to use Google and Artificial Intelligence (AI) as a tool? It does not feel like it should be the Government's job. It is up to individuals then.
Motivational speaker Jim Rohn said that, "You are the average of the five people you spend the most time with". I use this to take stock of my personal and professional growth periodically. Whenever I feel stagnant, time to review and change a bit, step out of the comfort zone, learn something new. Do not settle in too comfortably and be trapped in an echo chamber.
Lifelong learning is a challenge. How do we then cultivate this mindset in people? This leads me to my next point: cross-collaboration.
I think the COVID-19 Multi-Ministry Task Force was a good platform for leadership to discuss and share timely information on a rapidly evolving situation and align policy direction. Of course, there were problems as it filtered down, because humans being humans, we have a wide range of responses. We had people ranging from lawful good to chaotic evil, to use a Dungeons and Dragons reference. Some followed the exact letter of the law, some followed the spirit of what is intended. Some profiteered off other's desperations and some wilfully, selfishly lived by their own rules and not respect the society they are living in.
The Government of Singapore is complex: organised into 16 Ministries, further divided into departments, divisions and more than 50 Statutory Boards. Do people from different Ministries talk to one another, or is there a very strict protocol of how new ideas may be raised? I ask because previously when working within the confines of a restructured hospital as an employee, I know that there are clear hierarchical processes. And even now, I only have experience talking to certain folks within MOH.
I know there are incredibly smart and devoted people in the Civil Service at all levels of seniority. I know passionate and caring people who are active volunteers in various groups, charities and social enterprises. There is a flourishing ecosystem, but I wonder if perhaps there are too many small-to-medium groups. Can we pool these resources?
Every one of us may be a domain expert, but we do not know what we do not know.
From my participation in MHIC, I had the privilege of networking across different industries, to be acquainted with insurers, financial advisors, actuaries and to discuss healthcare problems from their point of view. It was humbling to realise how little of healthcare financing I knew before, as a clinician. I am yet again bringing up the story of blind men examining the elephant and everyone only touching the part they can touch and arguing about what the elephant looks like. Because it is true – we do not know what we do not know.
I now challenge you to think beyond your usual area and how you can apply your knowledge to better support healthcare, wherever you are in. You have heard the problems I brought up as a doctor, as a healthcare leader. Are you able to help me?
I respectfully share some of my ideas of how to align future policies, with the compass oriented towards healthcare. Formal workgroups seem very structured. I believe that when people with similar goals and ideas discuss casually, the mind-mapping and synergy may create something way better.
Starting from young, the Early Childhood Development Agency and MOE can work closely with MOH to identify key basic health messages for young Singaporeans to learn. And the challenge is not in rote learning but how to get updates on information, because some scientific breakthroughs develop rapidly.
The food pyramid that I learnt in primary school is now outdated, replaced by the healthy plate model and current nutrition and fitness research is leaning towards low-carb diet with resistance training. Who knows what will future research show?
Teach children how to eat right and cultivate the habit of regular exercise to maintain a healthy weight. A lot has been done for mental health education and safe, appropriate use of social media in primary schools. These can also be adopted for adults who did not grow up in the Internet age, so that they are also taught about online etiquette and safety.
Introduce and strengthen the idea of the family doctor and the importance of good primary care. Teach how to navigate the healthcare system, how to get into subsidised care and the role of different types of insurance.
MSF, in your mission to build strong families, could also collaborate with MOE and MOH to shape sex education, guide families on how to hold the tough conversations on morality, religious beliefs and identity. Ask the coaching industry, especially those who specialise in sexuality counselling.
Teach older teenagers and tertiary students about the parenthood journey, its many joys but also hardships so that in time, young couples can make an informed decision about marriage and the pros and cons of having children or not, and when to have children; in their 20s, 30s or 40s?
Once we enter the workforce, we often neglect our own health to pursue a career. In work with long hours or shifts, we develop unhealthy eating habits and irregular sleeping hours, and do not know how to make time to exercise. How many adults notice weight gain and lethargy over five or 10 years of working life? The weight creeps up on you.
Singaporean men have their yearly individual physical proficiency test to clear but women might not have a fitness benchmark. There is a phenomenon of being "skinny fat", where the person has a healthy weight range but has low muscle and bone mass.
I think this is where all the different Ministries can contribute to health, by continuing education on diet and exercise, screening and vaccinations as well as empowering adults.
For the Ministry of Manpower (MOM), look into how to develop healthy routines at the workplace; ask the fitness industry; make affordable healthy foods easily accessible; encourage 10 to 20 minutes of simple office or chair-based exercises; get the bosses to implement such health practices; teach workers screen time limits and the value of mental breaks; look into flexi-hours so that they may prioritise time for themselves, family and medical appointments; consider incentives for good health; work with MOH, Consumer Association of Singapore, Monetary Authority of Singapore to look into alleged complaints of poorly paying corporate insurances and panel limitations imposed by TPAs; help workers to access good quality care.
Ministries such as the Ministry of Culture, Community and Youth, MSF and Ministry of Communications and Information (MCI) might be ideal to be the facilitators of cross-collaborations between the different Ministries. Good ideas, content and projects can be supported by all, rather than every Ministry trying to come up with their own independent project.
I give one example. If you Google "Singapore how to lose weight", see what comes up. Articles on HealthXchange, HealthHub, Health Promotion Board (HPB) get buried amidst advertorials from aesthetics clinics, spas and gyms. One good quality article with a good video might be shared across different Ministries and across all the various social media platforms for wider reach. Repeat the same essential health messages in each of your various networks: eat right, exercise every day, protect your mental health, whichever division you are in, for social support, for youth or for sports.
I thank the Ministry of National Development for the new SkatePark at Lakeside Garden. I hope you continue to integrate sports into the community. Are you aware that Singapore's cityscape is acknowledged as a parkour paradise internationally? But practitioners frequently get chased away by residents who think they are vandalising and that the Police are called to chase them away. I hope for stronger support for the parkour community in Singapore.
The Ministry of Sustainability and the Environment (MSE)'s mission to supply water and safe food may also extend to more affordable fresh produce, as eating whole foods has more health benefits than processed foods. Food safety labels are regulated by the Singapore Food Agency (SFA), under MSE, but nutrition labelling is by HPB, under MOH. I found the 64-page handbook online. I think that people still buy a lot of bubble tea even when graded "C" or "D"!
