動議 · 2023-05-09 · 屆國會 14
支援後疫情時代醫療保障
議員Tan Yia Swam質詢醫療體系在後疫情時代的可持續支援，強調醫生與患者關係的複雜性及醫療資源有限。她呼籲政府採取全方位措施，關注醫療支出、慢性病管理及醫療服務質量。辯論聚焦醫療費用、患者權益與醫生責任的平衡，體現對醫療系統長期發展的關切。
關鍵要點
- • 醫生應關愛患者
- • 患者更自主質疑醫生
- • 醫療支出需持續支援
推動全政府醫療支援
“Why does anyone stand up to advocate for certain causes? We want to leave behind a better world than what we were born in.”
參與人員 (6)
完整譯文（中文）
Hansard 原始記錄 · 2026-05-02
副議長女士：陳雅琛博士。
下午4時01分
陳雅琛博士（提名議員）：女士，我提議，"本院承諾支援超越新冠疫情的醫療保健工作，以及政府整體努力以提供持續且穩定的支援"。
【程式文本】*該動議亦由阿卜杜勒·薩馬德先生和莎希拉·阿卜杜拉博士聯署。【程式文本】
我宣告本人為私人執業的乳腺外科醫生，並擔任新加坡醫務委員會指定委員及新加坡醫學會副會長等多個醫療領導職務。更重要的是，我以一名有年邁父母和岳父母的女兒身份，以及有患病子女的母親身份發言。請允許我用普通話說幾句話。
（普通話）：【請參閱方言發言】俗話說，“醫生有父母心”。醫生應像父母對待子女一樣，關心和關注患者。醫生應終身保持這種心態。然而，患者不一定願意一輩子被當作孩子對待。孩子年幼時無知，會服從父母的指令；長大後，會開始反抗父母的指令。
三十年前，患者通常會聽從醫生的話。但現在，由於科技進步和資訊獲取便利，越來越多患者會質疑醫生的診斷或指示，甚至挑戰醫生。
（英語）：為什麼有人會站出來倡導某些事業？我們希望留下一個比我們出生時更美好的世界。
我倡導醫患關係。作為患者，我希望醫生關注我的最大利益，而不必擔心被不公正投訴或起訴。作為醫生，我希望專注於患者的病情、需求和願望。
但生活比這複雜得多。許多其他因素影響這種關係——不同的求醫行為、不同的健康信念、融資模式、對結果的期望、客戶服務、社交媒體營銷、尋求盈利的商業實體等。
我為何推動政府整體努力？醫療開支是國家預算中的第二大項。強調建設更多醫院、綜合診所、健康新加坡計劃及招聘人員——這些不能無限制持續下去。
當前熱點新聞是關於癌症藥物清單，我分享一些令人警醒的健康統計資料：每年26%的死亡歸因於癌症；每年20%的死亡歸因於肺炎；每天有20人死於心臟病發作或中風；每天有4人因糖尿病截肢；新加坡糖尿病引起的腎衰竭居世界首位；60歲以上每10人中有1人患痴呆症；每10人中有1人患精神疾病；三分之一的絕經後女性患骨質疏鬆——若發生髖部骨折，五分之一會在一年內死亡。
這些是我們醫療界熟知的事實。健康新聞雜誌經常報道，但人們不關心，直到事情發生在自己身上。大多數人只有生病時才接觸醫療，這時已為時過晚。
人類記憶短暫，這就是為何制度必須記住並傳承教導。
感覺全國乃至全球在新冠疫情後都已向前邁進。但回顧疫情歷史，下一次疫情終將到來——可能十年後，也可能五年後。我們需要為下一次疫情、銀髮浪潮、心理健康危機做好準備。醫療保健必須是全球、國家的整體政府努力，而不僅僅是衛生部的工作。
我呼籲大家改變思維方式。我呼籲每個部門、每位政府官員、每位公務員——事實上，任何正在聆聽的人——都應思考如何更好地教育人民照顧健康、預防疾病。
接下來，支援醫護人員——這意味著什麼？不能只是一次性的快照、一次性健康活動、一次“感謝”運動或一枚獎章。定期調整薪資以匹配通脹和生活成本上漲至關重要。但更重要的是，對醫護人員的支援應是深植的尊重和對我們工作的認可。
我們許多人視工作為使命。我們承諾照顧患者。這不僅僅是一份工作。就像保護國家的武裝部隊一樣，醫護人員保護人民的健康和福祉。這不僅是買賣交易。
那麼醫護人員想要什麼樣的支援？回到我關於親子關係的比喻。我希望醫患關係是相互關愛和尊重的。我們不能只在父親節或母親節那一天愛父母，對吧？這應是一個持續的過程。考慮我們的意見，傾聽並讓我們參與決策。
我已說明為何需要超越疫情支援醫療保健，及為何需要政府整體努力。現在我分享三個大策略：一、識別並承認問題；二、各級教育；三、跨部門協作。
讓我講個有趣的故事。十多年前，作為一名初級醫生，我記得有一天手術室發生小騷動。我們被告知召回手術單，以清理等待手術的患者佇列。我質問原因，被告知“部長要來視察”。
我當時很憤慨，告訴主管護士，“讓他看看，讓他看看我們多忙。”當然，我被趕走了，接待團帶他參觀。我是個憤怒的年輕醫生，但我決心學會成為更好的變革倡導者。
領導者需要深入基層，醫護人員需要學會更好地為自己發聲。也許我們天性不願承認失敗或求助，因為這意味著軟弱，而我們決心為患者堅強。這或許是為何許多人工作至極限。
過去兩年，主流新聞和社交媒體大量關注床位短缺、初級醫生和護士長時間工作、欺凌和騷擾，但我告訴你，這對我們來說並不新鮮。
走廊床、帳篷內的臨時床位、將日間手術床轉為急症床。另一個故事——有一次我值班，半夜接到科主任電話，緊急找出明天可出院的患者，因為急診部有50多名患者等待床位。
有些患者適合出院，但常見的社會請求是留院至週末，因為子女無法請假接送，或需等幫傭抵新加坡。因此，我不是做手術，而是在做床位管理，還被家屬罵無情。然後，當我去處理新患者時，又被罵讓他們等太久。
一次值班從早上8點開始，次日早上8點結束，接著全天工作至後天下午6點。我們每月值班六到八次。80至100小時工作周並不罕見。醫生、護士、實驗室技術員、快遞員、護理員——醫療系統中的每個人都盡力滿足需求；有時，我們無法做到。
有多少人曾去廁所哭泣躲避？有多少人選擇離開？
過去幾十年，我們見證了問題的起伏。取消收費指導方針，加上按實際收費計劃，導致成本飆升，原因多樣，我們仍在多邊醫療保險委員會（MHIC）努力解決。住院醫培訓變革，導致導師流失，培訓生歸屬感下降。培訓時間縮短，部分專科受影響。
醫療私有化和商業化是“必要之惡”。必須有人確保有資金維持可持續經營。但當醫護人員被管理者視為商品時，這又是對醫患關係的負面影響。
目前，我們面臨新問題。私營部門因租金、人力成本及商業實體壓力，經營成本上升；IT系統持續問題；經驗豐富的護士、輔助醫療人員甚至醫生流失。
我曾談及健康和替代醫療服務，這些服務未受監管，有時弊大於利。谷歌使用不當導致搜尋引擎最佳化文章質量差，進一步加劇醫患脫節。
一些家庭醫生表達了對健康新加坡計劃的疑慮。許多醫生擔憂總額付費模式、藥物白名單影響及實際支付給全科醫生的費用，可能無法覆蓋運營成本。
我並非說這些不好。我說醫生對這些變化感到擔憂。我們經歷過帶來不良後果的變革，當別人規定我們如何行醫時，我們感到無助。
我們應從過去錯誤中學習，避免重蹈覆轍，但人類記憶短暫，少有人有時間或決心深入歷史。
政治官員來來去去，但大多數醫生和護士是一生的職業。任職最長的衛生部長是顏金勇先生，任期10年，我感謝他與我們行業保持的溫暖支援關係，翁毅康先生也善意延續了這一關係——希望未來也如此，在我發言之後。
