Committee of Supply – Head O (Ministry of Health)

The Chairman: Head O, Ministry of Health. Dr Tan Wu Meng.

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Health and Care – Forward New Foundations

Dr Tan Wu Meng (Jurong): Mdm Chair, I seek to move, "That the total sum to be allocated for Head O of the Estimates be reduced by $100".

I declare I am a medical doctor in a public hospital, looking after cancer patients. I am also an advisor to the Healthcare Services Employees' Union (HSEU).

Chair, SG60 is a time to look back and look ahead, and the same applies for our healthcare system as well. It is time for us to reforge, remake new foundations and move forward with new foundations for the future. Let me start by speaking about right-siting of healthcare. Right-siting, which means place of care, subsidy of care, access to care.

In 2022, I called for the Ministry of Health (MOH) to look at how care can be brought closer to home for patients, especially for residents who are less mobile, who find it more difficult to get to clinics.

If the care has to be in a hospital, there should be a medical reason, not because the subsidy and access to funding is tied to the hospital or to the specialist outpatient clinic. In short, bring subsidy to where the patient is, if the policy intent is to support the care where the patient is.

There has been progress in the years since then, improved access, also better financing support for palliative care at home, which is important for residents who are terminally ill, where time is even more precious than before, and where being at home in their last weeks and months is deeply important.

But there is room to do further and do even better as we remake our healthcare system. Let me speak about home medical care. One of my Clementi residents met up with me and my team. He is a husband looking after his wife who is ill. His wife is a young mother, with a lung infection, with tuberculosis and she just got out of the hospital.

As part of a treatment plan, she needs to go to a clinic every day to take her medicines under direct healthcare supervision in a healthcare setting. It is called Directly Observed Therapy (DOT). But because his wife is ill and in a wheelchair, he has to push her in a wheelchair to the polyclinic every day for the daily medicines. My resident is a dutiful and loyal husband. At the same time, his job cannot be done remotely, so he quit his job to support his wife, quit his job so he could bring his wife in a wheelchair to the polyclinic each day for DOT, to take medicines that have to be given under healthcare supervision.

Could there have been a way for my resident's wife to receive her medication at home? Could there have been a way for the system to support my resident's family better, so that the husband did not need to have to choose between keeping his job and making sure his wife got treatment every day? Could the treatment have been delivered in the home itself? Because when we help the patient, it can help the caregiver, and if by saving the caregiver's job, it helps the family as well.

Let me speak about outpatient scans, because today, more and more care can be delivered in the outpatient setting. People are getting older with more complex medical conditions. Healthcare is advancing and with advances in care, the use of scans is more common nowadays.

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Can MOH be more flexible with the use of MediSave for outpatient scans? Can we make it easier to access patients' MediSave for such scans, which may be medically necessary? This will help patients with chronic diseases who have to undergo certain types of scans and if we enhance access to outpatient MediSave for scans, it will help cancer patients as well, who often have to go for regular scans as part of their treatment plan and monitoring.

Let me also speak about access to care, not just the finances, but also the process of getting to the care. Let me speak about digital access and our polyclinic system. In the old days, patients would go to a polyclinic. They would queue and wait to be seen. That had its own challenges, but in recent years, there has been digitalisation at polyclinics nationwide.

I have older Clementi residents who share with me that, while this has brought modernisation, it has brought challenges for some of our older residents as well. In particular, we must avoid the phenomenon of digital drop-off when we go digital with healthcare, digital drop-off when patients who previously had access to care no longer show up, not because their healthcare conditions have gone away, not because their problems have been solved, but because they find it too hard to navigate a digital system to secure access to healthcare, or even a healthcare appointment.

One worry that my Clementi residents share about is how they have to go online to book an appointment at an offline consultation in the polyclinic. I have had Clementi residents, but even residents staying in the east of Singapore, writing to me to share about these challenges. They find that when the bookings open at 10.00 pm, in the case of some polyclinic systems, the online bookings get "choped", get reserved, very quickly within a few minutes. These are the bookings for the next day's consultation.

And so, it means that the residents or the patient with the best digital access, fastest fingers, sharpest eyes, quickest with their smartphone or their computer, they are the ones who "chope" the appointments. The seniors who find it harder to navigate a website, find it harder to go online, they are stuck. They find it very difficult.

Sir, this can be regressive towards the elderly and the less digitally-savvy. The systems made it harder for these seniors. And I have met elderly residents who tell me when they show up at the polyclinic without an appointment, sometimes they get turned away, asked to go online to make a booking, even though they do not know how to go online.

Or sometimes, they are told to go and visit a nearby general practitioner (GP) clinic, even though this might cost more than the polyclinic, and for retirees without income, retirees of limited means, every extra dollar spent on healthcare is one more dollar drawn down from their retirement savings.