What is commendable is the rise of urban farming, supported by state agencies such as the Singapore Land Authority, Urban Redevelopment Authority (URA), Agri-Food and Veterinary Authority, SFA and Animal and Veterinary Service and Housing and Development Board (HDB). I hope I did not miss anyone out. This has benefits such as a start towards food security and the health benefits of working with nature, learning to grow and eat our own organic foods will be lasting.
Information technology (IT) continues to be a huge challenge in so many aspects. I said in a previous speech; electronic health records are sometimes nothing better than Microsoft Word documents or PDF documents scanned and stored online. Systems are unwieldy and not instinctive. Vital signs are still keyed in manually. My patient tried to find her operation histology from HealthHub, Healthy 365 and Health Buddy; we could not find it.
I do not know how this can be achieved, but can MCI, GovTech, Integrated Health Information Systems (iHIS) and other IT Statutory Boards please coordinate and get a good national system up? I envision using Singpass and Healthhub, with trigger questions to remind the individual of major health checkpoints: height and weight; health screening; vaccinations; appointments.
Medical tourism is a complex international issue. Will the Ministry of Trade and Industry (MTI) look into how this could contribute to increasing healthcare costs locally but still help Singapore maintain a leading-edge reputation as one of the best places to get good quality care? I am still deeply bothered by the businesses of medical concierges who collect fees from healthcare providers in exchange for bringing in foreigners for healthcare.
Will MTI help MOH to attract Singaporeans to take up essential jobs in healthcare? Look into the development of healthcare workers to recruit, train and retain experienced workers. Human resource management will be essential, not to manage people as commodities, but to truly build a good working relationship for them, so that they feel appreciated and will stay for the long haul.
Complex medical conditions are managed by a multidisciplinary care team. I apply a similar concept to our healthcare system problem. Cross-collaborate; engage with healthcare providers; step outside of your comfort zones across the different Ministries and industries.
Appropriate remuneration for consultancy work may be something to consider and, in time, build up a network. I am very mindful of costs and ideally, if we can call upon volunteers, that would be great, but I also realise that runs the risk of the same few big-hearted people being called upon again and again.
Set up a think tank whom all the Ministries can have access to and call up on for brief consultations on global issues, not ad hoc requests to organisations.
As I end, let me recap. I have explained why healthcare should be a whole-of-Government concern and not just MOH. I have listed chronic problems in healthcare. I emphasised the need for education at multiple levels of engagement and I asked for everyone to cross-collaborate.
My old friend told me, "Don't pretend you want people to be healthy. You doctors want more patients, right? Got business!"
No! Ideally, I want to look after patients who become sick despite their best efforts, not those who have neglected themselves through the lack of knowledge, a lack of resources or lack of self-care. Let us work together to bring down the number of preventable illnesses. That is the real cost savings. It is our individual responsibility to keep as fit and healthy as we can. Be educated and keep up to date.
As a society, to be kind and civic-minded. For those who hoarded medical supplies and tried to profiteer during COVID-19, shame on you! As a doctor, I look after all patients equally. But when intensive care unit beds are full, who deserves it?
The pandemic has made everyone acutely aware of limited resources – masks, antigen rapid test kits, oxygen. That is the real fact of life. There are limited resources and who will be the gatekeeper as to who needs it most?
Healthcare workers need the Government to help shape these policies. We need everyone to prioritise health. Do not force us to have to have to triage and decide who to save. I look forward to a robust debate. [ Applause. ]
[(proc text) Question proposed. (proc text)]
Mdm Deputy Speaker : Dr Shahira Abdullah.
4.31 pm
Dr Shahira Abdullah (Nominated Member) : Before I begin, I would like to declare that I am an orthodontist working at Khoo Teck Puat Hospital.
Mdm Deputy Speaker, we are now in Disease Outbreak Response System Condition Green, the lowest health alert level since the COVID-19 pandemic began. The COVID-19 pandemic has had a profound impact on the world, with healthcare workers playing a vital role in providing critical care to those who need it. As we begin to move beyond the pandemic, it is clear that we need to continue to prioritise and support healthcare.
This Motion acknowledges the importance of healthcare in our society and seeks to ensure that healthcare workers and patients alike receive the support and resources they need to thrive. It recommends a whole-of-Government approach to build a healthier and more resilient society for all.
Beyond the pandemic and towards the future, I would like to touch on three areas that require our continued attention and support: firstly, the manpower shortage of healthcare workers which is related to burnout and the mental well-being of healthcare workers; secondly, the provision of dental care to our migrant workers; and thirdly, supporting the special care and geriatric dentistry scene.
Firstly, the manpower shortage of healthcare workers. Healthcare workers have always faced intense stress, emotional situations and challenging working conditions, with long and unpredictable work hours, risk of injury and exposure to diseases. These factors can contribute to burnout and mental health issues, even before the pandemic.
Although short-term measures such as counselling and mental health programmes are crucial, it is imperative to address the underlying root causes of burnout and mental health issues.
This requires addressing systemic issues such as workload, work-life balance, support, training and the workplace culture. At the core of this is actually manpower shortage, which MOH is already trying to address.
However, even globally, there is competition for a scarce healthcare workforce. Singapore experienced a significant attrition rate for foreign nurses, which increased from 9.5% to 14.5% between 2019 and 2022.
In her Committee of Supply (COS) speech this year, Senior Parliamentary Secretary Ms Rahayu Mahzam mentioned that "The loss of both local and foreign nurses to our competitor countries is a key reason for the stress and high workload for our nurses. We need to replace the manpower lost to other countries, safeguard the welfare of nurses, and meet increasing needs." If we were to go one step further, we need to ensure that our healthcare workers are supported and have the resources they need to provide the best care possible, we need to build "fat", or buffer, into the system.
I have a few suggestions on how we can retain and attract healthcare manpower.
Number one: granting permanent residency to the immediate family members of healthcare workers who are good performers. MOH is supportive of fellow Nominated Member of Parliament (NMP) Dr Tan Yia Swam's suggestion of granting permanent resident status to foreign healthcare workers who are good performers. For these good performers, can we go one step further and automatically grant their immediate family, namely spouse and children, permanent residency as well?
I know of several dental nurses at my workplace who have left due to this reason. After repeated applications, they have in the end given up, choosing instead to uproot their whole family to places such as Canada, New Zealand and Australia. If we grant permanent residency to their family, they will sink their roots in Singapore and the likelihood of losing them will reduce. When we lose good performers, especially senior ones, we do not just lose a worker, we lose their years of experience in our healthcare system.