沒有人全心全意關注醫療系統。醫生做臨床工作。臨床科學家做研究。護士照顧患者日常需求。許多人對“系統”感到不安和不滿，但沒有人專責評估和改進系統。
反而，其他服務行業的專家被引入提供意見，收取諮詢費——然後離開，而我們卻拼命努力，痛苦不堪。即使我為私營部門、Shield計劃、企業保險、禮賓服務、第三方管理員（TPA）多次遊說，許多人聽了卻未必在意。
遺憾的是，連我自己的醫生也未密切關注我的倡議，仍重複舊有抱怨。有些人知道但不敢行動，可能害怕若不遵守TPA規則會失去生計。TPA已介入醫患關係。我常對同行說，企業應盈利是常識，但我們絕不應從人的痛苦中牟利。
醫療服務提供者處於兩難境地——政府醫院因等待時間長被投訴，私營醫院被指收費過高。
患者期望極高。我們都想要完美——便宜、快速且優質。
我多次為重組醫院背書。我們都曾在那裡受訓和工作，它們提供優質護理。有時溝通不夠清晰或親切，僅因團隊規模龐大。
我認為重組醫院便宜且優質，但快速難以做到。我請求公眾理解。重組醫院是教學醫院。我們都從某處開始。我們通過導師指導學習，檢查小腫塊，做首次手術。
患者絕非實驗物件。有主治醫師領導，有專科醫生負責您的醫療過程。遇到有愛心的年輕醫生時，我希望您幫助醫生成長。
如果經濟允許，有些人會選擇私立醫院，因為服務更個性化，通常更快，且因團隊較小更具隱私。但我請求您理解，每位醫生都經營著業務，採用不同模式，承擔不同成本。如果您找到信任的醫生，溝通透明，我希望您也給予他所需支援。
我列舉了一系列長期存在、複雜且系統性的問題，不指望任何人能解決。
請繼續聽我談教育和跨部門協作的看法。
人們學習方式多樣。我認為最常見的是頻繁接觸和重複。我們經常吃飯，對吧？一天三次，甚至五次或更多。新加坡人熱愛美食。如果我問雞飯，必有激烈辯論，比較燒雞與蒸雞，姜、辣椒。愛好者甚至知道不同店鋪的具體收費：額外辣椒、額外飯、升級雞腿肉的價格。
但有多少人需要大手術或因重大疾病住院？
有些複雜病患反覆住院，醫療團隊隨著時間瞭解患者及家屬。這類家庭通常也很清楚治療費用。
但大多數人首次重大疾病時，是第一次必須在醫院就醫。那時才知道醫療費用昂貴，已非好時機。患者擔憂癌症診斷、生存率、治療副作用及併發症、工作與家庭責任。
許多人不瞭解新加坡治療費用，初見賬單震驚。我處理開胸手術賬單時就是如此。
醫療融資極其複雜，新加坡有多重安全網——公立與私立部門。誰付錢？納稅人資金、保險池。存在多種共付和補貼層級。問題是大多數健康人不關心這些，直到遇到健康問題。
若是擇期手術，有時間進行財務諮詢、預授權等。但緊急情況，團隊先行施救。患者及家屬可能揹負鉅額債務。或醫院沖銷壞賬——雖不常見，但確實發生，如無醫保的外勞僅有意外險，保障不足。當地人亦可能不熟悉所購產品，無論是住院、重大疾病或早期癌症計劃，可能不瞭解除外條款或保障限額。
我是在近三年才學會這些術語和知識，討厭必須瞭解它們，因為分散了我照顧患者的精力。但這是必要的。我三月時談過，保險公司應與醫療提供者建立更緊密合作關係，讓患者更有經濟保障。
人們需要學會如何導航我們的醫療系統。幾年前，我開設部落格，專門介紹如何進入醫療系統、不同路徑及優缺點。但我無法持續，其他事務優先。此後見過幾篇寫得好的文章，無需重複發明輪子。收集這些，建立中央資料庫，作為所有新加坡人的主要參考。
人們不主動關心，直到事情發生在自己身上。看看全球變暖，普通人是否擔憂？即使面對氣候變化證據？人們是否擔憂生育和早育？直到嘗試生育遇到困難？我知道大多數患者直到出現症狀或聽聞朋友同事確診乳癌才擔憂。人們只有在事情影響自己時才關心。
我希望我的孩子長大後能自我負責。同樣，我相信我們每個人都能為自身健康負責，但需要被賦能，知道如何做。
人類是情感動物，但有思考能力。學會調節情緒、用理智思考是寶貴技能，應從小培養。我認識一些成年人仍在掙扎。我不能低估科學和邏輯框架在解決問題中的重要性。恐懼、憤怒、憂慮、喜悅都是正常情緒反應，但我們必須學會調節。太多患者因焦慮癱瘓，影響治療過程。
某些疾病研究充分，進展清晰，例如乙型肝炎導致肝癌，乙肝疫苗有效。其他多因子疾病，如大多數癌症和心血管病。僅因我吸菸，不代表必得肺癌。同樣，不吸菸也不保證永不患肺癌。事情沒那麼簡單，沒有靈丹妙藥或“免死金牌”。
肥胖、中風、心臟病發作——我們稱這些為“生活方式疾病”，因為每天我們都會在飲食和活動水平上做出小的決定，這些決定會積累成疾病或預防疾病。有些疾病是隱匿性的。我們是否能識別心理健康問題，還是直到出現自殘等警示事件時才被發現？
可預防的創傷是我們可以改進的另一個巨大領域。提高兒童安全座椅的意識、所有道路使用者包括行人和騎行者的道路安全意識、駕駛執照的更嚴格規定、為緊急車輛讓路、工作場所安全。
有太多東西需要教授，也有太多東西需要學習。教育不能僅僅歸屬於教育部（MOE），正如健康不應僅僅是衛生部（MOH）的領域。我堅信，從嬰兒期開始並貫穿我們的學校和工作成年時期的教育，將是實現良好可持續健康的關鍵。我很高興翁部長上個月表示，衛生部將與教育部和社會及家庭發展部（MSF）合作，為我們的年輕人奠定堅實的健康基礎。
我對嬰兒在看著iPad時被餵食的頻率感到震驚。研究表明，螢幕時間對大腦發育有不利影響。嬰兒無法很好地識別人臉並發展社交技能，導致後期執行功能和高階功能出現問題，如注意力集中、衝動控制和情緒調節。我見過越來越多20多歲的年輕成年患者有此類問題，我對未來幾代人深感擔憂。
教授技術的適當使用不僅針對年輕人，也針對成年人。關於日益複雜的金融詐騙新聞層出不窮。與健康相關的趨勢包括聲稱能奇蹟般治癒癌症或保證減肥的療法。我見過患者嘗試黑蒜飲食、蘆薈、鹼性水、負離子服裝。清單無窮無盡。
我稱之為偽科學，因為其中有一絲真理。有一個實驗顯示該物品具有殺死培養皿中少數癌細胞的某種特性。對我來說，這就像觀察到“嘿，螞蟻能用葉子漂浮在水面上！因此，如果我用大葉子，我可以用它航行穿越海洋！”我無法專業地將此類研究推斷為能治癒癌症，而一些銷售人員卻這麼做，脆弱的患者會嘗試，甚至有時放棄經過驗證的治療。
在疫情期間，疫苗猶豫和大型製藥陰謀論對公共健康產生了直接負面影響。網際網路連線拉近了人們的距離，但也讓錯誤資訊氾濫。人們依賴口碑推薦，有些人使用谷歌評價，但有些人不知道這些評價可以被購買或偽造，或者存在惡意營銷機構故意給競爭對手差評。
那麼，教人們如何使用谷歌和人工智慧（AI）作為工具的責任是誰的呢？感覺這不應該是政府的工作。那就由個人自己負責吧。
勵志演講家吉姆·羅恩說過，“你是你花最多時間相處的五個人的平均值”。我用這句話定期審視我的個人和職業成長。每當我感到停滯不前時，就是時候審視並做出改變，走出舒適區，學習新事物。不要過於安於現狀，陷入迴音室。
終身學習是一項挑戰。那麼我們如何培養人們這種心態呢？這引出了我的下一個觀點：跨部門協作。
