Lam Pin Min

According to the Bloomberg Global Health Survey in 2012, Singapore has emerged top as the healthiest nation in the world. This is in part due to our highly efficient healthcare system, as well as the major role played by HPB in promoting healthy living among Singaporeans.

Yet let us not rest on our laurels. We need to do more to promote healthy living, with regards to obesity and smoking. Obesity is of particular concern. While our obesity rates are much lower than that of the OECD average of 17%, USA 34% and Australia 25%, our statistics show that Singaporeans are getting fatter. Obesity in Singapore rose from 6.9% in 2004 to close to 11% in 2010.  Coupled with a global obesity pandemic, more food choices and affluence in Singaporeans, we face an uphill task.

In our fight against obesity, there is a role for the Ministry of Health to consider strengthening food advertising. This would follow international norms where many countries, like UK and South Korea, have already regulated the food advertising market. Countries like Finland, Denmark and Malaysia have also set out government guidelines on food advertising.  Children in particular are of concern as most of the time they are easily influenced by temptations in persuasive advertisements.

The health of the individual is very much affected by the consumption of the type of food.  Many of our school children consume meals sold in the canteens.  In order to minimize the consumption of unhealthy and junk food, the ministry should consider mandating that only healthy diet be served in school canteens.  To encourage Singaporeans to eat healthily, the government can consider making healthier choice products sold in supermarkets cheaper and more affordable.  Take for example, a carton of sugar-free soya milk will cost about 20-30 cents more than its normal sweetened alternative.

While the government has imposed controls on harmful products like cigarettes, it is worrying that the prevalence of smokers amongst the young and the ladies are increasing. The recent extension of the smoking ban is also a step in the right direction. Non smokers will have more reprieve from second hand smoke and avoid the harmful effects of second hand smoke. While we have banned smokers from lighting up in public places, it would not eradicate the harmful habit of smoking.

Smoking has been linked to many medical conditions including ischemic heart disease, chronic obstructive lung diseases and cancers. We can do more to eradicate this harmful habit among Singaporeans.   One radical suggestion would be to gradually introduce a ban on smoking on certain segments of the population. For instance, the ministry can consider totally banning the sale of tobacco related products to cohorts of citizens born after a certain year.  While it is often difficult to make smokers change their habits and quit smoking, this would gradually eradicate the habit in the next generation of Singaporeans as they would not be exposed to the bad habit of smoking.

While looking after one’s health and well-being is an individual choice and responsibility, the government can facilitate and encourage Singaporeans to do so. Thinking out of the box: the ministry can consider working with the insurance industry, or even medishield to incentivise Singaporeans to lead a healthy lifestyle. This can be in the form of insurance rebates or further premium reduction.

Let’s us all work towards keeping Singapore a Healthy and Happy nation!

Healthcare has always been an emotive issue for many Singaporeans, as it affects all of us in one way or another.  Everyone seeks healthcare services at one point in our lives, whether we are newborns, children, adults or senior citizens.  It is also one of the essential services expected of a responsible government.

Singapore’s Healthcare System

Singapore’s healthcare system has developed and evolved through the years to what it is today, through a mix of pragmatism and eclecticism, learning and adapting from best practices to arrive at a formula that works for us.  Our healthcare system is generally cost-effective with a National Healthcare Expenditure (NHE) at 4% of GDP.  In comparison, OECD’s average is 9.6%. Even then, it is heartening to note that Singapore has achieved good health outcomes, in spite of spending less than many other developed countries when measured as a percentage of GDP.

What is Affordable Healthcare ?

However, I have often received feedback from residents and friends on the increasing cost of healthcare.  The old adage that “It is better dead than to be sick” seems to resonate with many Singaporeans.

Why is this so? The MOH has always pledged to provide affordable healthcare for all Singaporeans.  As parliamentarians, we have debated for years in parliament on affordable healthcare. What then is affordable healthcare?  Many academics have tried to define what affordability is.  Some measure affordability as the amount of money a household can spend on healthcare costs, while still having enough left to pay for other necessities.  Should it be measured as a percentage of total income, such as 5%, 10% or 15%? Or should it be measured as a percentage of the total bill size in the form of out of pocket costs for the patient?

