I refer to the article “Review of healthcare financing will involve fundamental shifts: Health Minister” (Channel NewsAsia, Mar12).

No more Medisave admin fee?

It states that “The Health Ministry said it will also absorb the fee of about S$3 that is charged to institutions for each Medisave claim that patients make.”

People have been calling for years, for this Medisave administrative fee introduced 29 years ago in 1984, to be scrapped. This fee can be as much as 22 per cent of the amount of Medisave utilised.

Why did it take so many years to finally decide to remove it? (“CPF – F1 or F9 : Pay up to 22% to use MediSave?, Jul 6, 2007)

Medifund for polyclinics?

As to “”By June 2013, we will also extend Medifund to the polyclinics, including dental services there”", people have been calling for years, for Medifund to be allowed for out-patient treatment in the polyclinics, so that the staff at public hospitals do not have to raise funds every year to cater for those who cannot afford to pay.

Why did it take so many years to finally decide to allow it? (“PAP Transformation Series – 12 Suggestions to reform healthcare“, May 23, 2011)

Higher public healthcare spending?

With regard to “The government will take on a greater share of national spending, from the current one-third to about 40 per cent and possibly even further”, people have been calling for years, for the gradual decline of the share of public healthcare spending from about 75 per cent in 1965 to about 33 (a third) per cent now, to be reversed.

So, Why did it take so many years to finally decide now to reverse the trend and spend more?

In this connection, according to the Department of Statistics’ “Singapore, 1965 – 1995
Statistical Highlights : A Review of 30 Years’ Development”,
Government Operating Expenditure on Health as a Per Cent of Total
Government Operating Expenditure, declined from 9.5 per cent in 1970
to 7.8 in 1980, 6.5 in 1990, and 6.3 per cent in 2005. (“Healthcare Costs“, Nov 22, 2006)

More hospitals?

In respect of “By 2020, there will be 4,100 more acute and community hospital beds, 400 more than what was announced in 2012.

Beyond 2020, the ministry is also planning to build four new acute hospitals in areas where demand is likely to grow”, people have been calling for years, for more hospital beds because the total number of hospital beds in Singapore decreased in the last decade or so, despite an increase in the population by more than a million.

Why did it take so many years to decide to increase? (“Not-so-ordinary ordinary Singaporean – Leong Sze Hian“, Nov 22, 2010)

More polyclinics?

As to “Mr Gan also announced plans for new polyclinics. By 2017, polyclinics will be opened in two new towns — Jurong West and Punggol.

He added that there will be four new polyclinics by 2020, and another six to eight more by 2030″, people have been calling for years, for more polyclinics because I understand that the number of polyclinics has remained the same for the last 15 years or so.

Why did it take so many years to decide to increase them?

How much longer?

With regard to “Mr Gan said the major review of the health financing framework, which was initiated in 2012, will take some time”, people have been calling for years for a revamp of the healthcare system – how much longer do Singaporeans have to wait?

More transparency?

We must continue to ask for greater transparency of the healthcare statistics, like the patients’ rejection rate for Medifund, out-of-pocket hospitalisation costs for subsidised wards at the higher percentiles and B1 and A wards, etc, so that this “Waking up slowly from years of slumber?” will continue. (“Hospitals: 80% of patients pay less than $100?“, Mar 11 and “Medifund helped over 0.5m patients?“, Feb 23)

Leong Sze Hian

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According to an article in Zao Bao (Mar 11), 80 per cent of hospital patients in Class C and B2 pay less than $100 of out-of-pocket expenses for their hospitalisation.

It has been said that in “Statistics”, whenever you are given statistics to show that most people don’t have problems, you should also try to find statistics that may show otherwise, so as to have an alternative and balanced perspective of the subject matter.

Let’s attempt to apply this to healthcare costs.

What about the higher percentiles?

What is the out-of-pocket expenses for Class C and B2 patients at the 90th and 95th percentile?

According to the Ministry of Health’s (MOH) web site, the 90th percentile hospital bill size at public hospitals for knee replacement surgery range from $5,124 to $7,164 for Class C, and $5,789 to to $7,737 for B2.

Another example is – the 90th percentile hospital bill size for stroke with serious complications, range from $5,754 to $12,178 in Class C.

No cap to healthcare costs?

The problem with our healthcare system is that there is no cap even in the lowest Class C ward. So, there is no limit as to how much one’s medical costs can be.

This “no cap” issue is underscored by the fact as reported in Parliament, that more than 90 people had annual MediShield claims exceeding $50,000 (after the deductibles and co-insurance) in both 2009 and 2010, shows how expensive healthcare is in Singapore, even in the two lowest class wards of Class C and B2 despite continuing “to enjoy government subsidies of up to 80 per cent”.