In 2024, I filed a Parliamentary Question (PQ) to MOH. I asked MOH to consider portable subsidy vouchers to help underwrite some of the cost difference between polyclinic care and private GP care, especially for seniors who may physically live right next to the polyclinic, nearby the polyclinic, but who due to digital challenges, find it very hard to go online to book an appointment for the next day at the polyclinic. Can MOH take a look at this again, as an interim measure, while the agencies continue working to improve polyclinic capacity and better support our healthcare sisters and brothers on the polyclinic healthcare front line.

Let me also speak about healthcare processes now, in particular, care and coordination. Today, we know many seniors have multiple medical conditions. It comes with an ageing population, multiple doctors, multiple teams looking after the patients, sometimes the care is complex – many experts, many teams looking after the same patient – and so coordination is even more important today, and it is especially important when the care is complex. I raised this 16 years ago, in the year 2009, in an article in the Singapore Medical Association newsletter, SMA News, and again more recently, in the 2022 MOH Budget debate Committee of Supply (COS).

In Government, in the Cabinet, we have Coordinating Ministers. That tells you that at the highest levels of Government, we recognise coordination is an important role and adds value beyond a single specialisation. So, for patients with multiple complex medical conditions, can there be a coordinating doctor supported by different specialists from medical, nursing, allied health, also with adequate admin support, so we can wrap care around the patient with complex needs. This can simplify the care journey, fewer visits to clinics, especially if the care can be coordinated backend.

In a previous PQ that I filed, MOH shared that just before the COVID-19 pandemic in 2019, there were 7,000 Singaporeans a year, with 24 or more specialist outpatient clinic visits in a year. That means two or more specialist outpatient visits in a month.

In the year 2019, there were over 2,000 Singaporeans who had 36 or more outpatient clinic visits to a specialist clinic in a year, three or more visits per month on average. Imagine the impact on caregivers who do not have flexible working arrangements (FWAs), or who have loss of income when they accompany a patient, their loved one, for care. So, coordination is not just a cost centre or an expense, it is an investment, it is a catalyst, it is an enabler to help families with worries about caregiving.

If we bring in social support agencies as well, so that more of the care can be done in the community, it can even be a pilot project for the Bureau of Service Simplification (BOSS), which I proposed during the Budget debate, and perhaps MOH and the Minister for Health can be part of this pioneering initiative to simplify the journey for citizens across healthcare, social care and citizen journeys.

In short, recognise patient navigation and coordination, not as a cost centre, but as an investment, an enabler and a catalyst.

The backend work of coordination takes time, energy bandwidth and our sisters and brothers in the HSEU have shared this as well. So, even as we invest in coordination, we have to recognise the hard work that healthcare frontliners put in to streamline care, coordinate care, wrap care around the patient. And we know from our sisters and brothers that sometimes this includes work taking place outside of duty hours and we should find ways to measure, recognise and factor this into our workforce planning.

I also call upon MOH to look at healthcare information technology (IT), because when there is a gap between what the software is and what we want it to be, it is technical debt. Healthcare workers, patients trying to navigate systems and computers. So, can MOH tell us what is being done to improve healthcare IT to help frontliners, including our junior doctors? Is AI being used to simplify the work for healthcare frontliners so that people can spend more time delivering care, caring for patients rather than navigating computer systems? Are we giving the same attention to IT that the big firms, like Apple and Google do?

As I said in 2022, technology must serve the people. Technology must serve, adapt and bend to the person, not getting our people to bend to the technology. And indeed, over the years I have spoken up for our healthcare workers, and in fact, as far back as 20 years ago in the SMA News, I and my fellow junior doctors had been advocating to improve the junior doctor journey, because our junior doctors are the future of our profession – and when we lift up, empower our juniors to do better, to be change agents – it lifts up the profession, it lifts up patients as well, it lifts up the care and quality of care in our community.

On healthcare financing, I want to speak about support for patients and how financing decisions shape behaviour. Last year, just before National Day, I spoke in an Adjournment Motion on fertility preservation support for young cancer patients. Every cancer patient goes through a difficult time, but for the very young patients, those who have yet to even start a family, it is especially stressful because certain treatments, while life-saving, can damage fertility, take away the dream of a family even before someone has a chance to start.

Working with a number of young healthcare workers across different hospitals, different clusters, we called upon MOH to look at four recommendations to help young cancer patients on the fertility journey. Firstly, for MediShield Life to cover fertility preservation for young cancer patients undergoing medically necessary treatment that will damage fertility irreversibly. If MOH moves on MediShield Life, this can be the first step to getting the Integrated Shield Plan insurers on board too.

Second, front load Government funding for young cancer patients needing fertility support, because a MediSave-based model does not work so well when the patient is too young to have earned MediSave from working and when the patient's family might not have much MediSave, if the family is starting with less.