While I do not have an answer for that, I would like to highlight some issues and concerns that have contributed to the perception that healthcare in Singapore has become less affordable.

Increase Government’s Share of Healthcare Spending

Singapore’s version of healthcare financing hinges on one of the key philosophy of individual responsibility.  Coupled with the time-tested 3M framework of Medisave, Medishield and Medifund, the government has been able to keep our national healthcare expenditure below 4% of GDP, of which only one-third comes from government spending.    However, with the rapidly ageing population and the ever escalating medical inflation, the burden of bearing the higher cost of healthcare has begun to fall significantly on Singaporeans.

Many Singaporeans have called for government’s share of healthcare expenditure to be increased. Compared to many OECD countries, the Singapore government’s share of the national healthcare expenditure has remained enviably modest.

Review of 3M Framework

While the 3M system has served us well, we need to ensure that the 3Ms remain relevant, to commensurate with the socio-economic-political situation and needs of Singaporeans.  The restriction imposed on the use of Medisave is a big bugbear amongst Singaporeans.  Many lamented: “What is the point of having so much money in the Medisave when they can’t even pay for their current healthcare needs?” Many young parents also shared their concerns of potential financial strain on the family should their newborn be inflicted with congenital illnesses.  On this note, I would like to thank the MOH for finally including the Medishield coverage for congenital diseases.  ManyMPs, including myself have been lobbying for this for many years.

While I would be happy if most Singaporeans can stay healthy and not require the use of healthcare services, the reality is that at some point in time, all of us would have to utilize the healthcare system.  It would be extremely sad if any Singaporean were to be made bankrupt as a result of seeking medical treatment for themselves or for their loved ones.

In view of this, the government should conduct a major review of the 3M system, in particular, with the view to enhance medisave usage, medishield insurance protection and medifund assistance to low and middle income Singaporeans.   Means Tested Subsidy Levels, Medishield and Eldershield insurance payouts need to keep pace with medical inflation?  MOH should also take a closer look at the high deductibles and co-payment which inevitably result in more out-of-pocket expenses for Singaporeans.

Cost of Drugs

I have also received numerous feedbacks on the affordability of drugs.  MOH’s classification of standard drugs seems to be too stringent, resulting in many drugs that are commonly used for many common conditions being listed outside the standard list for government subsidy.  One way the Ministry can help lower the out of pocket payment for Singaporeans is to subsidize the cost of more essential drugs.

Transparency of Fee Structure

Another way to ensure that healthcare stays affordable is to make the fee structure transparent.  Physician charges in the private sector can be rather arbituary, especially after the SMA’s schedule of fees was discarded in 2007.  I would also like to suggest to MOH to introduce some form of consolidated information on bill sizes and professional fees for all private and public sector hospitals and have them published and updated on a regular basis.

Conclusion

Affordable and accessible healthcare must remain a basic right for all Singaporeans.  The government must ensure that healthcare remains affordable and will not denied to any Singaporeans because of their inability to pay.

(This is an excerpt from my speech delivered at the recent Parliament Committee of Supply for MOH 2013)

As part of LTA’s nationwide Bus Services Enhancement Programme (BSEP), Sengkang West will benefit from the following enhancement to the public transport bus services:

1) Wheelchair-accessible Bus (WAB) Service 372

SBST will be rolling out WAB Service 372 from tomorrow (3rd Dec 2012), which will defintely cater to the needs of our wheelchair-bound residents. As the fleet of buses is currently undergoing fleet renewal programme, only about half of the fleet of service 372 deployed will be wheelchair friendly.  For efficient journey planning, residents who need to utilise this service can refer to the bus schedule on SBST website on the arrival times of these wheelchair accesible buses.

2) New Bus Service 50

It’s finally coming!! A brand new bus service, Service 50, will be introduced from Sunday, 16 December 2012, as part of LTA’s on-going Bus Service Enhancement Programme.  Service 50 will be a trunk service that connects Bishan to Punggol estates. It will enhance connectivity for SW residents travelling to Ang Mo Kio Avenue 8, Ang Mo Kio Avenue 5, Yio Chu Kang Road, Sengkang West Avenue, Sengkang East Way and Punggol Drive en route.  