35% elderly don’t have MediShield

What happens if you belong to the 35 per cent of elderly Singaporeans aged 76 to 85, or the 8 per cent of the general population who are currently not insured under MediShield? (“Health Ministry urges uninsured Singaporeans to apply for Medishield coverage” (Channel NewsAsia, Nov 14)

No Medisave?

What about those who don’t have MediShield, and have nothing or very little in their Medisave?

Even for those who have MediShield, but have nothing or very little in their Medisave – can they afford to pay cash for the increased deductibles and co-insurance from 1 March? (“MediShield: Deductibles increased by 5 times historically for elderly?“, Nov 12)

So, their last resort may be to apply for Medifund. I understand that the maximum Medifund subsidy for B2 is 60 per cent.

What is the criteria for approving Medifund applications?

What is the criteria for approving Medifund and Medifund Silver applications? Why is this not public information?

As I understand it, the only public information that is available in this regard, is that those who cannot pay for their medical bills can apply through the medical provider.

I have been told that to be successful, basically all family members must have hardly any Medisave in their accounts that can be used, have hardly any money in the bank, cannot stay in a larger than 5-room HDB flat or private property, etc.

How many patients (not the number of applications) who apply are rejected, and how many may be told that they don’t even have to apply because they don’t meet the criteria?

Healthcare system that some may fall through the cracks?

What if you are like the “more than 90 people who had Class C or B2 annual medical costs exceeding $50,000″, and do not have MediShield because your are uninsurable, and don’t qualify for Medifund?

What if you are a Singaporeans whose foreign spouse’s citizenship, permanent residence or long-term visit pass-plus (LTVP-Plus) application has been unsuccessful, and thus have to pay up to five times more for hospitalisation than a citizen?

B1 and A wards – just a matter of choice?

I also understand that in order to be admitted to Class C and B2 ward for treatment, which are the only classes whereby Medifund can be applied for, a patient must be referred by a polyclinic, or the patient has a medical benefits card referral from a private clinic participating in the Community Health Assistance Scheme (CHAS), or was a direct Accident and Emergency (A & E) admission.

When you are shown statistics for Class C and B2 only, you need to be aware that some patients may opt for Class B1 or A, because they literally “fear for their lives” due to the long waiting periods for subsidised Class C and B2 treatment.

14 months to diagnose?

To illustrate this with an example – it can take 14 months for a patient just to be diagnosed in our polyclinic and public hospital system? (Margaret Chong’s letter ”14-month wait needed before elderly father can be diagnosed” (Straits Times Forum, Dec 29), in which she said “This will make it some 14 months before his condition can be diagnosed and treated”)

Patients owe $110m?

If healthcare affordability is not a problem as the “80% pay less than $100″ statistics seem to suggest – why is it that after writing off $90 million, patients still owe public hospitals $110 million?

Public sector spending declined to 40%?

If healthcare affordability is not a problem as the “80% pay less than $100″ statistics seem to suggest – how is it possible that  public sector spending on healthcare, as a percentage of total healthcare spending, has declined gradually over the years, from about 75 percent to about 40 percent or less now?

Lowest public healthcare spending in the world?

If healthcare affordability is not a problem as the “80% pay less than $100″ statistics seem to suggest – why is our public healthcare spending as a percentage of GDP still so low? Even with the Government’s announced plans last year to double yearly health-care spending from $4 billion to $8 billion over the next five years – five years is a very long time?

With the previous year’s public healthcare spending as a percentage of GDP at about 1.6 per cent, which is one of the lowest in the world – even with the announced gradual increase in spending – after accounting for the expected rise in GDP, the population increase, aging population and inflation, I estimate that our public healthcare GDP spending may remain as amongst the lowest in the world in the next few years too.

Leong Sze Hian

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I refer to the article “Medifund supported more than half a million needy patients in 2012” (Straits Times, Feb 23).

It states that “Medifund supported more than half a million needy patients who needed financial aid to pay for their medical bills last year – an 8 per cent increase over the previous year.”

Medifund applications’ success rate?

In previous years, the statistics would also say what percentage of Medifund applications was successful.

I believe the last reported figure was that about 99 per cent of applications were successful.

However, for this year, I am unable to find any mention of this statistic.

Patients’ applications’ success rate?

I believe the “more than half a million needy patients” refers to the successful approval of applications, and not the approval rate of patients who apply.

For example, a patient who has 12 medical treatments in a year may be

counted as 12 approved applications. Whereas, the approval rate in terms

of the number of patients who apply has never been disclosed. It was

reported in 2008, that 301,126 approved applications were made by about

20,000 to 30,000 patients.

In this connection, the number of rejections increased dramatically by

2,900 per cent from 210 to 6,456 in 2006, and then declined dramatically

by 79 per cent from 6,456 to 1,266 in 2007.