我認為新冠肺炎多部委工作組是一個很好的平臺，領導層可以討論並分享快速變化情況下的及時資訊，並協調政策方向。當然，向下傳遞過程中存在問題，因為人畢竟是人，我們的反應各異。用《龍與地下城》的說法，有人是守法善良，有人是混亂邪惡。有些人嚴格遵守法律條文，有些人遵循法律精神。有些人利用他人的絕望牟利，有些人自私任性地按自己的規則生活，不尊重所處的社會。
新加坡政府結構複雜：分為16個部委，進一步劃分為部門、司局和50多個法定機構。不同部委的人會相互交流嗎？還是有非常嚴格的協議規定如何提出新想法？我之所以問，是因為我曾作為員工在一家重組醫院內部工作，知道存在明確的層級流程。即使現在，我也只與衛生部的某些人員有過交流經驗。
我知道公務員系統中各級都有非常聰明且敬業的人。我知道有熱情且關懷他人的人，他們積極參與各種團體、慈善和社會企業。生態系統蓬勃發展，但我懷疑是否存在過多中小型團體。我們能否整合這些資源？
我們每個人可能都是某一領域的專家，但我們不知道自己不知道的東西。
通過參與心理健康產業委員會（MHIC），我有幸跨行業建立網路，結識保險公司、理財顧問、精算師，並從他們的角度討論醫療問題。作為臨床醫生，我謙卑地意識到自己之前對醫療融資知之甚少。我再次提起盲人摸象的故事，每個人只觸控自己能觸及的部分，卻爭論大象的樣子。因為事實如此——我們不知道自己不知道的東西。
我現在挑戰大家跳出常規領域，思考如何運用你的知識更好地支援醫療，無論你身處何處。你們聽到了我作為醫生、醫療領導者提出的問題。你們能幫我嗎？
我恭敬地分享一些如何將未來政策與醫療方向對齊的想法。正式工作組顯得非常結構化。我相信，當志同道合的人隨意討論時，頭腦風暴和協同效應可能創造出更好的成果。
從小做起，早期兒童發展局和教育部可以與衛生部緊密合作，確定年輕新加坡人應學習的關鍵基礎健康資訊。挑戰不在於死記硬背，而是如何獲取資訊更新，因為一些科學突破發展迅速。
我小學時學的食物金字塔現已過時，取而代之的是健康餐盤模型，當前營養和健身研究傾向於低碳水化合物飲食配合抗阻訓練。誰知道未來研究會顯示什麼？
教孩子們如何正確飲食，培養定期鍛鍊的習慣以保持健康體重。小學已做了大量心理健康教育和安全、適當使用社交媒體的工作。這些也可以推廣給未在網際網路時代成長的成年人，讓他們學習網路禮儀和安全知識。
引入並強化家庭醫生的理念及優質初級護理的重要性。教授如何導航醫療系統，如何獲得補貼護理以及不同型別保險的作用。
社會及家庭發展部（MSF）在建設強大家庭的使命中，也可以與教育部和衛生部合作，塑造性教育，指導家庭如何進行關於道德、宗教信仰和身份的艱難對話。可以諮詢教練行業，尤其是專注於性諮詢的教練。
教導年長青少年和高等教育學生關於為人父母的旅程，其諸多喜悅與困難，使年輕夫婦能夠做出知情的婚姻決定，權衡生育與否的利弊，以及何時生育；是在20多歲、30多歲還是40多歲？
進入職場後，我們常常忽視自身健康以追求事業。在長時間工作或輪班中，我們養成不健康的飲食習慣和不規律的睡眠時間，不知道如何安排鍛鍊時間。有多少成年人在五年或十年的工作生活中注意到體重增加和疲憊？體重悄然增加。
新加坡男性每年需通過個人體能測試，但女性可能沒有健身基準。存在一種“瘦胖”現象，即體重在健康範圍內，但肌肉和骨量較低。
我認為這是各部委可以為健康做貢獻的地方，通過持續教育飲食和鍛鍊、篩查和疫苗接種以及賦能成年人。
對於人力部（MOM），研究如何在工作場所培養健康習慣；諮詢健身行業；讓負擔得起的健康食品易於獲取；鼓勵10至20分鐘的簡單辦公室或椅子鍛鍊；讓老闆推行此類健康實踐；教導員工螢幕時間限制和心理休息的重要性；研究彈性工作時間，以便員工優先安排個人、家庭和醫療預約時間；考慮健康激勵措施；與衛生部、新加坡消費者協會、新加坡金融管理局合作，調查企業保險支付不足和第三方管理員（TPA）施加的面板限制的投訴；幫助員工獲得優質護理。
文化、社區及青年部、社會及家庭發展部和通訊及新聞部（MCI）可能是促進各部委跨部門協作的理想推動者。好的想法、內容和專案可以得到所有部門的支援，而不是每個部門都試圖獨立開展專案。
舉一個例子。如果你在谷歌搜尋“新加坡如何減肥”，會出現什麼？健康交流（HealthXchange）、健康中心（HealthHub）、健康促進局（HPB）的文章被美容診所、水療中心和健身房的廣告文章淹沒。一篇優質文章配上好影片，可以在不同部委和各種社交媒體平臺廣泛分享。重複傳播相同的基本健康資訊：正確飲食、每天鍛鍊、保護心理健康，無論你在哪個部門，是社會支援、青年還是體育。
感謝國土發展部為湖濱花園新建的滑板公園。我希望你們繼續將體育融入社群。你們知道新加坡的城市景觀被國際認可為跑酷天堂嗎？但跑酷者經常被居民驅趕，居民認為他們在破壞環境，警方也被叫來驅趕他們。我希望新加坡能給予跑酷社群更強有力的支援。
可持續發展與環境部（MSE）供應水和安全食品的使命，也可以擴充套件到更實惠的新鮮農產品，因為食用全食物比加工食品更有益健康。食品安全標籤由新加坡食品局（SFA）監管，隸屬於MSE，但營養標籤由健康促進局（HPB）監管，隸屬於衛生部。我在網上找到了一本64頁的手冊。我認為即使飲品被評為“C”或“D”，人們仍然大量購買珍珠奶茶！
值得稱讚的是城市農業的興起，得到了新加坡土地管理局、新加坡城市重建局（URA）、農糧獸醫局、新加坡食品局、動物與獸醫服務局以及建屋發展局（HDB）等國家機構的支援。我希望沒有遺漏任何機構。這帶來了食品安全的開端，以及與自然共事、學習種植和食用有機食品的健康益處，這將是持久的。
資訊科技（IT）在許多方面仍是巨大挑戰。我在之前的演講中提到，電子健康記錄有時不過是微軟Word文件或掃描儲存的PDF檔案。系統笨重且不直觀。生命體徵仍需手動輸入。我的患者試圖在HealthHub、Healthy 365和Health Buddy中查詢手術組織學報告，但都找不到。
我不知道如何實現，但請通訊及新聞部（MCI）、GovTech、綜合健康資訊系統（iHIS）及其他IT法定機構協調，建立一個良好的國家系統？我設想使用Singpass和HealthHub，配合觸發問題提醒個人重要健康檢查點：身高體重、健康篩查、疫苗接種、預約。
醫療旅遊是一個複雜的國際問題。貿易與工業部（MTI）會否研究這如何可能增加本地醫療成本，但仍幫助新加坡保持作為優質醫療領先地位的聲譽？我仍對醫療禮賓業務深感不安，他們向醫療服務提供者收取費用以引入外國患者。
MTI會否協助衛生部吸引新加坡人從事醫療必需崗位？研究醫療人員的招聘、培訓和留任。人力資源管理至關重要，不是將人視為商品，而是真正建立良好的工作關係，使他們感到被重視並長期留下。
複雜的醫療狀況由多學科護理團隊管理。我將類似概念應用於我們的醫療系統問題。跨部門協作；與醫療服務提供者接觸；跨部委和行業走出舒適區。
適當的諮詢工作報酬值得考慮，並逐步建立網路。我非常關注成本，理想情況下，如果能依靠志願者，那很好，但我也意識到這可能導致同一批熱心人被反覆呼叫。
建立一個智囊團，所有部委都能訪問並在全球問題上進行簡短諮詢，而非零散地向組織提出請求。
最後讓我總結。我已說明為何醫療應是全政府關注的事項，而非僅衛生部的責任。我列舉了醫療中的長期問題，強調了多層次教育的必要性，並呼籲大家跨部門協作。