Operating daily at a frequency of 10 to 15 minutes from Bishan and 10 to 19 minutes from Punggol, it will provide our Sengkang West residents with convenient access to key transport nodes such as the Ang Mo Kio and Bishan MRT stations, facilities and amenities, including the town centres, schools, the new ITE College Central along Ang Mo Kio Avenue 5, Anchorvale CC and the Sengkang Sports & Recreation Centre in Anchorvale.  

With the growing population in Sengkang West, the BSEP will progressively introduce enhancement intiatives to the bus services, in tandem with other improvements to the LRT. I would like to thank all residents for your kind patience all these years.  My grassroots leaders and I will continue to work towards improving the living environment in Sengkang West.

Bus Service 85 is a trunk route that operates between Punggol and Yishun.  Currently, it serves Sengkang East Way and Sengkang West Way in the direction of Yishun only after 9.00am on weekdays.  Before 9.00am, it travels via Sengkang East Road before getting on to the Tampines Expressway.  There has been many feedback from residents to provide this route service throughout the day, including before 9.00am.

With our continual consultation with LTA / SBST and our continuing efforts to cater to the transport needs of our residents better, Bus Service 85 will be amended to serve Sengkang East Way and Sengkang West Way throughout the day including the morning peak hours with effect from Monday, 19th November 2012.

With this change, residents along Sengkang East Way, Sengkang West Way and Jalan Kayu will be better served as this Service will call at the six bus stops (towards Yishun) along these roads throughout the day.

As announced by Minister for Transport during the 2012 Committe of Supply Parliamentary sitting, MOT / LTA will be looking into improving the LRT capacity and frequency.

In a recent visit to the Sengkang MRT station, Mrs Josephine Teo, Minister of State for MOT confirmed that the current single-car system will be converted into a two-car system by 2016.  This is to cater to the increased damand from the rising population in the Sengkang/ Punggol area.  As the changes require engineering and system upgrade and modification, it will take some time for the new system to be implemented.

In addition, the Land Transport Authority will also be adding 16 new trains cars- bringing the total fleet size to 57.  This new addition will boost the capacity by about 40 percent.   16 of the existing train cars will also be modified to make them suited for two-car operations. 

With the increase population in Sengkang and Punggol, this is indeed a welcome move, and hopefully will help ease the peak hours demand in the coming years.

We are also monitoring the ridership in the Sengkang West LRT loop very closely and will request for the LRT to run dual direction when we have reach the critical threshold level.

The new commercial centre to be built at the junction of Sengkang West Avenue and Fernvale Road has been named The Seletar Mall.

According to reports in the newspaper, the mall will be ready by the end of 2014, and will house a cinema, foodcourt and supermarket, in addition to other retail shops.  The inclusion of a cinema is indeed most welcome as I have received many feedback from residents in Sengkang West requesting for one.  Many residents have also shared that there is a lack of cinema in the Sengkang / Punggol area, and very often they would have to travel some distance from their place of residence just to watch a movie.

With the many new BTO developments in Sengkang West, especially in Fernvale, the Seletar Mall is an entertainment venue many will look forward to.

The New Paper has featured the story of a case of altruistic kidney donation over the past 2 days.

It is indeed very inspiring and uplifting to read about such altruistic act of selfless giving.  It gives us much hope that the society has not turned “cold” and there are still many heros and heroines out there in our midst.

Such altruistic organ donation with no expectation of reward or compensation  to a total stranger is rare in Singapore.  The shortage of cadaver organs in Singapore has resulted in a long waiting list for organ recipients, some waiting as long as 5-7 years.

In an attempt to address this problem, many transplant centres in other countries rely on living donors as an important kidney source. Many such donations from living donors are from loved  ones or close friends where there are often strong emotional bonds or even unspecified obligation to donate an organ.

Nonetheless, such unconventional altruistic donation is not that common because of the difficult ethical issues raised by this practice. This is especially when the donor happens to be a stranger, and there is always a lingering doubt on the underlying motivation for the donation.

The hesitancy to perform this procedure from these unconventional donors arises from a number of concerns:-

1) One of the arguments is the concern for the safety and welfare of the donor, particularly since the donor has a less favourable risk–benefit profile.

Whilst the procedure of removing a kidney is relatively safe in today’s context, it is not risk-free and the donor can potentially loose one’s life should the rare complication or eventuality occur.