What about those who were told that they do not meet the basic criteria,

which is not public information, and may be told that they do not even need to apply?

Medifund criteria?

I have tried to ask many medical social workers for the criteria to qualify for Medifund, but have been told that it is confidential.

As I understand it, all family members’ Medisave, as well as the bulk of their savings, must be depleted, before one can qualify for Medifund. What this may mean is that by the time one qualifies for Medifund, the entire family may in essence be left with almost nothing already.

Therefore, I would like to suggest that the Medifund criteria be made public, so that Singaporeans may not have a false sense of complacency, that if they cannot pay for medical costs, they can always rely on Medifund.

For example, some important information that Singaporeans may need to be made aware of, are that as I understand it, about one out of five patients who apply may be rejected, Medifund generally cannot be used for polyclinic out-patient treatment and medicine, patients who are referred by a general practitioner cannot select subsidized Class C and B2 hospital wards and medical treatment and thus may not qualify for Medifund, the maximum Medifund subsidy for B2 is 60 per cent, etc.

In this connection, it is interesting to note that “Ms Esther Lim, who heads the medical social workers team at the Singapore General Hospital – which gave out more than $5 million from Medifund Silver to the elderly – said the fund’s criteria for help are less stringent than those of the main Medifund.

She said: “An elderly patient who might not qualify under Medifund, but who gets help from other siblings who are also old and may have medical needs of their own, can get help from Medifund Silver”.

Medifund limitations?

In 2008, Madam Halimah Yacob,

chairperson of the Government Parliamentary Committee for Health,

expressed some concerns that the conditions for Medifund was too

stringent, some procedures are excluded, and that for some ailments, B2

is the lowest class of ward available which only gives a maximum

Medifund subsidy of 60 per cent.

Medifund cannot use for polyclinic?

Medifund also cannot be used for polyclinic out-patient general consultation treatment, such that the medical providers have been raising funds through their own efforts to help such patients who cannot pay.

Medifund have surplus?

Despite the above statistics and Medifund use restrictions, I understand that about $86 million of Medifund unultilised (surplus) has been transferred to the protected reserves. (Note: “The protected reserves comprise accumulated unutilised interest monies that were locked-up at the change-over of Government in December 2001, May 2006 and 2011. Authorisation from the President is required before the protected reserves can be used”)

Funds not allocated based on patients’ needs?

I am rather puzzled as to why the last reported total assistance given by Medifund-approved institutions (MFIs) to patients formed less than (98%) of the Medifund and Medifund Silver grants disbursed by MOH to MFIs in FY10 – utilisation of allocated funds increased compared to FY09, and any unspent funds will be carried over to assist patients in the next financial year.

As I understand it, MOH allocates a grant to each MFI at the beginning of the year for the whole year, and MFIs have to be prudent in ensuring that the grant is sufficient for the whole year. So, it may not be based on the needs of patients for the year, but rather like how well the MFI is able to keep within the allocation for the whole year. In such a system, is it any wonder that there is always under-ultilised  funds, as no MFI would want to find itself in a situation whereby there may be no money left for needy patients before the year ends?

So, does it mean that total disbursements from Medifund for the year may be more dependent on the interest from the Medifund Endowment Fund, rather than the needs of patients?

Endowment transfers means less Budget surplus?

The Medifund and Medifund Silver Endowment funds now stand at $3,740 million, with a capital injection of $600 million in the last financial year. In this connection, our Budget surpluses may have been in a sense, under-reported in comparison with other countries, as such transfers are made almost annually to the various endowment funds, like Medifund and the ComCare fund.

Leong Sze Hian

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I refer to the article “Seniors ‘need not worry’ about affordability of healthcare” (Today, Jan 24).

It states that “Mr Gan assured that “senior citizens will always receive the necessary healthcare services without (having to) worry about affordability”.”

What is the criteria for approving Medifund applications?

How can seniors not worry when we do not know what is the criteria for approving Medifund and Medifund Silver applications?

As I understand it, the only public information that is available in this regard, is that those who cannot pay for their medical bills can apply through the medical provider.

I have been told that to be successful, basically all family members must have hardly any Medisave in their accounts that can be used, have hardly any money in the bank, cannot stay in a larger than 5-room HDB flat or private property, etc.

I also understand that in order to be admitted to Class C and B2 ward or treatment, which are the only classes whereby Medifund can be applied for, a patient must be referred by a polyclinic or if the patient has a medical benefits card referral from a private clinic participating in the Community Health Assistance Scheme (CHAS).

Medifund cannot use for polyclinic?

Medifund also cannot be used for polyclinic out-patient general consultation treatment, such that the medical providers have been raising funds through their own efforts to help such patients who cannot pay.

Patients owe $110m?

How can the elderly not worry when after writing off $90 million, patients still owe public hospitals $110 million?