我的老朋友曾說：“別假裝你想讓人們健康。你們醫生想要更多病人，對吧？有生意！”
不！理想情況下，我想照顧那些盡力而為仍然生病的患者，而不是那些因缺乏知識、資源或自我照顧而忽視自身健康的人。讓我們共同努力減少可預防疾病的數量。這才是真正的成本節約。保持健康是我們每個人的責任。要有教育並保持資訊更新。
作為社會，我們應當友善且有公民意識。那些在新冠疫情期間囤積醫療物資並試圖牟利的人，羞愧吧！作為醫生，我平等照顧所有患者。但當重症監護病床滿員時，誰更應得到照顧？
疫情讓每個人都深刻意識到資源有限——口罩、抗原快速檢測包、氧氣。這是生活的現實。資源有限，誰來做守門人決定誰最需要？
醫療工作者需要政府幫助制定這些政策。我們需要每個人優先考慮健康。不要逼我們進行分診決定救誰。我期待一場激烈的辯論。[掌聲]
[(程式文本) 提出問題。 (程式文本)]
副議長女士：沙希拉·阿卜杜拉博士。
下午4時31分
沙希拉·阿卜杜拉博士（提名議員）：在開始之前，我想宣告我是就職於邱德拔醫院的正畸醫生。
副議長女士，我們目前處於疾病爆發應對系統綠色狀態，這是自新冠疫情開始以來的最低健康警戒級別。新冠疫情對世界產生了深遠影響，醫療工作者在為需要者提供關鍵護理方面發揮了重要作用。隨著我們開始走出疫情，顯然我們需要繼續優先支援醫療工作。
本動議承認醫療在社會中的重要性，旨在確保醫療工作者和患者都能獲得他們茁壯成長所需的支援和資源。它建議採取全政府方法，建設一個更健康、更有韌性的社會。
超越疫情，展望未來，我想談三個需要我們持續關注和支援的領域：首先，醫療人員短缺，這與醫療工作者的倦怠和心理健康有關；其次，為我們的外來勞工提供牙科護理；第三，支援特殊護理和老年牙科領域。
首先，醫療人員短缺。醫療工作者一直面臨巨大壓力、情緒挑戰和艱難的工作環境，工作時間長且不可預測，存在受傷和疾病暴露風險。這些因素可能導致倦怠和心理健康問題，即使在疫情之前也是如此。
雖然短期措施如諮詢和心理健康專案至關重要，但必須解決倦怠和心理健康問題的根本原因。
這需要解決系統性問題，如工作量、工作與生活平衡、支援、培訓和職場文化。其核心實際上是人力短缺，衛生部已在努力解決。
然而，即使在全球範圍內，醫療人力資源也存在競爭。新加坡外籍護士的流失率顯著上升，從2019年的9.5%增至2022年的14.5%。
在今年的供應委員會（COS）演講中，高階議會秘書拉哈尤·馬哈贊女士提到：“本地和外籍護士流失到競爭國家，是導致護士壓力大和工作量高的關鍵原因。我們需要替代流失到其他國家的人力，保障護士福利，並滿足日益增長的需求。”如果我們更進一步，我們需要確保我們的醫療工作者得到支援，並擁有提供最佳護理所需的資源，我們需要在系統中建立“緩衝”或餘地。
我有一些關於如何留住和吸引醫療人力的建議。
第一：給予表現良好的醫療工作者的直系親屬永久居民身份。衛生部支援提名議員陳雅森博士提出的建議，即給予表現良好的外籍醫療工作者永久居民身份。對於這些表現良好者，我們能否更進一步，自動給予他們的直系親屬，即配偶和子女永久居民身份？
我知道我工作場所的幾位牙科護士因這個原因離開。經過多次申請後，她們最終放棄，選擇帶著全家移居加拿大、紐西蘭和澳大利亞等地。如果我們給予她們家屬永久居民身份，她們將在新加坡紮根，失去她們的可能性將降低。當我們失去表現良好者，尤其是資深者時，我們不僅失去一名員工，還失去他們在醫療系統中的多年經驗。
第二：確保薪酬在本地和國際上具有競爭力。新加坡公共醫療部門已於2022年將護士基本工資提高了5%至14%，並提供留任獎金。我知道衛生部定期監測我們薪酬的本地和國際競爭力。薪資可能不是醫療工作者唯一的決定因素，但對於許多人選擇職業路徑時仍是重要考慮，尤其是在護理工作需求巨大的情況下。它也能激勵外籍醫療工作者繼續在新加坡工作。坦率地說，更高的薪酬待遇總是有幫助的。
第三：靈活工作安排（FWA）。這是陳武明議員在COS辯論中詳細談及的，我無法過分強調其重要性。醫療工作者也是母親、父親、女兒和兒子。他們可能有年邁的父母或年幼的子女。是的，醫療工作者已有靈活工作安排。然而，衛生部和人力部可以合作，提出更多創造性的靈活且家庭友好的人力資源工作實踐，適合醫療工作者不同人生階段及各醫療環境的獨特需求。例如，除了錯峰班次外，我們可以考慮靈活的班次長度，將班次分割為更短的安排時間，或為醫療工作者提供更多帶薪假期。
第四：提升公眾對醫療工作者的尊重。公眾應理解醫療工作者不僅是需要順從患者要求的交易性服務提供者。對虐待或威脅應零容忍。因此，我對我們在這方面取得的巨大進展以及三方工作組防止虐待和騷擾醫療工作者的建議感到鼓舞。我的提名議員同事拉傑·約書亞·托馬斯先生將進一步就此話題發言。
第五：通過提供更廣泛的支援和幫助改善家庭護理環境。為減輕醫療部門壓力，照顧者是居家養老的基礎。然而，我從親屬處目睹了這條路的艱難。
我們可以考慮的一個簡單措施是實施更多包含照顧者的人力資源工作實踐，並增加長者護理假，這一建議此前已有提出。另一個是各部委如何協作，確保已感到壓力山大的家庭能順利瞭解不同的護理選項和可用補貼，確保每個即將開始這段旅程的家庭都能聯絡到醫療社工，進行需求評估並提供指導。這樣，在照顧長者需求的同時，我們也應關注照顧者自身的需求評估，避免忽視他們的心理健康自我照顧或他們自己年老時的經濟保障。
其次，我想談談為弱勢群體，特別是外籍勞工、老年人和特殊需求人群提供牙科護理的重要性和服務。牙齒健康是一個容易被忽視但非常重要的健康方面，現代研究顯示口腔健康與全身健康及生活質量有關。例如，牙齦疾病可增加糖尿病、感染性心內膜炎及其他血管疾病的風險。因忽視導致的牙痛也可能使人虛弱。我們不能忽視口腔健康及其對整體健康和生活質量的影響。
然而，對於外籍勞工，即使牙科治療被認為必要，僱主也必須承擔治療費用，而牙科治療費用可能很高。
目前，初級保健計劃確保符合條件的外籍勞工能獲得可負擔的醫療服務。我建議將牙科護理也納入外籍勞工服務範圍。護理不必涵蓋所有牙科服務，如常規洗牙和拋光，但應針對緊急需求，即可能非常疼痛的牙科病例，以及感染和腫脹病例，若不治療可能危及生命。
我現在想談談支援老年人和特殊需求群體。隨著我們朝著“更健康的新加坡”目標努力，我們希望確保口腔健康在成功老齡化和包容性醫療中得到關注。
在開始之前，我想講述一位同事的案例。一名嚴重智力障礙女性到老年及特殊護理牙科診所接受治療。她的行為挑戰使得區域性麻醉（即清醒狀態下）治療不可行。然而，全身麻醉（即睡眠狀態）治療也存在問題。風險大於收益，尤其是單顆牙齒拔除。
此外，醫院政策要求對精神無行為能力成年人進行法律代理同意，獲得法院指定代理人可能需數月且費用高昂。更糟的是，該女性曾在醫院環境中經歷過創傷。其家屬權衡後選擇了椅旁管理。
經過三次適應性訪問嘗試準備後，牙醫嘗試用身體約束進行拔牙，但因困難重重未能成功，治療被終止。
這一經歷凸顯了患者家屬在系統中導航的困難，也反映了牙醫和醫療團隊在治療複雜需求個體時面臨的挑戰。
我想觸及幾個方面。
第一：與老年及特殊護理患者及其社群互動。這些群體缺乏口腔健康知識和健康目標，凸顯了倡導和觀念轉變的必要。患者和照顧者常難以瞭解各種服務，不知道向誰尋求經濟援助及其他支援服務。