Number two: ensuring remunerations are competitive locally and internationally. Singapore's public healthcare sector has increased the base salaries of nurses by 5% to 14% by 2022 with retention payments as well. I am aware that MOH monitors our pay competitiveness locally and internationally regularly. Salary may not be the sole determining factor for healthcare workers, but it is still an important consideration for many individuals when choosing their career paths, especially with the tremendous demands of care work. It can also incentivise foreign healthcare workers to continue working in Singapore. Honestly, higher pay packages will always help.
Number three: flexible work arrangements (FWAs). This is something Member Dr Tan Wu Meng has spoken about at length during the COS debates and it is something I cannot overstate the importance of. Healthcare workers are also mothers, fathers, daughters and sons. They may have an elderly parent, or young children at home. Yes, there are already FWAs available for healthcare workers. However, MOH and MOM can work together to come up with more creative permutations of flexible and family‐friendly human resources (HR) work practices suited for healthcare workers in different stages of their lives as well as the unique needs of each healthcare setting. For example, other than staggered shift times, we can consider having flexible shift lengths that split shifts into shorter scheduled times or offering healthcare workers even more paid leave.
Number four: increasing the public's respect for healthcare workers. The public should understand that healthcare workers are not just transactional service providers who need to kowtow to the patient's demands. There should be zero tolerance for abuse or threats. Therefore, I am encouraged by the great strides that we have taken in this area and with the recommendations of the Tripartite Workgroup to Prevent Abuse and Harassment of Healthcare Workers. My fellow NMP Mr Raj Joshua Thomas will speak further on this topic.
Number five: improving the home caregiving landscape by providing broader support and help. To relieve the healthcare sector, caregivers are the foundation of ageing-in-place. However, I have witnessed, from my relatives, how difficult the journey can be.
One low-lying fruit that we could consider is having more caregiver-inclusive HR work practices and granting more eldercare leave, a suggestion that has been raised before. Another is how we can work between Ministries to ensure that families who are already overwhelmed, can navigate the different caregiving options and available subsidies, ensuring that every family about to start this journey is attached to a medical social worker who can do a needs assessment and guide them along the way. This is so that while they look after the needs of the elderly, we should also look at needs assessment for the caregiver itself so that they are not ignored, whether in self-care for their mental well-being or financial security when they themselves grow old.
Secondly, let me turn my attention to the importance and provision of dental care to vulnerable cohorts, particularly the migrant workers, the geriatric and the special needs population. Dental health is a very important health aspect that can be easily overlooked, but modern research has shown links between oral health, systemic health and quality of life. For example, gum disease can increase the risk of diabetes, infective endocarditis and other vascular diseases. Dental pain due to neglect can also be debilitating. We cannot ignore the importance of oral health and its impact on overall health and quality of life.
However, for the migrant workers, even if the dental treatment is deemed necessary, employers will have to bear the cost of dental treatment and dental treatment can be costly.
Currently, the Primary Care Plan ensures accessible and affordable healthcare for eligible migrant workers. May I suggest extending this dental care for migrant workers as well? The care may not need to encompass all dental care, like routine scaling and polishing but really to address the urgent needs, which means dental cases which can be very painful as well as cases with infection and swellings which, if untreated, can actually be life threatening.
I would now like to speak about supporting the geriatric and special needs scene. As we work towards the goal of Healthier SG, we want to ensure oral health is addressed in successful ageing and inclusive healthcare.
Before I start, I would like to talk about the case of my colleague. A woman with a severe intellectual disability presented at the Geriatric and Special Care Dentistry Clinic for treatment. Her challenging behaviour meant that treatment under local anaesthesia – that means when she is awake – was not viable. However, dental treatment under general anaesthesia, which is going to sleep, came with its own set of problems. Risks outweighed the benefit, especially for a single tooth extraction.
Furthermore, hospital policy requires legal representation for consent involving mentally incapacitated adults, and obtaining Court-appointed deputyship could take months and can be costly. To make matters worse, the woman had previously had a traumatic experience in the hospital environment. Her family therefore chose chair-side management after weighing the options.
After attempting to prepare her with three acclimatisation visits, the dentist attempted the extraction with physical restraints. However, due to profound difficulties faced, they just could not do it. The treatment was aborted.
This experience highlighted the struggles faced not only by the patient's family in navigating the system, but also by the dentist and the medical team in treating individuals with complex needs.
I would like to touch on a few areas.
Number one: engaging elderly and special care needs patients and their communities. The lack of oral health knowledge and health goals in these groups underscores the need for advocacy and mindset change. Patients and caregivers often struggle to navigate the various services available and may not know who to approach for financial help and other supportive services.
To address this, there may be a need for closer cross-collaboration between those involved in their care; professionals such as dentists, ward nurses and caregivers need to know basic oral health literacy as well as where to get reliable treatment information. We can consider looking at Nursing Practice Guidelines to ensure that oral care offered to residents is also up-to-date and practical.
Number two: reserving capacity for those with complex needs. Dentists are doing their best to help out, but there is a lack of guidance on standards of care. A clinical practice guideline as well as care pathways are needed to help ensure quality and appropriate care is offered. Complex cases with multiple health and behavioural problems can be seen in the hospital settings and milder cases can be referred to a network of dentists in GP clinics. Complex cases can also be sent to GPs once they are stabilised.
Number three: the lack of access to dental care in elderly and special needs facilities. Some of our communities and organisations serving vulnerable persons have taken the lead to develop their own dental capacities. Out of all nursing homes in Singapore, only some have access to onsite dental services through Unity Denticare buses or mobile teams provided by volunteer groups or institutions. Even fewer homes have a fixed brick-and-mortar clinic run by a volunteer dentist when manpower is available.
An example is the Hospice Care Association where a dental clinic was built in their newest day hospice Oasis@Outram.
On the special needs front, Movement for the Intellectually Disabled of Singapore (MINDS) Developmental and Disabilities Medical Clinic was launched last year and is already working towards providing dental screening and referral services for patients. This has the potential to scale as MINDS open their cross-disciplinary Health Hubs.
However, the lack of coordination between volunteer groups is also a major issue. The Agency for Integrated Care (AIC) coordinates care for the caregivers and seniors but dental services are not included. This results in inefficient allocation of resources, such as manpower, and unmet needs in homes yet to be served.
While we must commend the spirit of volunteerism as well, almost all these services do not have any cost-recovery component, making this model unsustainable. The cost of consumables, materials and manpower needs to be considered if services rendered are intended for the long term.
Therefore, to address these issues, I would like to call for more support from MOH and the MSF in helping different social service organisations develop their personalised dental capacities. Having onsite dental services has various advantages. For someone with an autism spectrum disorder, going to an unfamiliar place for dental care can be a difficult experience. Injections can be scary. Removing a tooth is also scary.