Third, work with financial institutions to see if we can have interest-free loans to support young cancer patients needing fertility preservation.

Fourth, support philanthropy in the fertility preservation for young cancer patients. Seven years ago, I spoke up in Parliament for children with rare diseases. The Government later set up a Rare Disease Fund with three-to-one matching grant for public donations. Can MOH learn from this model, learn from this journey, to better support philanthropic efforts to help young cancer patients?

Let me also speak on mental health. Last year, I spoke about access to insurance. I shared about young Singaporeans who are afraid to seek help in a mental health crisis because they are worried that once a diagnosis is on the record, some insurers will not cover them even for conditions unrelated to mental health. One Clementi resident said to me: "Dr Tan, some insurers are kind, but some are one kind", and indeed, we have to make sure that there is not such market failure.

At the same time, can MOH also improve access to non-clinical, more community-based mental health support, so that young Singaporeans with mental health worries can find help in the community without necessarily having to go to a healthcare setting. If the situation is serious, they can go and see a clinical assessment, whether a psychologist or an informal medical consult, but at least there are more options there, even while MOH works out the issues with the insurance companies.

In short, as I said five years ago in Parliament, sometimes the invisible hand of the market becomes unbalanced. And that is why we need the visible hand of the regulator to re-shape insurance behaviour and ensure proportionate, fair and more reasonable decisions on insurance for young Singaporeans who have gone through a mental health situation.

Sir, in the Budget debate, I made three points. Firstly, if implementation is policy, then the residents' journey is implementation and I will add that the patients' journey is implementation too. Second, Government spending must look not just at a single item on a budget, but the broader impact to society, because sometimes, spending on coordination of care becomes an enabler, a catalyst to help a family, and sometimes save a breadwinner's job.

Lastly, technology must serve the people. People must not bend to serve technology or the design of technology. These principles apply not just in a budget, but across the whole-of-Government and in MOH as well. So, I call upon MOH to consider our suggestions as we aim towards healthier, happier lives for the people of Singapore and our future. [Applause.]

Question proposed.

Workload of Junior Doctors

Mr Muhamad Faisal Bin Abdul Manap (Aljunied): Madam, I would like to address the issue of the workload of junior doctors. MOH has mentioned on 10 January 2024 in Parliament, that their guideline for junior doctors stipulates that, when average out over a month, the total work hours per week of junior doctors should not exceed 80 hours. Thus, over an average month of four weeks, the total work hours should not exceed 320 hours.

Anecdotally, I hear that many junior doctors, particularly in our acute hospitals, regularly hitting or coming close to this limit.

A nationwide survey published in the Journal of the Academy of Medicine Singapore, in 2023, reports that junior doctors work an average of 71 hours a week, which adds up to 284 hours on an average month.

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In contrast, the Ministry of Manpower's (MOM's) employment guidelines stipulates that the contractual hours of work for common work arrangement under part four of the Employment Act is 44 hours a week and a typical employee is only allowed to work up to 72 overtime hours a month. For an average month, MOM's guidelines suggest that a typical work month would see one work 176 hours and even if one works overtime, one should not exceed 248 hours. Any more would presumably not be healthy for the employee.

This suggests that MOH allows junior doctors to work 72 hours more than what is usually deemed healthy for a typical employee. Why have we institutionalised the practice of overworking our junior doctors?

The Employment Act does not mention that managers, executives, solicitors and such are also excluded from this guideline, and doctors, being highly qualified and with special knowledge, belong in this category. To this I say, doctors hold the lives of the vulnerable and ill in their hands. Some indeed may be capable of operating at such an intense level for prolonged periods of time, but I believe many are not.

Do we want our doctors that have been consistently overworked to attend to our sick parents and children in their hours of need? Do we want doctors that are stressed to make decision that can literally involve life and death? The same survey mentioned earlier found a significant correlation between the number of medical errors made with the amount of additional clinical hours worked per week.

I note that in many parents' guides that MOH publishes, they emphasise the importance of parents being heavily involved in their children's life for children's health development. Many junior doctors in the public healthcare system are bonded and do not have the option of quitting if they are unable to deal with the stress and workload. They have no recourse and are forced to make choices that compromise their family time. Is it not ironic that even MOH, as MOH puts out these guidelines, their own doctors are unable to follow them due to the amount of hours they need to put into work?

Madam, the current system to me does not seem sustainable. As the workload of junior doctors increases, many choose to leave the public healthcare system for better pay and lesser working hours. This only serves to aggravate the workload of the remaining doctors, leading to a self-reinforcing cycle. To me, MOH must intervene fast and decisively to change the system.