為此，可能需要加強相關護理人員之間的跨部門合作；牙醫、病房護士和照顧者等專業人員需掌握基本口腔健康知識及可靠治療資訊來源。我們可考慮審視護理實踐指南，確保為住戶提供的口腔護理既更新又實用。
第二：為複雜需求患者預留容量。牙醫盡力協助，但缺乏護理標準指導。需要臨床實踐指南及護理路徑，確保提供優質且適當的護理。多重健康及行為問題的複雜病例可在醫院處理，較輕病例可轉介至全科診所的牙醫網路。穩定後複雜病例也可轉回全科醫生。
第三：老年及特殊需求設施缺乏牙科護理服務。部分社群及服務弱勢群體的機構已主動發展自身牙科能力。在新加坡所有護理院中，只有部分通過Unity Denticare巴士或志願團體及機構的流動團隊獲得現場牙科服務。更少有護理院設有固定的實體診所，由志願牙醫在有人力時運營。
例如，臨終關懷協會在其最新的日間臨終關懷中心Oasis@Outram設立了牙科診所。
在特殊需求方面，新加坡智障人士運動（MINDS）發展及殘疾醫療診所去年成立，已開始為患者提供牙科篩查及轉介服務。隨著MINDS開放跨學科健康中心，該服務有潛力擴大。
然而，志願團體間缺乏協調也是主要問題。綜合護理署（AIC）協調照顧者及長者護理，但不包括牙科服務。這導致資源配置效率低下，如人力浪費，以及尚未服務的護理院需求未被滿足。
雖然我們應讚揚志願精神，但幾乎所有這些服務均無成本回收機制，令此模式難以持續。若服務為長期提供，消耗品、材料及人力成本需納入考慮。
因此，為解決這些問題，我呼籲衛生部和社會及家庭發展部更多支援不同社會服務機構發展其個性化牙科能力。現場牙科服務有多種優勢。對自閉症譜系障礙者而言，去陌生場所接受牙科護理可能是困難體驗。注射令人害怕，拔牙也令人恐懼。
無現場服務，患者需被送往初級保健服務，有時需昂貴的私人救護車。外部診所治療受限於跨機構資料共享限制、專科服務費用高昂及等待時間長等問題。因此，老年人及特殊需求者的牙科需求“就地”管理更為有利。此類診所也能避免將資源用於選修治療如牙齒美學，而專注於基本需求，提高效率並節省成本。
資金是支援的重要方面，牙科服務資本成本高。其他支援方面可包括行政及許可靈活性。例如，我們嘗試將手持行動式牙科X光作為家庭護理拔牙的護理標準，但至今仍未獲批准。
第四：利用牙科官員資源。我們仍缺乏志願為該群體服務的牙醫。為培養志願服務精神，可安排牙科官員在履行合約期間短期派駐，服務老年及特殊需求患者。此舉也可擴充套件至其他弱勢群體如外籍勞工。希望他們合約期滿後也能繼續志願服務。
總之，在我們承諾支援疫情後醫療工作並確保持續穩定支援時，不能忘記牙齒健康是實現整體健康和生活質量的關鍵組成部分。弱勢群體如外籍勞工及老年和特殊需求人群的牙科醫療需求不應被忽視。副議長女士，我支援本動議。
副議長女士：阿卜杜勒·薩馬德先生。
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阿卜杜勒·薩馬德先生（提名議員）：副議長女士，在兩位領域專家醫生之後發言確實不易。不過，我感謝提名議員陳雅森博士讓我參與提出本動議的團隊。
作為工人階層的代言人，我的發言將聚焦兩個主要領域，即醫療工作者福利及吸引年輕新加坡人投身醫療行業的挑戰——他們是我們醫療勞動力的未來。
首先，我想向本院分享，醫療服務員工工會（HSEU）和新加坡手工業及商業工人工會（SMMWU）代表護士、輔助醫療專業人員及支援人員，合計擁有超過35,000名會員。
我們呼籲尚未加入工會者儘快加入。原因很簡單。工會不僅代表你們在工作場所的聲音，也會為你們發聲。
雖然醫療行業不在我的職責範圍內，但我已聯絡HSEU和SMMWU的領導，瞭解他們成員近期及長期的關切、挑戰和願望。
通過近期疫情，我們意識到醫療工作者為新加坡默默付出多少。確實，工作時間長，且時常遭遇患者家屬的辱罵。問題是，為什麼只有在疫情期間我們才意識到醫療工作者的重要性？為什麼必須經歷疫情才能學會感激他們？
遺憾的是，這就是現實。只有在危機時期，我們才知道這些前線工作者的重要性。
就像我在電力行業一樣，只有在電費上漲或停電時，我們才開始意識到穩定可靠電力供應的重要性，而這在日常生活中被視為理所當然。不要羞於承認現實。
女士，去年本院就“更健康的新加坡”議題進行了相當長時間的辯論。各位提出了許多良好建議和想法，提醒我們過更健康的生活方式。雖然重點是發展健康生活方式，但我們不應忘記那些幫助我們實現健康生活方式的人，即我們的醫療工作者。
讓我們關注醫療工作者面臨的挑戰，包括行政和支援人員，而不僅僅是直接面對患者的醫生和護士。也不要忘記放射科、病理科等其他部門支援人員同樣關鍵的角色。
這讓我聚焦於醫療工作者的福利及培養未來一代服務於此行業。
本次會議前，我不僅聯絡了兩個工會，還聯絡了我網路中的朋友及親眼見證醫療工作者辛勤工作的新加坡人。我們認可衛生部通過醫院管理層已做出支援，但仍有如輪班、薪資等方面可進一步改進。
我想談談輪班安排，事實上，衛生部多次宣告不監管此類安排，交由醫院管理團隊負責。因此，我呼籲衛生部設立專門團隊獨立監督醫療工作者的輪班安排。不要等到意外發生才開始調查。
我們需確保輪班安排充分考慮休息時間，因為我們需要時刻保持身體警覺的工作人員照顧患者和支援醫生。
我對此感受深刻，因為我女兒是成千上萬醫療工作者之一。我親眼見證她過去十年在盛港醫院經歷的長時間工作。有時，我覺得問題不在於企業輪班政策，而是排班的直線經理可能偏向自己喜歡的員工。她最近離職，也告訴我她團隊約半數同事早已離開。她現在開始新的工作旅程。
諷刺的是，她曾於2020年作為實習生在同一家醫院實習，當時是共和理工學院最後一年學習。我當時震驚地得知她實習期間沒有任何津貼。我之前未提出此問題，是因為我還在與行業內親友核實。核實過程中，我回憶起多年前在某些對話會上也曾提出此問題，巧合的是，我女兒也經歷了同樣的情況。
我想問衛生部是否知道有實習生沒有獲得勞動報酬的情況。我們不要把實習描繪成像在學校上課的另一種形式。學術經歷和工作經歷永遠不會相同。我不認為給這些學生髮放津貼會讓醫院或衛生部的財政陷入困境，因為他們是在真實的工作環境中，而不是在學校。
我呼籲衛生部或醫院立即審查此事，不要讓我們的學生淪為免費勞動力。我們不要讓我們的孩子，未來的勞動力，成為今天的免費勞動力來源。我們不應延續這種做法。
女士，隨著新加坡在全島建設更多重組醫院，這意味著會有更多的就業機會。這將使醫療工作者能夠遷移到離家更近的首選醫院，或者獲得更好的薪酬，甚至兩者兼得。
我們是否準備好迎接希望進入醫療行業的新加坡人，尤其是年輕人？
雖然我們仍然歡迎外國醫療工作者來補充本地勞動力，但有哪些措施確保有足夠的新加坡人作為醫療工作的核心？上述關切也是我工會兄弟姐妹們與我分享的眾多關切之一。
雖然醫院工作人員的情況被廣泛討論，但我們不要忘記社群診所的醫療工作者。他們面臨的工作壓力與醫院工作人員相當。根據我的交流，有人指出他們希望社群診所嚴格實行預約制度，因為即使預約已滿，仍有許多未預約的病人前來。這極大地增加了他們和醫生的負擔。另外，有人希望社群診所經過運營時間審查後，能儘快實行五天工作制。