Without onsite services, patients have to be ferried to primary care services, which may sometimes require costly private ambulances. Treatment in clinics outside is limited by cross-institutional restrictions of data sharing, higher costs in specialised services and long waiting times to be treated, plus many more. Therefore, it is beneficial that dental needs of the seniors and special needs persons to be managed "in place". Such clinics will also divert the efforts away from elective treatment such as dental aesthetics, and instead focus on primary needs – increasing their efficiency and cost-savings.
Funding is an important aspect of support as dental services have a high capital cost. Other aspects of support could be flexibility in administration and licensing. For example, we have tried to get the handheld portable dental X-ray as the standard of care for extractions done in home-based settings. However, until now it is still not approved here.
Number four: tapping on dental officers. We, however, still do have a shortage of dentists who volunteer and treat this population. To ingrain the spirit of volunteerism and service, we could have dental officers serve short postings while serving out their bond, to treat these elderly and special needs patients. This could also be extended to other vulnerable groups such as the migrant workers. This would hopefully encourage them to do the same when their bond has completed.
In conclusion, as we commit to supporting healthcare beyond the COVID-19 pandemic and ensuring consistent and sustainable support, we must not forget that dental health is a crucial component of healthcare to achieve an overall well-being and quality of life. The dental healthcare of vulnerable groups such as the migrant workers and the unique needs of the elderly and special needs populations should not be overlooked. Mdm Deputy Speaker, I support the Motion.
Mdm Deputy Speaker : Mr Abdul Samad.
4.45 pm
Mr Abdul Samad (Nominated Member) : Mdm Deputy Speaker, it is difficult to speak after two doctors who are experts in their fields. Nevertheless, I thank fellow NMP Dr Tan Yia Swam for allowing me to take part in the team rising this Motion.
As I represent the voices of the working people, there are two main areas that my speech will focus on, namely, the welfare of healthcare workers and the challenges of enticing young Singaporeans to embark on a career in the healthcare sector – they are the future of our healthcare workforce.
For a start, I would like to share with this House that the Healthcare Services Employees Union (HSEU) and the Singapore Manual and Mercantile Workers' Union (SMMWU), which represent nurses, allied health professionals and support staff, collectively have a membership strength of more than 35,000 members.
We call on those who are not members yet to quickly join the unions. The reason is simple. Unions will not just represent your voice at the workplace, but will also be your voice for a reason.
While the healthcare industry is not within my purview, I have nonetheless reached out to the leaders of both HSEU and SMMWU to get their feedback on their members' concerns challenges and aspirations, both in the near- and the long-term future.
With the recent pandemic, we realise how much our healthcare workers are doing for Singapore behind the scenes. Indeed, the hours are long and from time to time, they are on the receiving end of abuse by families of the patients. The question is, why should it take a pandemic only for us to realise the importance of healthcare workers? Why do we need a pandemic to learn how to appreciate them?
Sadly, this is a reality of life. It is only in periods of crises that we know the importance of these frontline workers.
Just like myself in the power industry, it is only when there are tariff hikes or power failures that we start to realise the importance of a stable and reliable power supply which we have taken for granted in our daily lives. Do not be ashamed to deny this reality in this real world.
Madam, this House debated quite at length last year on the topic of Healthier SG. Many good suggestions and ideas were proposed by all in this Chamber for us to remind ourselves on leading a healthier lifestyle. While the focus was on developing healthy lifestyle, we should not forget the efforts of those who help us to develop healthier lifestyles, namely, our healthcare workers.
Let us be aware of the challenges faced by the healthcare workers, including those by our administrative and support staff, not just doctors and nurses who are facing patients directly. Let us not forget the equally critical roles of those supporting at various other departments like radiology, pathology and more.
This, then, brings me to focus on the welfare of healthcare workers now and preparing the future generation to serve in this industry.
Prior to this Sitting, I reached out to not just the two unions, but also current friends in my network, as well as fellow Singaporeans, who observed first-hand the hard work of our healthcare workers. We acknowledge that while the Ministry has done their part to better support this group of workers via the hospitals' management, there are still areas that can be further improved like shift work, wages and more.
I would like to touch on shift rosters and, in fact, note that the Ministry has repeatedly stated that it does not regulate such rosters and leaves the same to the hospitals' management teams. Accordingly, I appeal to the Ministry to clearly have a team to independently observe the shift rosters that the healthcare workers are assigned. Let us not wait until an unforeseen incident happens before we start to investigate.
We need to ensure that shift rosters pay close attention to rest time in between, as we need physically alert workers at all times to attend to patients and support doctors.
I feel strongly for this because my daughter is one of the thousands of healthcare workers. I have witnessed first-hand the long working hours that she has had to go through during her past 10 years at Sengkang Hospital. Sometimes, I feel that it is not about the corporate shift policy, but the line managers who plan the rosters who may be biased toward their preferred choice of workers. She left recently and also shared with me that about half of her colleagues in the same team had also left much earlier. She is now embarking on the new journey at a new workplace.
Ironically, prior to that, she was an intern in that same hospital in 2020 during her final year of studies in Republic Polytechnic. I was shocked then to hear that she received zero allowance during her internship. I did not raise this flag earlier as I was still doing my checks with my close friends within the sector. While doing my checks, I then recall this same issue was raised many years earlier at some dialogue sessions, and incidentally, my daughter also suffered the same fate.
I would like to ask if MOH is aware of such situations where interns are not compensated for their labour. Let us not paint internships like another day at school. It is not and will never be the same between academic and work experiences. I do not think you will cripple the hospitals' or MOH's finances to grant an allowance to these students as they are working in the real world, not in school.
I call on the Ministry or hospitals to review this immediately and not make subject our students to free labour. Let us not make our children, the workforce of the future, a source of free labour for today. We should not be perpetuating such practices.
Madam, as Singapore builds more restructured hospitals across the island, that means there will be more job opportunities. This will mean healthcare workers may be able to relocate to their preferred hospitals near their homes, or get better pay, or even both.
Are we prepared for the pipeline of Singaporeans wanting to work in this healthcare sector, especially the young ones?
While we remain open to foreign healthcare workers to help supplement our resident workforce, what are the steps in place to ensure that there will be sufficient Singaporeans to be the core of our healthcare workers? The above concern also represents a few of the many concerns that were shared with me by my fellow brothers and sisters in the unions.