35% elderly don’t have MediShield

How can the elderly not worry when 35 per cent of elderly Singaporeans aged 76 to 85 are currently not insured under the scheme, compared to only 8 per cent for the general population. (“Health Ministry urges uninsured Singaporeans to apply for Medishield coverage” (Channel NewsAsia, Nov 14)

Reach out, more awareness?

Health Minister Gan Kim Yong said his ministry is reaching out through events like public talks run by the Central Provident Fund Board.

The ministry is also encouraging children to apply for Medishield coverage on behalf of their elderly parents”.

Over the years, we have been getting almost the same reply along the lines that more will be done to reach out and have more awareness to encourage Singaporeans to apply for MediShield.

We have failed our senior citizens?

Any country that has a so called national health insurance scheme, whereby 35 per cent of the very old – age  76 to 85, do not even have the most basic cover of MediShield, is a failure by any measure. We have failed our country and more importantly we have failed our senior citizens, when they need healthcare most.

Why can’t the reply tell us the percentage of those age 76 to 85 who may have nothing or so little in their Medisave that they may not be able to afford the MediShield premiums?

How can awareness be repeatly replied as the main cause of so many uninsured elderly?

Has the percentage of uninsured elderly been increasing over the years?

What are we doing to solve this problem, and how are we going to help them?

80% subsidy – so affordable?

As to “”Beyond MediShield, the elderly can also receive help for their health care costs. All elderly Singaporeans will continue to enjoy government subsidies of up to 80 per cent for subsidised health care treatment at our public health care institutions, regardless of their insured status”, the fact as reported in Parliament, was that more than 90 people had annual MediShield claims exceeding $50,000 (after the deductibles and co-insurance) in both 2009 and 2010, shows how expensive healthcare is in Singapore, even in the two lowest class wards of Class C and B2 despite continuing “to enjoy government subsidies of up to 80 per cent”.

How many elderly patients who could not pay, were able to get help under Medifund to fully cover their bills, and how many were rejected?

Medifund top-ups help you?

Under the GST Voucher scheme, the government will also provide annual Medisave top-ups for the majority of elderly Singaporeans to help with medical expenses. But, how many elderly had their Medisave top-ups consumed by increasing healthcare costs within say a year of receiving their top-ups?

If your top-ups are consumed by medical costs, how do you pay for your MediShield premiums even if you are aware of the scheme?

Just insure the uninsured?

Since we know who are the citizens aged 76 to 85 who don’t have MediShield, why don’t we just use the Medisave top-ups to directly pay for their MediShield premiums and insure them?

Medishield deductibles and premiums will increase?

How can seniors not be worried when Medishield deductibles and premiums will increase from 1 March 2013 which affects the lower-income elderly more? – if we really want to help, we could spend some money on Medishield.

After all, Medishield does not cost the Government any money, as it is a self- funding scheme paid by policyholders. (“MediShield: Deductibles increased by 5 times historically for elderly?“, Nov 12).

14 months to diagnose?

How can the elderly not worry when It can take 14 months for a patient just to be diagnosed in our polyclinic and public hospital system? (Margaret Chong’s letter ”14-month wait needed before elderly father can be diagnosed” (Straits Times Forum, Dec 29), in which she said “This will make it some 14 months before his condition can be diagnosed and treated”)

Medisave – paying for parents?

How can the elderly not worry when perhaps the most alarming indicator that our healthcare system is failing, is that out of the total amount of Medisave withdrawn for the elderly’s healthcare expenses in the year 2010, about 45% was from their children’s Medisave accounts (Parliamentary reply, Oct, 2011)?

What this means is that the current generation is already using up a lot of their Medisave for other generations – in healthcare funding terms, this may be what many countries fear most and try very hard to avoid – that the current generation is paying for older generations and depleting their own healthcare funding in the future.

21% in debt due to healthcare?

How can the elderly not worry when the last available statistic was that about 21 per cent of Singaporeans who sought help from Credit Counseling Singapore cited healthcare costs as one of the reasons for getting into debt?

Down-grading 99% unsuccessful?

How can the elderly not worry when the last time that a reply was given in Parliament, about 99 per cent of down-grading requests to a lower ward class in hospitals were unsuccessful due to means testing?

Public sector spending declined to 40%?

How can the elderly not worry when public sector spending on healthcare, as a percentage of total healthcare spending, has declined from about 75 percent to about 40 percent now?

Lowest public healthcare spending in the world?

How can the elderly not worry when even with the Government’s announced plans last year to double yearly health-care spending from $4 billion to $8 billion over the next five years – five years is a very long time?

With the previous year’s public healthcare spending as a percentage of GDP at about 1.6 per cent, which is one of the lowest in the world – even with the announced gradual increase in spending – after accounting for the expected rise in GDP, the population increase, aging population and inflation, I estimate that our public healthcare GDP spending may remain as amongst the lowest in the world in the next few years too.