輕鬆一點，我理解目前三方正在努力保護和防止對我們醫療工作者的虐待和騷擾。無論程度如何，對醫療工作者的任何虐待都必須採取更嚴厲的措施。請允許我用馬來語發言。
（馬來語）：[請參閱本地語演講。] 在為應對人口老齡化做準備的過程中，我們加強了包括醫療工作者在內的醫療計劃。鑑於工作需求和勞動力短缺，裝備現有醫療工作者掌握新知識和技能至關重要。我們需要受過培訓且富有愛心的醫療工作者照顧我們的老齡新加坡人，無論是在醫院還是社群養老院。這項工作不僅需要體力，還需要在面對困難病人和挑戰性照護者時具備心理韌性。
正如我之前英文演講中提到的，我們都面臨過、正在面臨並將繼續面臨挑戰。請注意，有兩個工會，衛生服務員工聯盟（HSEU）和社會及醫療支援工作人員聯盟（SMMWU），是你們的聲音，傾聽併為你們在工作場所的挑戰發聲。如果你還沒加入，請加入他們！
你們的工會了解你們的工作挑戰，並將盡最大努力為你們爭取利益，從工作場所事務到其他福利待遇。不要害羞提供反饋，因為我知道我的工會兄弟姐妹們永遠支援你們。
挑戰之一是輪班人員的長時間工作、長時間工作帶來的疲勞、苛刻的病人和照護者，以及薪資應反映工作量，而不僅僅是在危機期間。
我呼籲衛生部認真審視醫院的輪班工作時間，不要等到發生不幸事件才採取行動。議員們已多次提出此呼籲，我希望這次不會被輕視。
另一個令人擔憂的問題是醫院實習生沒有獲得任何津貼，卻做著與正式員工類似的工作，這可被視為免費勞動力。過去聽說此類做法時我曾懷疑，但當我女兒2020年在盛港醫院實習時親身經歷後，我深刻體會到現實。因此，我呼籲高等院校和衛生部審查此做法，禁止在新加坡實行此類免費勞動力。
如果不停止上述做法，可能會阻礙年輕新加坡人加入這一有意義的行業。隨著人口老齡化，我們需要更多年輕新加坡人加入醫療行業。新醫院正在建設中，我感謝衛生服務員工聯盟和社會及醫療支援工作人員聯盟的工會兄弟姐妹們與管理層合作，提升會員和員工技能，以適應當今先進的工作模式併為未來做準備。
請確保接受培訓的員工獲得更好的薪資和更好的工作前景。
（英文）：我再次呼籲相關各方提醒自己關注這群醫療工作者和醫生的重要性，訪問重組醫院、私立醫院、社群診所甚至鄰里診所時，永遠不要害羞表達感謝。代表勞工運動的所有領導者，我們感謝你們為照顧我們的家庭、朋友和新加坡同胞所做的努力。
再次提醒大家不要忘記加入工會，因為工會——始終以會員為先，永遠支援工人。副議長女士，我支援該動議。[掌聲]
副議長女士：黃玲玲女士。
下午4時58分
黃玲玲女士（宏茂橋）：副議長女士，我支援三位被提名議員提出的動議。事實上，我毫不懷疑政府致力於在新冠疫情後繼續支援醫療保健。回顧本議院最近在財政預算委員會會議上支援的2023年國家預算，衛生預算預計總支出為125.9億新元，僅次於國防預算134.1億新元。
我認為政府需要繼續警惕的是預算的使用情況，更重要的是是否轉化為我們老齡人口更好的健康成果。此外，我完全同意被提名議員的觀點，認為新加坡人的健康必須是全政府的努力。我還要進一步強調，這必須是全社會的努力。
讓我通過三點詳細說明：一是通過“更健康的新加坡”計劃支援我們的家庭醫生；二是關心我們的前線工作人員，尤其是急診科的工作人員；三是賦能新加坡人，提供更多知識和支援，以更好地管理自身健康。
首先，支援全科醫生（GP）診所的家庭醫生。我堅定支援“更健康的新加坡”計劃，幾年前曾訪問荷蘭、英國和美國的多個地區，瞭解他們如何管理老齡化人口中日益增加的慢性病負擔。
然而，新加坡的全科醫生，作為“更健康的新加坡”運動的核心，直到近年來才成為政府確保優質醫療服務的重心。
舉個例子，我宏茂橋選區有一位非常勤奮的全科醫生。他的診所位於組屋大廈地下室的防空洞內，組屋發展局（HDB）多年來將該防空洞租給診所使用。疫情期間，作為公共衛生預備診所，他在空置的組屋底層公共空間設立了臨時攤位，協助進行新冠檢測和疫苗接種。事實證明，老年居民更容易進入底層公共空間，而非只能通過樓梯進入的地下防空洞。
新加坡民防部隊（SCDF）未批准診所在樓梯處安裝輪椅升降機。擴建電梯至地下診所需等待組屋發展局的電梯升級計劃，目前無明確計劃或時間表。
我與該全科醫生一起向組屋發展局申請永久提供空置的底層公共空間給診所使用。雖然原則上獲得批准，但從概念設計到臨時佔用許可證的流程還需6至12個月。該醫生剛收到約20萬新元的裝修報價，正苦惱是否放棄。即使籌集到資金，審批還需獲得城市重建局（URA）、建築與建設局（BCA）和民防部隊的同意。
幫助醫生更多地幫助病人，減少行政負擔。我舉的這個例子只是我在動員選區內全科診所支援“更健康的新加坡”計劃時遇到的幾個例子之一，目的是讓居民能早日與可信賴的家庭醫生開始預防健康之旅。若要讓全科醫生擁抱“更健康的新加坡”，推動這一多部門戰略成功，必須以全政府思維加強各部門間的協調，減少繁瑣耗時的工作流程。
其次，關心我們的前線醫療工作者，尤其是急診科人員。上週，我們有人獲悉新加坡西部某公立醫院向社群團體發出的求助資訊。該醫院過去兩週急診負荷極高，床位100%滿員。急診醫生盡力工作，但入院等待時間延長，約有100名病人等待床位。醫院呼籲基層志願者幫助傳播資訊，勸導居民非必要時不要前往急診科，若病情穩定應先諮詢全科診所。
感謝政府在本議院宣佈的多項臨時策略，緩解醫院床位緊張的壓力，以及通過“更健康的新加坡”計劃提升全科診所能力和容量。與此同時，必須加大人力資源力度支援前線醫療工作者。我再次建議考慮在公立醫院採用超編制聘用機制，為應對突發需求提供緩衝，更重要的是保障醫生、護士和前線醫療工作者的身心健康。
最後，我強調不僅需要全政府承諾，還需全社會行動，共同維護老齡人口的健康。
我提出具體建議，加快利用遠端醫療技術，不僅是影片諮詢，還包括端到端的遠端生命體徵監測系統，用於管理高血壓、糖尿病和高脂血症等常見慢性病。
政府資助的臨床試驗應加快並擴充套件至私人全科診所。慢性病是無聲的疾病，心臟病發作和中風等併發症往往讓新加坡人措手不及。
許多遠端生命體徵監測技術已被臨床證明能改善特定慢性病患者的健康結果，但我看到兩大制約因素阻礙其在新加坡的普及。一是需要進行操作試驗，確保患者與初級醫療團隊之間資料傳輸順暢，以及護理團隊對異常生命體徵的響應流程；二是個人同意程式，決定向其信任的醫生（公立或私立）及支援團隊（包括積極老齡中心等社群組織）開放個人生命體徵資料的範圍。
這兩項制約因素需要政府建立信任、制定協議甚至立法，並由公私醫療服務提供者（包括全科診所和非營利社群醫療服務機構）促進和支援，以賦能更多新加坡人獲得正確的健康知識，並在護理團隊的協助下以知情方式管理自身健康。
副議長女士，最後，我在本議院多次引用“健康就是財富”這句話。為了避免這句話淪為空洞口號，而我們身邊的人卻不斷因心臟病發作或突發中風等慢性病併發症失去健康，隨著人口老齡化，讓我們以臨床知識為基礎、行政高效且協調一致的方式，全力以赴，確保這句話在未來多年成為大多數新加坡人的真實寫照。副議長女士，我支援該動議。
副議長女士：嚴彥松先生。
下午5時06分