While much have been said for those at hospitals, let us not forget the healthcare workers at our neighbourhood polyclinics. The stress that they face at work is equivalent to those working in hospitals. Based on my interaction, some have highlighted that they hoped polyclinics operate strictly on appointments as they still see many walk-ins even when appointments are already full. This really stretches them and even the doctors there. Separately, there are those that hope that polyclinic operations can soon be reduced to a five-day work week upon review of operating hours.
On the lighter note, I do understand the ongoing tripartite efforts around the protection and prevention of abuse and harassment of our fellow healthcare workers. More severe action must be taken against any such abuse towards our healthcare workers, regardless of the magnitude. Please allow me to speak in Malay.
( In Malay ) : [ Please refer to Vernacular Speech .] In our journey towards preparing for an ageing population, we ramped up our healthcare plans inclusive of fellow healthcare workers. Equipping the current ones with new knowledge and skillsets is vital in view of job demands and labour shortage. We need trained and caring healthcare workers to look out and take care of our ageing Singaporeans, both in hospitals and community homes. This job requires not just physical strength but also demands mental toughness when faced with difficult patients and challenging caregivers.
As mentioned in my English speech earlier, there were, are and will be challenges for all of us. Please note that there are two unions, HSEU and SMMWU, that are your voices to hear and speak for you about your workplace challenges. Join them if you had not!
Your unions are aware of your workplace challenges and will try their very best to advocate for your interest ranging from workplace matters to the provision of other welfare benefits. Do not be shy to provide feedback because I know that my union brothers and sisters will always to be there for you.
Amongst the challenges are long working hours for those on shift, fatigue from extended hours, demanding patients and caregivers, and a salary that should be reflective of the workload, not just during crisis.
I am appealing to MOH to seriously look into shift working hours at hospitals and not wait for an unwanted incident to take place. This call has been made repeatedly by Members of the House and I hope that it will not be taken lightly.
Another worrying area is students doing internships at hospitals who are not getting any allowances but are doing work similar to the staff, which can be classified as free labour. I used to doubt such practices in the past when I heard about it, but reality hit me when my own daughter experienced it when she was did an internship at Sengkang Hospital in 2020. Hence, I call on the Institutes of Higher Learning (IHLs) and MOH to review this practice and disallow this sort of free labour to be practiced in Singapore.
If the above practice is not stopped, it could hinder young Singaporeans from joining this meaningful sector. We need more young Singaporeans to join this sector as we prepare for an ageing population. New hospitals are being built and they appreciate the efforts of my fellow union brothers and sisters from HSEU and SMMWU who are working with management partners to upskill their members and workers for the advanced mode of today's work and preparing for the future.
Please also ensure that our workers who have gone through such training will have better wages and better work prospects than before.
( In English ): Once again, I call on the relevant parties to remind ourselves about the importance of this group of healthcare workers and doctors, and never be shy to appreciate and say thank you to them whenever you visit hospitals, both restructured and private, polyclinics and even neighbour clinics. On behalf of all my fellow leaders from the Labour Movement, we would like to thank you for your efforts to look out for our families, friends and fellow Singaporeans.
Once again, do not forget to join the union because for the union – members first, workers always. Mdm Deputy Speaker, I support the Motion. [ Applause. ]
Mdm Deputy Speaker : Ms Ng Ling Ling.
4.58 pm
Ms Ng Ling Ling (Ang Mo Kio) : Mdm Deputy Speaker, I stand support of the Motion raised by the three Nominated Members. In fact, I have no doubts that the Government is committed to supporting healthcare beyond the COVID-19 pandemic. Looking at the 2023 national Budget that this House supported recently at the COS Sitting, health, with a projected total expenditure of S$12.59 billion is only second to defence, with a total projected expenditure of S$13.41 billion.
Where I think the Government needs to continue to be vigilant is how this Budget is being spent and, more importantly, if it is translating to better health outcomes for our ageing population. In addition, I cannot agree more with the NMPs that health for Singaporeans must be a whole-of-Government effort. I will push further to say that it must be a whole-of-society effort.
Let me elaborate through three points: one, supporting our family doctors through the Healthier SG implementation; two, looking after our frontline workers, especially those in the emergency wards; and three, empowering Singaporeans with more knowledge and support to manage our own health better.
Firstly, on supporting our family doctors in GP clinics. I am a firm proponent of the Healthier SG initiative, having visited various parts of Netherlands, the United Kingdom and the United States a few years back on their healthcare systems to manage increasing chronic disease burdens in ageing populations of advanced countries like ours.
GPs in Singapore, who are in the heart of the Healthier SG movement have, however, not been the centre of gravity in how our Government ensures delivery of good healthcare until recent years.
I cite an example of a very hardworking GP in my Jalan Kayu constituency. He has a GP clinic situated at the basement of a HDB block, a bomb shelter built by HDB and leased out to this clinic for many years. During the COVID-19 pandemic, as a Public Health Preparedness Clinic, he was given a temporary booth at the vacant void deck as his clinic stepped up to help in the administering of COVID-19 tests and vaccinations. It was proven then that senior residents could access this clinic more readily with the void deck space, instead of the basement bomb shelter space which can only be accessed through a stairway.
The Singapore Civil Defence Force (SCDF) could not approve the clinic to install a wheelchair lifter down the flight of stairs. Extending a lift to this basement clinic will need to wait for HDB's Lift Upgrading Programme, with no definite plan or timeline in sight.
With the GP, I appealed to HDB to provide the vacant void deck space permanently to this GP Clinic. While the in-principal approval came, we were told the process from concept drawing to Temporary Occupation Permit will take another six to 12 months. This GP is struggling with the capital renovation quotes of about $200,000 he has just received from potential contractors and he is thinking of giving up. Even if he manages to raise the amount, we were informed that the approval is further subject to agreement by the URA, Building and Construction Authority and SCDF.
Help doctors to help patients more and to do administration less. This example I cited is just one of several that I have experienced while rallying GP clinics in my constituency to support Healthier SG, so that our residents can start their preventive health journey early with a trusted family doctor as exhorted by the Government. More handshakes across agencies under different Ministries for a less onerous and time-consuming workflow must be made with a whole-of-Government mindset if we want to see GPs embracing Healthier SG to help this multinational strategy succeed.
Secondly, looking after our frontline healthcare workers, especially those in the emergency wards. Last week, some of us were informed of a message that some community groups in a western part of Singapore have received from a good public hospital. It was a cry for help. The message shared that the hospital had been facing a very high emergency load, with 100% occupancy in the past two weeks. ED doctors were operating as fast as they could with admission waiting time increasing and about 100 patients waiting for beds. Their plea is for grassroots volunteers to help spread the message of not going to emergency wards unless necessary and to consult the GP clinics first if their conditions are stable.