Leong Sze Hian

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I refer to the article “PAP leaders: govt is delivering on ge promises” (Straits Times, Jan 19).

It states that “In housing, transport, education and healthcare, the Government had taken the initiative and moved ahead”.

Let’s look at some of the statistics that are related to the election promises and statements.

TRANSPORT

Public transport fares were increased again in October 2011. (“Formula almost guarantees fare increases“, Jul 29, 2011)

This was the ninth fare increase in the 11 years from 2000 to 2011. As it is arguable whether the 2010 change to distance-fares was actually an increase or decrease, it may actually have been the tenth increase.

If we can decide to spend $1.1 billion on buses to help the transport operators, why can’t we spend a single cent to keep fares from increasing?

EDUCATION

Miscellaneous fees in schools have been increased for all students.

Whilst the principle of further differentiating fees by citizenship is a valid one, why is it that when fees are increased – be it for university, healthcare, etc – fees for Singaporeans are also raised?

It appears that the estimated additional revenue from PRs and foreigners may be about 10 times that of the increase in miscellaneous fees for all students.

If that is the case, why not keep the miscellaneous fees for Singaporeans at the current level or, better still, reduce them? (“Why increase fees of local students? “, Jul 25 and “Foreigners’ school fees up, Singaporeans’ too? “, Jul 16)

HOUSING

With 5,500 letters of appeal on HDB in one year in just one GRC, how many letters of appeal were written for all the GRCs and SMCs? – About 99,000? (15 GRCs and 12 SMCs) (“5,500 letters of appeal on HDB in 2012 in 1 GRC?”, Jan 17)

This may indicate that Singaporeans’ housing problems appear to be continuing unabated.

HEALTHCARE

Instead of increasing Medishield deductibles and premiums from 1 March 2013 which affects the lower-income elderly more – if we really want to help, we could spend some money on Medishield.

After all, Medishield does not cost the Government any money, as it is a self- funding scheme paid by policyholders. (“MediShield: Deductibles increased by 5 times historically for elderly?“, Nov 12)

HELPING THE POOR

As to “help for the poor”, according to the CDCs’ annual report for FY2011, the number of applications for financial assistance was 72,700 for the whole year from 1 April 2011 to 31 March 2012.

Is this an all-time record high?

Giving the statistics for only nine months, may mask the stark reality that 72,700 families applied for social assistance under ComCare schemes in a year.

Missing statistics: Successful applications?

it may be somewhat odd, that the ComCare media release does not say how many of the applications were successful, like in the past.

For example, according to the reported statistics in February 2011, 39,500 or 71 per cent of approved applications for financial assistance under ComCare were successful, up from 42,100, or 67 per cent, in 2009. (“Saddest statistic ever: 200,000 families helped?, Aug 22, 2011)

$4b in 2007 for 5 years?

The GST rate increase from 5 to 7% in 2007 was accompanied by an offset package to help Singaporeans with the increase in GST, and which would cost the government $4 billion over five years. (“GST rate to rise to 7% from July 1“, Channel NewsAsia, Feb 15, 2007)

Now $3.6b for next 5 years?

Now five years later, the Government will be spending much less, at $3.6 billion over the next five years (2012 – 2016) under the new GST Voucher package.

Since the GST Offset Package was to help particularly lower-income families offset the GST increase, and considering that the population has increased and inflation has risen by about 19 per cent since 2007, and huge budget surpluses of about $10.5 billion over the last seven years, why are we spending less now?

More help for lower-income in 2007?

When the GST rate was raised from 5% to 7% in July 2007, a household in the bottom 20% had to pay additional GST of $370 per year, but received an offset package of $910 per year, in addition to permanent benefits of $1,000 per year. (“Budget debate round-up speech“, Mar 2, 2011)

Less help now?

So, let’s see how much less lower-income families will get now.

It’s GST Cash of $250 and GST U-Save Rebate of $260 (1 and 2-room HDB) and no Medisave top-up if there are no family members age 65 and above.

For example, family members age 65 – 74, 75 – 84 and 85 and above (staying in homes with annual value not more than $13,000) wiil get a Medisave top-up of $250, $350 and $450, respectively.

In any case, even if a lower-income family qualifies for a Medisave top-up, it can only be used for medical purposes, and is thus not cash that can effectively offset GST expenditure.

Also, in the past, Medisave top-ups were given to those age 55 and above. So, why is the age now increased to 65 and above?

So, are lower-income families effectively getting much less now under the GST Voucher scheme, compared to the previous GST Offset Package?

GST increase to help the poor?