嚴彥松先生（阿裕尼）：副議長女士，全球正面臨醫療和社會護理領域嚴重的人力短缺。國際護士理事會（ICN）執行長去年表示，“全球護士短缺的規模是全球健康面臨的最大威脅之一。”ICN估計，由於現有護士短缺、護士隊伍老齡化及新冠疫情影響，未來全球需要多達1300萬名護士來填補缺口。根據世界衛生組織（WHO），東南亞地區單獨面臨190萬名護士的短缺。
新加坡到2030年需要再增加2.4萬名護士、輔助醫療專業人員和支援護理人員，以運營醫院、診所和養老中心。我們快速老齡化的人口導致醫療和社會護理需求大幅增加。然而，新加坡護士流失率高。護士報告辭職的原因之一是工作量大和壓力大，這在很大程度上是由人力短缺引起的。
迫切需要採取措施解決人力短缺問題。沒有快速解決方案。我們需要鼓勵更多新加坡人選擇醫療和社會護理作為職業，以增強未來專業人才的儲備。
我在三月關於新加坡抗疫的演講中指出，新加坡護士常被視為醫生的助理，而非獨立的專業人士。我們需要提升該職業形象，增強社會對護士和輔助醫療工作者的尊重。護士應獲得更多自主權，承擔更高級別的職責。
學校應及早向學生介紹醫療和社會護理職業。專業協會應制作相關材料和影片，介紹該領域職業，並與學校分享以傳播給學生。我贊同譚雅琛議員剛才提出建立醫療系統導航文章庫的建議——希望她能重新開設部落格，讓我們繼續借鑑她的知識。職業指導應從中一開始，以激發學生對醫療和社會護理職業的興趣，並讓他們在升至中三時開始選擇合適科目。
正如我四月關於教育系統的演講中提到，學校應摒棄按成績分流學生，轉而允許學生根據興趣選擇科目組合。這樣我們才能培養出熱愛並熱情從事醫療工作的未來專業人才。
高等院校可編寫指南，幫助本地學生為申請這些院校做好準備。指南可包括所需科目、成績要求以及參與的課外和課內活動，幫助學生為入讀理想院校和專業做好準備。例如，指南可建議學生選擇特定科目組合，加入科學俱樂部，尋找科學研究機會，撰寫和發表研究論文，或在學校假期期間在醫療或社會護理機構實習。
指南還應指導如何尋找這些機會，並與專業醫療和社會護理協會合作，為學生創造機會。這些措施有助學生早期專注於醫療和社會護理領域的興趣，更好地為未來職業做準備。臨近申請大學或理工時才匆忙準備作品集為時已晚，但許多學生正是如此，因為他們在中學階段對興趣缺乏明確認識，未參與為未來職業做準備的活動。
相反，資源較豐富家庭的學生通常從父母那裡獲得指導，並通過父母的職業關係獲得實踐機會。為了提升社會整體水平，發掘更廣泛的人才，我們需要讓每位學生都能獲得這些資訊。
然而，改變公眾對健康和社會護理職業的看法並提高公眾意識需要時間，並且需要包括政府、媒體、學校和家長在內的各方利益相關者共同努力。我們必須繼續制定有針對性的舉措，解決醫護人員關心的問題，如工作與生活的平衡、薪酬和職業發展。
儘管如此，僅依靠增加人力供應來滿足我國的健康和社會護理需求是不可持續的。考慮到新加坡自身的人口老齡化，這將帶來更大的護理需求，如果我們要為所有健康和社會護理機構配備足夠的醫生、護士、輔助醫療專業人員和護理人員，以達到理想的醫護人員與患者比例，健康和社會護理部門可能會佔用新加坡人力資源的過大份額，從而使其他經濟部門的人才和技能短缺。
技術在提升生產力和增強人力方面可以發揮重要作用。在我2013年於本院提出的關於降低醫療成本的休會動議中，我曾表示，在醫療系統人力有限的情況下，應將技術作為倍增力量來使用。如今這一點比十年前更為重要。
醫療技術（HealthTech）是一個快速發展且前景廣闊的領域，必須在新加坡進一步發展。當前正在開發的變革性技術將徹底改變未來醫療服務的提供方式。這些技術包括基於人工智慧的診斷，能夠比傳統方法更早發現疾病並更快速地做出更準確的診斷。例如，麻省理工學院的研究人員開發了一種名為Sybil的人工智慧模型，能夠利用低劑量計算機斷層掃描預測患者未來六年內患肺癌的風險。
新興的精準醫療領域有潛力改變醫療服務，已被用於癌症、心血管疾病和遺傳疾病等疾病的治療。它能夠通過提供更有針對性和更有效的治療，減少藥物不良反應，並最佳化疾病預防策略，從而潛在地改善患者的治療效果。我注意到，目前新加坡有一項精準醫療計劃，旨在生成多達一百萬人的精準醫療資料，整合基因組、生活方式、健康、社會和環境資料。這是一個非常積極的發展。
還有一些醫療技術雖然不像前述的“深度技術”那樣先進，但已進入市場，能夠提升醫護人員的生產力，增強患者體驗並改善健康結果。
國家電子健康記錄（NEHR）系統是一項重要的多年期醫療技術計劃。根據衛生部網站，截至2023年5月5日，有2231家醫療機構參與NEHR。該名單似乎每天都在增長，我注意到自今年年初以來，參與的醫療服務提供者數量顯著增加。
《海峽時報》於5月2日報道，“自2011年NEHR啟動以來，私營部門參與緩慢”。根據2023年3月衛生部長王乙康對議員Leon Perera的議會質詢回覆，只有約30%的持牌私營門診醫療機構擁有NEHR的檢視許可權，且不到4%的機構在貢獻資料。
樟宜綜合醫院臨床助理教授施慶勇於2020年發表的題為《新加坡全科醫生對NEHR的態度和看法》的調查和論文發現，年齡超過40歲且執業超過15年的獨立執業全科醫生較少檢視和貢獻NEHR資料。自認為計算機技能較差以及認為技術或財政支援不足的醫生也較少使用NEHR。
《健康資訊法案》原計劃於2018年提交議會，規定持牌醫療集團在寬限期後必須強制向NEHR貢獻資料。但由於當年7月SingHealth系統遭受網路攻擊和資料洩露，該法案被推遲，以便先實施技術和流程改進，提升NEHR的安全防護水平。
根據衛生部高階國務部長詹尼爾·普圖切裡所述，這些安全改進大部分應於去年完成。我想請問高階國務部長，NEHR的所有安全改進是否已全部實施？
我瞭解到衛生部計劃今年下半年提交《健康資訊法案》。衛生部是否正在與醫生溝通，解決他們對必須向NEHR貢獻患者資料安全性的擔憂？衛生部如何協助剩餘的全科醫生和牙醫加入NEHR？
前衛生部長顏金勇於2017年表示，“只有資料全面，患者才能充分發揮NEHR的潛力。”他補充說，“為了使NEHR資料全面，每個醫療服務提供者和醫療專業人員都需要貢獻相關資料。”
鑑於NEHR的目標以及迄今為止已投入6.6億新元的系統建設，必須在解決醫生合理關切的同時，毫不拖延地全面推廣該系統。
我們需要利用多年執業的全科醫生的知識和經驗，尤其是在推進“更健康的新加坡”計劃時，全科醫生將在促進健康生活方式和預防醫療中發揮關鍵作用。
技術可以幫助全科醫生專注於他們最擅長的工作。許多私人診所發現管理各種IT系統是一大挑戰，這些系統需要連線社群健康援助計劃（CHAS）、“更健康的新加坡”以及NEHR。
我注意到有一項技術補貼計劃，幫助全科醫生實施與“更健康的新加坡”相容的診所管理系統。然而，實施這些系統仍需全科醫生及其診所助理投入大量時間和精力——而他們若想專注於直接患者護理，根本沒有這些時間。
衛生部應探索為全科醫生和牙科診所提供IT經理服務的可能性。這樣，他們可以受益於IT專業人員的專業知識，協助解決醫療IT相關問題。
通過提供IT事務的聯絡點，全科醫生及其診所助理便能專注於為患者提供高質量的臨床護理。這一方案不僅能提升全科醫生的效率和生產力，還能幫助他們跟上最新技術進展。