I thank the Government for the various interim strategies announced in this House to provide a valve to the high demands of beds faced by our hospitals and the long-term strategies through Healthier SG to build capabilities and capacities among our GP clinics. In the meantime, it will be important to step up bolder HR actions to support the frontline healthcare workers. I repeat my suggestion for consideration of employing above establishment with the appropriate HR mechanism in public hospitals to allow buffer for surges and more importantly, essential rest for the physical and psychosocial wellness of our doctors, nurses and frontline healthcare workers.
Lastly, my point on not only the need for whole-of-Government commitment, but also whole-of-society actions for maintaining health in our ageing population.
I would like to make a specific suggestion to exploit faster the telehealth capabilities of not just video consultations, but end-to-end full-loop remote vital sign monitoring systems for management of common chronic diseases like hypertension, diabetes and hyperlipidemia.
Government funded clinical trials must speed up and extend to private GP space. Chronic diseases are silent diseases, and complications in the form of heart attacks and strokes are too late for Singaporeans to know that their health is not in a good shape.
Many of the remote vital sign monitoring technology has been clinically proven to have better health outcomes for specific segments of chronic disease patients, but I see two constraints slowing its proliferation in Singapore. One, operational trials to smoothen end-to-end data transmission between patients and primary healthcare teams, and care team workflows for responses to anomalies in the vital signs; and two, consent procedures for individuals to decide on the extent of releasing their personal vital signs data to their trusted doctors, public or private, and supporting teams, including community organisations like Active Ageing Centres.
Both constraints require the trust and protocols or even legislation to be established by the Government, with the trust and facilitation from the private and public healthcare providers, including GP clinics as well as the not-for-profit charities providing community healthcare services, to empower more Singaporeans to receive the right knowledge of their health and take charge in managing our own health in an informed way with our care teams.
Mdm Deputy Speaker, in conclusion, I have quoted the phrase "Health is Wealth" several times in my speeches in this House. Lest it becomes a motherhood statement, where we talk about but see people around us constantly losing their health with a heart attack or a sudden stroke, complications for chronic diseases as our population continues to age, let us have all hands on deck, in a clinically informed, administratively efficient and coordinated way, to ensure that this phrase is truth for most Singaporeans in the many years to come. Mdm Deputy Speaker, I support the Motion.
Mdm Deputy Speaker : Mr Gerald Giam.
5.06 pm
Mr Gerald Giam Yean Song (Aljunied) : Mdm Deputy Speaker, the world is facing a severe manpower crunch in health and social care. The chief executive officer of the International Council of Nurses (ICN) said last year that, "The scale of the worldwide nursing shortage is one of the greatest threats to health globally." The ICN estimates that due to existing nursing shortages, the ageing of the nursing workforce and the effect of COVID-19, up to 13 million nurses will be needed to fill the global nurse shortage gap in the future. The Southeast Asia region alone is facing a shortfall of 1.9 million nurses, according to the World Health Organization (WHO).
Singapore needs another 24,000 nurses, allied health professionals and support care staff to operate hospitals, clinics and eldercare centres by 2030. Our rapidly ageing population is causing demand for health and social care to increase dramatically. Yet, Singapore is facing a high attrition rate of nurses. One of the reasons why nurses in Singapore have reported to be resigning is because of their heavy workload and stress, which is caused, in large part, by the manpower shortage.
Urgent measures are needed to address this manpower shortage. There are no quick fix solutions. We need to encourage more Singaporeans to choose health and social care as a career, so as to boost the pipeline of future professionals in this field.
I highlighted in my speech on Singapore's COVID-19 response in March that nurses in Singapore are often still seen as the assistants to doctors instead of being professionals in their own right. We need to boost the image of the profession and enhance societal esteem for nurses and allied healthcare workers. Nurses should be granted more autonomy and entrusted with higher level responsibilities.
Schools should highlight careers in health and social care early to students. Professional associations should come up with materials and videos highlighting the careers in this field and share them with schools to disseminate to their students. I agree with Member Dr Tan Yia Swam's call just now for a repository of articles on navigating the healthcare system – and I hope she starts her blog again so that we can continue to tap on her knowledge. Career guidance should start in Secondary 1. This is so that students' interest in health and social care careers can be sparked early, and they can start working towards choosing suitable subjects as they move up to Secondary 3.
As I mentioned in my speech on the education system in April, schools should move away from sorting students according to their grades and towards allowing students to take subject combinations based on their interests. This is how we can continue to raise up a generation of future healthcare professionals who love what they do and are passionate about their work.
IHLs could develop guidebooks to help local students prepare themselves for their eventual applications to these institutions. These guidebooks could include information on the subjects they need to take in school, the grades they need to obtain and the co-curricular and extracurricular activities they need to get involved in to best prepare themselves to get admitted to the institution and major of their choice. For example, this guide could recommend that students take certain subject combinations, join the science club, find opportunities to conduct scientific research, write and publish research papers, or work as an intern in a health or social care institution during their school holidays.
It should provide guidance on how to search out these opportunities and work with professional health and social care associations to create these opportunities for students. These could all help our students focus early on pursuing their area of interest in health and social care and better prepare them for their eventual careers in this exciting field. It is too late to attempt to put together a portfolio just before applying for university or polytechnic. Yet, this is often what many students do, because they go through secondary school with little idea of what they are interested in and do not participate in activities that prepare them for their future careers.
Students from more well-resourced families, on the other hand, often obtain this guidance from their parents and are provided with opportunities for hands-on experience through their parents' professional connections. In order to level up our society and capture a wider pool of talent in our population, we need to make this information available to every student.
However, changing public perceptions and increasing public awareness about health and social care careers takes time and requires a concerted effort from various stakeholders, including the Government, the media, schools and parents. We must continue to develop targeted initiatives to address the concerns of healthcare workers, such as work-life balance, remuneration and career progression.
Having said all this, it is simply not sustainable to rely on increasing manpower supply alone to meet the health and social care needs of our nation. Considering our own ageing population in Singapore, which will require greater care needs, if we are to staff all our health and social care institutions with the doctors, nurses, allied health professionals and care workers to meet the ideal healthcare worker-to-patient ratios, the health and social care sector will likely take up a disproportionate share of Singapore's manpower and will starve other sectors of the economy of skills and talent.
Technology can play an important role in boosting productivity and augmenting manpower. In my Adjournment Motion in this House in 2013 on easing the cost of healthcare, I said that technology should be used as a force multiplier in the face of limited manpower in our healthcare system. This is even more so now than it was a decade ago.