Since the main reason given for increasing GST was to help the poor, why is it that lower-income families are now apparently getting less under the GST Voucher scheme? (“GST Offset much lower now for lower-income? “, Dec 31)

COST OF LIVING

If we really want to help on “the cost of living”, why do we keep increasing basic goods and services, like property tax for 3-room HDB flats and Service and Conservancy Charges (S & CC), etc? (“HDB rentals up 10%, but property tax up 118%?, Nov 27 and “Each town council different, but raise charges together?“, Oct 3)

FOREIGN WORKERS

The tightened foreign labour policies may not be reflected in the full yearly statistics which still show the rate of increase in the foreign workforce at 7.6 and 5.7 per cent in 2011 and 2010, respectively. (“S Pass increased 12.5% last 6 months“, Oct 1)

JOBS

More job seekers?

Job seekers dropped from 100,504 to 24,500?

Between January and November 2012, the number of people approaching the CDCs for training and employment assistance was 24,500, a 3 per cent drop compared to the same period in 2011.

The success rates of those being placed into employment has also been higher in 2012. 11,800 were placed into jobs between January and November 2012, compared to 10,100 for the same period in 2011″

However, according to the Department of Statistics’ (DOS) Monthly Digest of Statistics Singapore June 2012, job seekers attended to by the CDCs and e2i, was 99,608 and 100,504, in 2010 and 2011, respectively, and job seekers placed in employment was 17,732 and 14,223, respectively. (“Easier to get jobs?“, Sep 7 and “Latest statistical highlights: Job placement rate drops to 14%, Jul 17)

So, how is it possible that 100,504 job seekers attended to by the CDCs and e2i in 2011, has dropped dramatically to only 24,500 job seekers approaching CDCs in 11 months (excluding e2i?)?

The latest statistics indicate that in the six months from June to November 2012, the number of job seekers attended to was 57,992. Thus, it may appear that the total for the full year of 2012 may end up to be even higher than 2011′s 100,504.

Declining job placement rate?

Similarly, the 11,800 were placed into jobs between January and November 2012, seems to be much lower than the 14,223 placed in employment for the full year of 2011.

Job placement rate improved from 14 to 48%?

If we take the CDCs’ statistics now, the job placement rate (for 11 months) is 48 per cent, but if we take the DOS’s statistics, the placement rate for the 12 months in 2011 was only 14 per cent?

WAGES

The real median income growth for workers (excluding Employer CPF Contributions) was negative in 2008, 2009, 2011, 2012 (June) and only 0.5 per cent in 2010. (“2012 real income declined – 2.3%?”, Nov 30), and I estimate that the real basic wage growth in the last 12 years or so (1999 to 2011), was negative for 4 of the 8 occupational categories in Singapore, and only around 0.5 per cent or less per annum for the other 4 categories. (“Workers’ rights: 12 years of near negative wage growth for almost all workers?“, Dec 9)

There may be little justification for much of the above pertaining to price increases, with tax revenues being up for the current year, budget surpluses of about $10.5 billion over the last seven years and an estimated over $800 billion in the reserves.

Leong Sze Hian

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I refer to the article “Major review to keep health care affordable“, (Straits Times, Dec 28).

Review next year

It states that “The Ministry of Health (MOH) is embarking on a major review next year to ensure that public health care remains accessible and affordable to Singaporeans”.

After all these years of problems, issues and debate on our healthcare system, what we get now is just another major review next year. After the review, how mcuh longer will it take before we really take concrete steps to fix the serious problems in our healthcare system?

Wait 14 months to diagnose?

How do you know that our healthcare system is breaking down? Well, for starters – just read the newspaper foreign pages.

For example, in Margaret Chong’s letter ”14-month wait needed before elderly father can be diagnosed” (Straits Times Forum, Dec 29), she said “This will make it some 14 months before his condition can be diagnosed and treated”.

If it takes 14 months for a patient just to be diagnosed in our polyclinic and public hospital system, you know that our healthcare system is not working well.

Lowest public healthcare spending in the world?

As to “The Government announced plans early this year to double yearly health-care spending from $4 billion to $8 billion over the next five years”, five years is a very long time. With last year’s public healthcare spending as a percentage of GDP at about 1.6 per cent, which is one of the lowest in the world – even with the announced gradual increase in spending – after accounting for the expected rise in GDP, the population and inflation, I estimate that our public healthcare GDP spending may remain as amongst the lowest in the world in the next few years too. 

What we may need is to urgently spend more now.

Hospital beds decreased 5% last decade?

As to “They include increasing the number of beds in acute public hospitals by 30 per cent and more than doubling beds in community hospitals by 2020″, according to the Department of Statistics’ Yearbook of Statistics 2012, the total number of hospital beds declined from 11,936 in 2001 to 11,394 in 2011. This is a drop of about five per cent over the last 10 years!