副議長女士，迫切需要採取行動解決健康和社會護理機構的人力短缺問題，並培養更多新加坡人進入該領域。我在發言中提出了一些建議，希望衛生部和教育部予以考慮。
為了提升健康和社會護理部門的生產力並增強人力，我們需要加大力度利用技術作為倍增力量，並協助服務提供者實施和使用這些技術。
本週五，即5月12日，是國際護士節，也是弗洛倫斯·南丁格爾的誕辰紀念日，我藉此機會向新加坡公私營醫療機構的所有護士致以衷心感謝。我們感謝你們無私的奉獻、犧牲和對人民的關懷。女士，我支援該動議。
副議長女士：梁文韜先生髮言。
下午5時20分
梁文韜先生（非選區議員）：副議長女士，進步新加坡黨（PSP）支援該動議，呼籲議會支援疫情後醫療保健及政府整體努力，持續穩定支援新加坡醫療體系。
PSP再次感謝所有醫護人員的犧牲和奉獻，特別是在過去三年的疫情期間為新加坡人服務。
我們歡迎政府通過“更健康的新加坡”計劃支援醫療保健，該計劃從以反應性照顧已患病者的交易型系統轉向以預防新加坡人患病為目標的結果導向型系統。
譚雅珊醫生、莎希拉·阿卜杜拉醫生和阿卜杜勒·薩馬德先生熱情談及了涉及醫生、醫護人員、患者及社會各界的自下而上的改進。
我們支援他們提到的改進，但也認為應首先著眼於改革醫療融資和控制醫療成本，以更好實現這些改進。
PSP將醫療可持續性定義為為所有新加坡人提供最有效、可負擔且公平的醫療服務。重點不應僅是保護政府財政，而應建立具備適當激勵機制的醫療體系，鼓勵健康生活，同時保障新加坡人在其一生中所有醫療狀況下的保障。
目前，新加坡人通過其醫療儲蓄（MediSave）、子女的醫療儲蓄、醫療保險（MediShield Life）、私人保險及現金支付承擔了大部分醫療費用。
我承認過去十年政府在醫療方面的支出增加，推出了先驅一代和獨立一代計劃以及社群健康援助計劃（CHAS）。但這些計劃的實際支出相較於部分先驅和獨立一代新加坡人醫療儲蓄不足的需求而言仍然較小。實際支出也相較於先驅一代基金和獨立一代基金的總資產而言較少。
總體而言，政府對醫療支出的貢獻不足。
根據世界衛生組織資料，政府承擔的醫療支出比例從2011年的33%增加到2019年的43%，但仍遠低於經濟合作與發展組織（OECD）75%的平均水平。
新加坡人享受的是一流的醫療服務，但政府提供的財政支援遠遠不足。
過去二十年醫療支出翻了一番多。新加坡人繼續承擔自己及父母、子女的醫療賬單已不可持續。
為減少社會不平等，政府必須加大力度幫助新加坡人應對不斷上漲的醫療費用，增強其財務保障。
無論貧富，人們都不會選擇生病。富裕家庭能更好應對醫療災難，而類似災難可能輕易耗盡低收入家庭的醫療儲蓄和現金儲備，即使有醫療保險賠付。
因此，女士，我提出三項建議，以減輕新加坡人的醫療財務負擔。
第一，政府應為所有新加坡公民支付醫療保險（MediShield）和護理保險（CareShield Life）保費。
新加坡人的退休保障是長期問題。首先，住房成本耗盡了他們的大部分中央公積金（CPF）儲蓄。因此，許多新加坡人必須在退休年齡後繼續工作才能生存，而不出售組屋。
保險保費佔用了他們另一部分CPF儲蓄，這些儲蓄本可用於退休。
我在2021年預算演講中估算，一個四口之家為父母支付至65歲、兩個子女支付至25歲的醫療保險和護理保險總保費至少會耗費11萬新元的CPF儲蓄，且未計複利損失。
如果保費每五年上漲10%，這筆財務負擔可能超過25萬新元。換言之，如果該家庭無需支付醫療保險和護理保險保費，父母在65歲時將多出25萬新元以上的CPF儲蓄用於退休。
因此，我重申2021年預算辯論中的呼籲，敦促政府為所有新加坡公民支付醫療保險和護理保險保費。
這將使政府每年支出增加約30億新元，但同時意味著新加坡人的CPF餘額將相應增加。這將使普通新加坡人的醫療儲蓄餘額享受更長時間的CPF利息複利效應，更好地應對醫療事件。
更健康的醫療儲蓄餘額最終將增強新加坡人的退休保障，因為他們需要轉入醫療儲蓄賬戶的CPF儲蓄將減少。
第二，我建議政府增加醫療儲蓄賬戶的注資和使用範圍，增加對有需要新加坡人的醫療基金（MediFund）支援，並提高先驅一代和獨立一代基金對老年人的支援。
截至2020年，醫療儲蓄賬戶持有人累計餘額達1100億新元。然而，當年僅提取了10億新元，約佔不足1%，用於直接醫療費用。這一比例很小，且較2015年（當時從760億餘額中提取了9.05億，佔1.2%）有所下降。鑑於新加坡人口老齡化和醫療需求增加，這種情況不合理。
醫療儲蓄賬戶的提款規則是否過於嚴格？政府一直限制醫療儲蓄賬戶的提款。但總體來看，新加坡人甚至未充分利用其醫療儲蓄餘額每年獲得的利息用於醫療費用，更不用說本金了。
限制醫療儲蓄資金使用比要求維持退休賬戶最低儲蓄額更難以辯解。因此，我再次呼籲放寬醫療儲蓄提款限制。
我也贊同同僚Poa女士在2021年預算中提出的擴大醫療儲蓄用於門診治療的建議。
對於醫療儲蓄餘額低於平均水平、難以支付醫療費用的低收入新加坡人，政府應通過增加醫療儲蓄賬戶注資或大幅增加醫療基金援助來提供更多幫助。
目前，醫療基金每年僅發放約1億新元，僅覆蓋新加坡人約250億新元醫療支出的0.4%。
先驅一代基金和獨立一代基金也應增加對老年人的支付。自2018年以來，先驅一代基金餘額約70億新元，但每年僅支付約4億新元，佔總資產的5%至7%。獨立一代基金餘額約60億新元，但每年僅支付約2億新元，佔總資產的3%至5%。
第三，我建議政府統一公共和私人醫療機構的藥品採購。
目前，新加坡三大公共醫療集團實行集中採購，但私人醫療機構未實行。因此，私人診所通常支付比公共部門更高的藥品價格，而公共部門能談判獲得優惠價格。這推高了整個醫療鏈的成本。保險必須收取更高保費以覆蓋更高藥價，導致國家醫療支出不可持續地上升。
PSP呼籲政府統一公共和私人醫療機構的藥品採購，並以非營利方式向公私營醫療設施分發藥品。這樣，作為一個小國，我們可以最大化與大型製藥公司的議價能力，降低整體藥品成本。
在公共部門，政府應確保向所有新加坡患者收取的藥品價格（無論是否補貼）接近藥品成本價。政府可以為補貼患者提供額外補貼以降低藥品費用。但不應對非補貼患者的藥品價格進行不合理加價以交叉補貼補貼患者。對非補貼患者收取更高價格以換取更好服務是合理的，但藥品本身應保持一致。
國家級集中藥品採購系統將消除為控制醫療成本而突然改變政策的需要，為新加坡人提供確定性，並增強他們的退休保障。
總之，副議長女士，我呼籲政府加大努力解決新加坡醫療體系中的不平等問題。這將放大“更健康的新加坡”等舉措帶來的益處。
對許多新加坡人來說，高昂的生活成本帶來的財務壓力是其健康狀況不佳的主要原因，包括日益嚴重的心理疾病問題。如果能進一步改善新加坡醫療體系的可負擔性和公平性，我們可以期待新加坡人整體健康狀況的改善。這應成為支援疫情後醫療保健的國家優先事項之一。新加坡人值得擁有更好的醫療保障。為了國家，為了人民。
英文原文
SPRS Hansard · Fetched: 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.