Healthcare technology, or HealthTech, is a fast-growing and promising field which must be developed further in Singapore. Transformational technologies are being developed now which will revolutionise the way healthcare is delivered in the future. These include AI-driven diagnostics that can detect diseases early and make more accurate diagnoses more quickly than conventional means. For example, researchers at Massachusetts Institute of Technology have developed an AI model called Sybil that can predict a patient's risk of lung cancer within six years using low-dose computed tomography scans.
The emerging field of precision medicine has the potential to transform healthcare and is being used in the treatment of diseases like cancer, cardiovascular diseases and genetic disorders. It can potentially improve patient outcomes by providing more targeted and effective treatments, reducing adverse reactions to medications and optimising disease prevention strategies. I note that there is now a Singapore Precision Medicine initiative aiming to generate precision medicine data of up to one million individuals, integrating genomic, lifestyle, health, social and environmental data. This is a very positive development.
There are also other healthcare technologies that are not as "deep tech" as what I mentioned earlier but are already in the market and can provide a boost to the productivity of healthcare workers, enhance the patient experience and improve health outcomes.
The National Electronic Health Records (NEHR) system is a major, multi-year HealthTech initiative. According to the MOH website, there are 2,231 healthcare institutions participating in the NEHR as of 5 May 2023. This list appears to be growing every day and I note there has been a marked increase in the number of participating healthcare providers since the start of this year.
The Straits Times reported on 2 May that, "The private sector has been slow to participate in the NEHR since it was launched in 2011". According to a Parliamentary Question reply by Minister Ong Ye Kung to Mr Leon Perera in March 2023, only about 30% of licensed private ambulatory care institutions have view-access to the NEHR and less than 4% are contributing data.
A 2020 survey and paper by Clinical Asst Prof See Qing Yong of Changi General Hospital entitled "Attitudes and Perceptions of General Practitioners Towards the NEHR in Singapore" found that solo practising GPs who are more than 40 years old and who had practised for more than 15 years were less likely to view and contribute data onto the NEHR. Doctors who regarded themselves as less computer savvy and those who perceived that an inadequate level of technical or financial support was available were also less likely to use the NEHR.
The Health Information Bill was supposed to be tabled in Parliament in 2018 to make contribution of data to the NEHR mandatory for licensed healthcare groups after a grace period. However, this was deferred in the wake of the cyberattack and data breach of SingHealth's system in July that year, in order for technical end process enhancements to improve the security posture of the NEHR to be implemented first.
Most of these security enhancements were supposed to be completed by last year, according to Senior Minister of State for Health Janil Puthucheary. Can I ask the Senior Minister of State if all the security enhancements to the NEHR have now been implemented?
I understand that MOH aims to table the Health Information Bill in the second half of this year. Is MOH reaching out to doctors to address concerns they might have about the security of the patient data they will be required to contribute to the NEHR? How is MOH assisting the remaining GPs and dentists to get onboard the NEHR?
Former Minister for Health Gan Kim Yong said in 2017 that, "Patients can realise the full potential of the NEHR only if the data is comprehensive." He added that, "For NEHR data to be comprehensive, every provider and healthcare professional needs to contribute relevant data to it."
Given the NEHR's goals and the fact that $660 million has been spent on the system so far, it is imperative that the full rollout is implemented without undue delay while addressing valid concerns from doctors.
We need to tap on the knowledge and experience of GPs who have been practising for many years, especially as we move forward into the Healthier SG initiative, which will see GPs playing a key role in promoting healthy lifestyles and promoting preventive healthcare.
Technology can be used to help GPs focus on what they do best. Many private clinics find it a challenge to manage the dizzying array of IT systems that they need to manage in their clinics, connect to the Community Health Assist Scheme (CHAS), Healthier SG and the NEHR.
I note that there is a technology subsidy scheme available to help GPs to implement clinic management systems that are compatible with Healthier SG. However, implementing these systems still requires a lot of time and effort on the part of GPs and their clinic assistants – time which they simply do not have if they want to focus on direct patient care.
MOH should explore the possibility of offering an IT manager as a service to GPs and dental clinics. This would enable them to benefit from the expertise of IT professionals who can assist them in resolving their healthcare IT-related issues.
By providing a point of contact for IT matters, GPs and their clinic assistants can then concentrate on delivering high quality clinical care to their patients. This solution would not only enhance the efficiency and productivity of GPs but also help them stay current with the latest technological advancements.
Mdm Deputy Speaker, urgent action is needed to tackle the shortage of manpower in health and social care institutions and grow the pipeline of Singaporeans entering this field. I have proposed some ways in my speech on how we can do so and I hope that MOH and MOE will consider them.
To boost productivity and augment manpower in the health and social care sector, we need to double down on the use of technology as a force multiplier and assist providers to implement and use these technologies.
As the world celebrates International Nurses Day this Friday on 12 May, which is the anniversary of Florence Nightingale's birth, I would like to take this opportunity to say a huge thank you to all our nurses in both public and private healthcare institutions in Singapore. We appreciate your selfless service, sacrifice and care for our people. Madam, I support the Motion.
Mdm Deputy Speaker : Mr Leong Mun Wai.
5.20 pm
Mr Leong Mun Wai (Non-Constituency Member) : Mdm Deputy Speaker, the Progress Singapore Party (PSP) supports the Motion which calls on the House to support healthcare beyond the COVID-19 pandemic and the whole-of-Government effort in consistent and sustainable support of Singapore's healthcare system.
PSP, once again, thanks all healthcare workers for their sacrifices and dedication to serving Singaporeans, especially during the past three years of the pandemic.
We welcome the Government's move to support healthcare through the Healthier SG initiative, which shifts away from a transactional system that reactively cares for those who are already sick towards an outcome-based system aimed at preventing Singaporeans from falling ill.
Hon Members Dr Tan Yia Swam, Dr Shahira Abdullah and Mr Abdul Samad have spoken passionately about ground-up improvements involving the doctors, healthcare workers, patients and society at large.
We support those improvements that they had mentioned but we also think that they can be better realised by first looking at how to reform healthcare financing and bringing healthcare costs under control.
PSP defines sustainability in healthcare as providing the most effective healthcare to all Singaporeans that is affordable and equitable. The focus should not be on protecting the Government's coffers alone but on how to put in place a healthcare system that has the proper incentives to encourage healthy living and, at the same time, covers Singaporeans for all medical circumstances throughout their lives.