Against this decline, hospital admissions increased by 22 per cent,  from 384,054 to 469,445 in the same period.

Isn’t this in a way, like too late too little – have to wait another eight years to grow the beds in acute public hospitals by 30 per cent. What we need is to know on a year to year basis going forward to 2020, how many more hospital beds there will be?

Public dental care visits decreased 12%?

Public dental healthcare is even worse – with visits to public sector dental clinics declining by about 12 per cent,  from 983,792 to 863,187 in the same period, despite the rise in the population by more than a million.

No wonder people say that public dental healthcare is practically non-existent in Singapore, as one has to make an appointment which is typical months in advance.

Medisave – paying for parents?

Finally, perhaps the most alarming indicator that our healthcare system is failing, is that out of the total amount of Medisave withdrawn for the elderly’s healthcare expenses in last year (2010), about 45% was from their children’s Medisave accounts (Parliamentary reply, Oct, 2011).  What this means is that the current generation is already using up a lot of their Medisave for other generations – in healthcare funding terms, this may be what many countries fear most and try very hard to avoid – that the current generation is paying for older generations and depleting their own healthcare funding in the future.

P. S. You may also like to read “Hospital bill: 42 years instalment plan! ” (Oct 16)

Leong Sze Hian

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I refer to the report “Real growth in household incomes over past 5 years despite higher inflation: MOF” (Channel NewsAsia, Dec 26).

Real incomes have risen?

According to the the Ministry of Finance’s second issue of the Singapore Public Sector Outcomes Review (SPOR),  “Real incomes have risen in the past five years, driven by good economic growth and a tight labour market.”

However, the above is based on “Real Median Monthly Household Income per Household Member (including Employer CPF Contributions) among Resident Employed Households (in 2009 dollars)”. What is the outcome, if we use the income excluding Employer CPF Contributions?

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I refer to the NUH Patientcare Charity Fund’s annual report for the financial year ended 31 March 2011.

17% spent in the year

According to it’s profit and loss statement, total incoming resources were $12.4 million, with total resources expended of $2.1 million.

This means that it received $12.4 million and spent $2.1 million, resulting in a surplus for the year of $10.3 million.

In other words, about 17 per cent was spent in the year.

Of the $2.1 million spent, $1.1 million was spent on needy patients, $1 million on medical education and training (including the Annual Asia Pacific Evidenced-based Medicine and Nursing (APEBMN) workshop and conference), and $3,941 on patientcare and research.

Since the name of the charity fund is “NUH Patientcare Charity Fund”, some donors may be under the impression that the majority of the funds would go to help needy patients.

48% on medical education and training

As cited above, about 52 per cent was spent on needy patients, with the bulk of the balance ($1 million) of about 48 per cent on medical education and training.

As a public hospital, why is it that such medical education and training funds do not come from the hospital’s budget or the Ministry of Health (MOH)?

According to the Tan Tock Seng Community Charity Fund’s annual report for the financial year ended 31 March 2011 – the total resources expended in the year was $1.8 million.

$2.3 m spent on constructing centre

For the year ended 31 March 2010, the total resources expended was a much larger amount of about $4.3 million, which had a footnote which said “The increase in expenditure is mainly due to the expenditure of $2.3 million in the construction of Emergency Diagnosis and Therapy Centre (EDTC)”.

53% spent on constructing centre

So, about 53 per cent of the expenditure was spent on the construction of the EDTC in the year.

Shouldn’t the building of infrastructure be funded from a hospital’s budget or the MOH, instead of from it’s “Community Charity Fund”?

Like the NUH Patientcare Charity Fund, the name “Tan Tock Seng Community Charity Fund” may have some donors getting the perception that as a “community charity fund”, most of the funds may be used for needy patients.

LEONG Sze Hian

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I refer to the report “Cleaning fees raised at nine hawker centres” (Channel NewsAsia, Nov 14).

http://www.channelnewsasia.com/stories/singaporelocalnews/view/1237130/1/.html

Cleaners pay increased? Don’t know?

It states that “On how the fees hikes will impact cleaners’ salaries, Ms Fu said she is not able to provide details on the extent to which the increases in fees would benefit the cleaners since it would depend on the operations of each cleaning service provider”.

So much has been said recently about the issue of very low pay cleaners that almost everybody including Parliamentarians have been asking how much has the pay of cleaners increased, after all the initiatives, schemes, etc.

And the answer now in Parliament is essentially we are not able to tell you.

KPI achieved? Don’t know?

Imagine you are in the private sector or for that matter in the public sector, and your Key Performance Indicator (KPI) is pay, and when asked as to how you have performed – the answer is I am unable to tell you”

What would be the reaction of the shareholders, board of directors, Chief Executive Officer (CEO), etc?

Don’t know? Why don’t just ask?