2) The other major concern against the use of altruistic donors is based on ethical considerations. There is much concern about the donor’s motivation, and that the establishment of using strangers as donors would set transplant medicine on a slippery slope towards potential commercialism of vital organs.

However, there is a counter argument that the desire to donate an organ to a stranger is not necessarily a pathological obsession or something sinister.  In fact, if the offer to donate is made altruistically, there is a greater likelihood that the patient is truly acting autonomously after much careful considerations; likewise, it may be argued that these altruistic donors are the only living donors that can truly give an informed consent, since there is are no overlying emotional concerns or sense of obligation that would invalidate voluntary consent.

Some people do believe in the psychological benefit of such donation. It had been suggested that unrelated donors may experience an even more enhanced sense of self?esteem compared to related donors, since no sense of obligation exists, making the act of donation truly extraordinary.

 (Picture courtesy of My First Skool @ Sengkang West)

Sengkang West is a fast growing division with a relatively young demographic.  Many young families are beginning to shift into the new BTO flats in both Anchorvale and Fernvale estates.    As a result, I have received many requests from residents to look into the increasing demand for childcare and pre-school facilities in Sengkang West. 

At the moment, almost every single childcare and kindergarten is functioning at full capacity with a long waiting list.  I have been working with MCYS, HDB, Grassroots organisations (RCs) and the service providers to identify potential suitable sites at void decks for conversion to house such facilities.  Due to the preculiar designs of the new generation HDB blocks, and taking into consideration the need for some open spaces at void decks for residents’ use, there are only a few sites that have been identified to be suitable. 

I am glad to announce that there will be several new setups and extension of existing centres to help alleviate the high demand situation in the constituency.  There will be 2 new NTUC My First Skools in Anchorvale Block305D and 314A/D.  The former (block 305D) consists of 2 bays (Bay A 179.53sqm + Bay B 136.09sqm = 315.62sqm) and will be operational from 1st September 2012.  It will be able to take up to 10 infant and 55 childcare places ( Playgroup – 20 places; Nursery – 21 places; K1 – 14 places).

Moriah Schoolhouse at Blk 409A Fernvale is also in the process of extending their operations at Blk 410C and Blk 411B.  This should yield another additional 165 sqm of space.

We are also in the process of seeking support from the authorities and residents for extension plans for other operators, including PCF.  In addition, many of the new BTO developments have designated void deck spaces for pre-school facilities but this will only yield additional supply in the next few years. 

Increasing the capacity to meet the demands of young families will continue to be one of my priorities in the coming years and I hope that residents will continue to support our many initiatives, including converting some existing void deck spaces to good use.

The Sengkang Sports & Recreation Centre and the Anchorvale Community Club have been a very popular hangout for many residents of Sengkang and Punggol.  Besides numerous education and music centres, restaurants such as Brewerkz and McDonald’s, many community activities are also being organised.

The carpark situation has always been challenging and we have increased the capacity by building a 2-level carpark extension and adding more curbside parking lots.  The soon to be completed new BTO opposite the hockey stadium will also offer residents an alternative parking location at the HDB MSCP in the near future.

I have received many complaints and feedback about the current coupon parking system as insufficient display of coupons often led to summons being issued.  Many residents feedback that at times, they may be delayed or held up while waiting for their children to finish their enrichment classes.  This has caused much distress amongst those affected.

After discussing with the management of the Sports Council and Anchorvale CC, we have decided to adopt the electronic parking system from 1st July 2012, which charges according to the time spent in the carpark.  This is a fairer system and visitors will not have to worry about insufficient display of carpark coupons resulting in unnecessary fines.

The long sought after ATM machine will finally make its debut at Block 308 Anchorvale in June/July 2012!

During my last 6 years as MP for Sengkang West, I have received numerous requests for an ATM machine to be installed at the retail shops at 308 MSCP.  We have approached several banks on various occasions but each time we were turned down because of the less than optimal human traffic at that area. 

However, with the popularity of the foodcourt at 308, more residents are patronising the eatery, thereby increasing the human traffic.  The population growth in Sengkang West and the persistent appeals from the grassroots organisations also helped in convincing the bank to install an ATM machine there.  This will definitely be a welcome news for many residents residing in Anchorvale.