Currently, Singaporeans shoulder much of the cost of healthcare through their MediSave savings, their children's MediSave savings, payments from MediShield Life, private insurance and cash outlay.
I acknowledge that over the past decade, the Government has spent more on healthcare, with the introduction of schemes like the Pioneer and Merdeka Generation Packages as well as CHAS. But the actual spending of these packages is small, relative to the needs of some Singaporeans of the Pioneer and Merdeka Generations who do not have much MediSave savings. The actual spending is also small, relative to the total assets of the Pioneer Generation Fund and the Merdeka Generation Fund.
Overall, the Government has not contributed enough to cover healthcare expenditure.
According to the WHO, the share of healthcare expenditure covered by our Government has increased from 33% in 2011 to 43% in 2019, but this is still much lower than the Organisation for Economic Co-operation and Development (OECD) average of 75%.
Singaporeans are experiencing first-world healthcare cost but receiving much less first-world financial support from the Government.
Healthcare spending has more than doubled over the past two decades. It is not sustainable for Singaporeans to continue footing much of their healthcare bills as well as those of their parents and children.
To reduce social inequality, the Government must do more to help Singaporeans cope with rising healthcare costs and strengthen their financial security.
People do not choose to fall ill, whether they are rich or poor. But while a wealthier family can handle a medical catastrophe better, a similar catastrophe can easily wipe out the MediSave and cash savings of a low-income family even after MediShield payouts.
As a result, Madam, I would like to make three recommendations to reduce the financial burden of healthcare for Singaporeans.
One, the Government should pay for MediShield and CareShield Life premiums for all Singapore Citizens.
Retirement adequacy for Singaporeans is a perennial issue. First, housing cost depletes most of their Central Provident Fund (CPF) savings. So, many Singaporeans must continue to work beyond their retirement age to survive without selling their HDB flats.
Insurance premiums take up another chunk of their CPF savings, which could have been used for retirement.
In my Budget 2021 speech, I estimated that the total MediShield and CareShield premiums paid by a family of four up to 65 years old for the parents and 25 years of age for two children will drain at least $110,000 from the parents' CPF savings, not including the loss in compound interest over the years – and that is at current premium levels.
If the premium increases by 10% every five years, which is highly possible, the financial drain could be more than $250,000. In other words, if the family did not need to pay MediShield and CareShield premiums, the parents would have more than $250,000 extra CPF savings for retirement at age 65.
So, I repeat my call from the 2021 Budget Debate and urge the Government to fund MediShield Life and CareShield Life premiums for all Singapore Citizens.
This will increase the Government's expenditure by about $3 billion a year, but this also means the CPF balances of Singaporeans will increase correspondingly by that amount. This will allow the average Singaporean to have their MediSave balances enjoy the compounding effect of the CPF interest for a longer period and be better prepared for a medical event.
Healthier MediSave balances would ultimately strengthen the retirement adequacy of Singaporeans, because less CPF savings will need to be transferred to their MediSave Account.
My second recommendation is for the Government to top up and expand the use of MediSave, increase MediFund support for needy Singaporeans and increase Pioneer and Merdeka Generation Fund support for older Singaporeans.
As of 2020, MediSave Account holders have accumulated $110 billion in balances. However, only $1 billion, or less than 1%, was withdrawn for direct medical expenses that year. This is a tiny percentage and has decreased from 2015, when $905 million, or 1.2%, was withdrawn from a $76 billion balance. This does not make sense, given Singapore's ageing population and increasing demand for healthcare.
Are the rules of withdrawal from the MediSave Account too restrictive? The Government has always restricted withdrawals from the MediSave Account. But, on aggregate, Singaporeans are not even fully utilising the interest they earn each year on their MediSave balances for medical expenses, let alone their principal sums.
The withholding of MediSave monies for use by its owner is even more unjustifiable than the requirement to maintain a Minimum Sum balance for the Retirement Account. I, therefore, repeat my call for the MediSave withdrawal limit to be relaxed.
I also echo my colleague Ms Hazel Poa's suggestion at Budget 2021 for the expansion of MediSave eligibility for outpatient treatment.
For low-income Singaporeans who have below average MediSave balances and, therefore, have trouble paying medical expenses, the Government should provide more help by either topping up their MediSave Account or increasing assistance from the MediFund substantially.
Currently, the MediFund only dishes out about $100 million a year, which only covers a paltry 0.4% of Singaporeans' total healthcare expenditure of about $25 billion a year.
The Pioneer and Medeka Generation Fund should also increase its payout to help older Singaporeans. Since 2018, the Pioneer Generation Fund has a balance of about $7 billion but it only pays out about $400 million, or about 5% to 7% of its total assets each year. The Medeka Generation Fund has a balance of about $6 billion but it only pays out about $200 million, or about 3% to 5% of its total assets each year.
My third recommendation is for the Government to centralise drug procurement across public and private medical institutions.
Currently, drug procurement is centralised for Singapore's three public healthcare clusters but not for private medical institutions. Consequently, private clinics generally pay more for drugs than the public sector, which can negotiate good prices. This drives up costs across the healthcare chain. Insurance must charge higher premiums to cover higher drug prices. This will cause the national healthcare expenditure to rise unsustainably.
The PSP calls on the Government to centralise drug procurement across all public and private medical institutions and distribute drugs to public and private health facilities on a not-for-profit basis. This will reduce our overall cost of drugs by maximising our bargaining power as a small nation with the big pharmaceutical companies.
In the public sector, the Government should ensure that the price of drugs charged to all Singaporean patients, subsidised or non-subsidised, is at or near the cost price of drugs. The Government can provide additional subsidies to lower drug costs for subsidised patients. But drug prices should not be marked up unreasonably for non-subsidised patients to cross-subsidise the subsidised patients. It is reasonable to charge non-subsidised patients higher prices for the better services that they receive, but not the drugs they take because they are the same.
A centralised drug procurement system at the national level would do away with the need for sudden policy changes to control healthcare costs, provide certainty to Singaporeans and strengthen their retirement adequacy.
In conclusion, Mdm Deputy Speaker, I call on the Government to make a greater effort to address the inequalities in Singapore's healthcare system. This can amplify the benefits brought about by initiatives, such as Healthier SG.
For many Singaporeans, financial pressures from the high cost of living are a major cause of their poor health, including the growing problem of mental illnesses. If more is done to improve the affordability and equity of Singapore's healthcare system, we can expect an improvement in the general health of Singaporeans as well. This should be one of the national priorities as we support healthcare beyond the COVID-19 pandemic. Singaporeans deserve better. For country, for people.