Can’t we simply ask the National Environment Agency (NEA) to ask the cleaning companies it awarded contracts as to how much more they are paying their cleaners?

Can’t we just send a few people to ask the cleaners at these nine food centres as to how much their pay has gone up?

“First world” Parliament?

Such is the standard of our Parliament in a so called “first world” country!

PAP town councils know, but we don’t know?

By the way, if the PAP town councils were able to announce triumphantly not so long ago that they were able to increase the pay of town council cleaners to $1,000, why is it that the Minister can’t?

Accreditation?

As to “However, the tender stipulated the contract would only be awarded to cleaning companies awarded the Clean Mark Accreditation which requires cleaners to be provided basic statutory benefits stated under the Employment Act including CPF contributions and paid public holidays”, are we saying that some cleaning companies were breaking the law by not paying basic statutory benefits like CPF and paid public holidays?

How many cleaning companies have been prosecuted for breach of the employment act?

What kind of accreditation are we talking about, when it requires mere compliance with the legislation?

More cleaners per food centre?

With regard to “”The most sustainable solution to the moderation of cleaning charges for the hawkers is for all of us – the patrons, the stallholders – to help keep our hawker centres clean. It is not possible for us to infinitely increase the numbers of cleaners at our centres to clean up after our mess,” she said”, are we implying that the number of cleaners has gone up per hawker centre?

Is there any data to support this?

Productivity up? Don’t know?

Is it not in a way, self-contradictory, when we keep saying that pay can only go up with productivity, and yet there is no mention as to whether the productivity of cleaners has gone up or not?

In this connection, “Ms Fu said that even with efforts to improve working conditions and career prospects of the cleaning industry, the longer term solution would be to mitigate manpower shortage with increased productivity as the industry remains unattractive”.

So, the reply does not answer the fundamental questions as to whether pay or for that matter productivity has gone up!

MediShield

Next, let me move on to the reply in Parliament about MediShield, as reported in “Health Ministry urges uninsured Singaporeans to apply for Medishield coverage” (Channel NewsAsia, Nov 14).

http://www.channelnewsasia.com/stories/singaporelocalnews/view/1237104/1/.html

It states that “The Ministry of Health is encouraging eligible, uninsured Singaporeans to apply for Medishield coverage. 

35% elderly don’t have MediShield

It said 35 per cent of elderly Singaporeans aged 76 to 85 are currently not insured under the scheme, compared to only 8 per cent for the general population. 

Reach out, more awareness?

Health Minister Gan Kim Yong said his ministry is reaching out through events like public talks run by the Central Provident Fund Board. 

The ministry is also encouraging children to apply for Medishield coverage on behalf of their elderly parents”.

Over the years, we have been getting almost the same reply along the lines that more will be done to reach out and have more awareness to encourage Singaporeans to apply for MediShield.

We have failed our senior citizens?

Any country that has a so called national health insurance scheme, whereby 35 per cent of the very old – age  76 to 85, do not even have the most basic cover of MediShield, is a failure by any measure. We have failed our country and more importantly we have failed our senior citizens, when they need healthcare most.

Why can’t the reply tell us the percentage of those age 76 to 85 who may have nothing or so little in their Medisave that they may not be able to afford the MediShield premiums?

How can awareness be repeatly replied as the main cause of so many uninsured elderly?

Has the percentage of uninsured elderly been increasing over the years?

What are we doing to solve this problem, and how are we going to help them?

80% subsidy – so affordable?

As to “”Beyond MediShield, the elderly can also receive help for their health care costs. All elderly Singaporeans will continue to enjoy government subsidies of up to 80 per cent for subsidised health care treatment at our public health care institutions, regardless of their insured status”, the fact as reported in Parliament last month, that more than 90 people had annual MediShield claims exceeding $50,000 (after the deductibles and co-insurance) in both 2009 and 2010, shows how expensive healthcare is in Singapore, even in the two lowest class wards of Class C and B2 despite continuing “to enjoy government subsidies of up to 80 per cent”.

How many elderly patients who could not pay, were able to get help under Medifund to fully cover their bills, and how many were rejected?

Medifund top-ups help you?

As to “Under the GST Voucher scheme, the government will also provide annual Medisave top-ups for the majority of elderly Singaporeans to help with medical expenses,” he said”, how many elderly had their Medisave top-ups consumed by increasing healthcare costs within say a year of receiving their top-ups?

If your top-ups are consumed by medical costs, how do you pay for your MediShield premiums even if you are aware of the scheme?

Just insure the uninsured?

Since we know who are the citizens aged 76 to 85 who don’t have MediShield, why don’t we just use the Medisave top-ups to directly pay for their MediShield premiums and insure them?

Perhaps what we sorely need in Parliament are answers to questions and not just quite meaningless replies!

Leong Sze Hian

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