Madam, Minister Ong mentioned in May 2024 that the National Wellness Committee on Junior Doctors has finalised its recommendation and are now progressively implementing them. Are the details of this recommendation and findings going to be made public? Is MOH looking into more aggressively hiring junior doctors, especially those that have left the public healthcare system? How do they intend to do so? Will it include increasing doctor's salaries to better compete with the private sectors and, if so, how much?

Madam, I would close by saying, just because generations of doctors have survived such conditions is no excuse for MOH to continue to perpetuate such attitudes and working conditions. Should we not strive to be a society that is kinder and more compassionate, especially to those that care for us?

Provide Nurses More Rest Time

Mr Louis Ng Kok Kwang (Nee Soon): In my Budget speech two years ago, I shared about how nurses' workloads are heavy, their shifts are long and they get little time to rest. I spoke up, calling for MOH to ensure that nurses have sufficient rest time. I ended that speech with a quote from a nurse, "We are called back for overtime when staff is down, when we don't go to work because we are tired, the management counts the number of times and mentions it in our appraisal for not being a team player and marks us down for it. These are just sad realities. We end up feeling burnt out and essentially hating the very job that we started loving. People leave because they see no end to this dark tunnel."

I know there is light at the end of this dark tunnel and MOH has been doing a lot to address these issues. Can the Minister share what steps have been taken to ensure that nurses have enough time to rest during their shifts and between their shifts.

Seniors Age Well

Assoc Prof Razwana Begum Abdul Rahim (Nominated Member): Madam, promoting healthy ageing among seniors, especially older women, is vital to ensuring their well-being and dignity. In this context, what initiatives are currently in place to promote healthy ageing among seniors, particularly older women, ensuring they have access to resources and programmes that support their physical, mental and social well-being?

How is the Ministry collaborating with other Government agencies and community organisations to create a comprehensive support system specifically for older women, ensuring they can age with dignity and security?

The Chairman: Ms Ng Ling Ling. You can take your four cuts together.

Access to HPB Healthy Lifestyle Activities

Ms Ng Ling Ling (Ang Mo Kio): Madam, the roll-out of Heathier SG nationwide since July 2023 is an important move towards supporting the growing disease burden of our fast-ageing population, where long-drawn chronic diseases are the key suffering of our people. I would like ask for the following updates.

One, what is the latest number, out of about 1,600 GP clinics in which focus on primary care, that have voluntarily become a Healthier SG clinic?

Two, what are the percentages of Singaporeans who have enrolled in Healthier SG in each of these age segments: between (a) 40- and 49-years-old; (b) 50- and 59-years-old; (c) 60- and 69-years-old; (d) 70- and 79-years-old; and lastly, (e) above 80-years-old.

Three, I am extremely grateful to MOH for approving two new Active Ageing Centres to be opened in Serangoon North Avenue 4, part of Jalan Kayu, after I spoke about the importance of scaling up Active Ageing Centres faster. The public servants have responded to the Minister for Health's comment that he "was in a hurry" and "we are racing against time" in his reply to my Committee of Supply cut about this last year.

I would like to ask if the Minister will also consider new Active Ageing Centres in Hougang Avenue 9 and Street 91, part of my constituency, as well as large private estates like Seletar Hills, which has some of the highest proportion of seniors above 60-year-olds and the other private estates that also have no existing Active Ageing Centres in my constituency?

Four, Jalan Kayu residents are very supportive of the Health Promotion Board's (HPB's) healthy lifestyle activities. May I ask what are the efforts to tie these with our Healthier SG GP clinics for their social prescriptions for enrolled residents who need the lifestyle interventions to manage their chronic diseases?

Five, more than one year into implementation, how much of the estimated $200 million annual budget for Healthier SG that has been disbursed to GP clinics in either calendar year or financial year 2024, and how much goes to GPs in (a) service fees earned per enrolled patient; (b) information technology (IT) grants to help enhance their Clinic Management Systems to better link up with MOH's Healthier SG systems; and (c) additional clinic administrative costs to coordinate with partners like HPB in their GPs' prescription?

Availability of Healthier Meal Options

I would like to commend MOH for its success so far in the "War on Diabetes" and the implementation of the Nutri-Grade mark as a labelling scheme for drinks based on sugar and saturated fat content. With hypertension and high cholesterol having increasing prevalence rates among Singaporeans in the last few years, I would like to ask: one, how is MOH planning to extend Nutri-Grade labelling and advertising prohibition to key contributors of sodium and saturated fat in popular food and beverage places like hawker centres, food courts and restaurants in the especially high footfall city and heartland malls?

Two, what are healthier alternatives to sodium and how will MOH increase public education in this important health topic? What types of cuisines that are popular among Singaporeans of all ages, for example, Chinese dishes, Indian food, Malay delicacies, Mediterranean diets, Japanese meals, Korean cuisines, just to name a few, have more developed recipes using healthier alternatives than sodium?

Three, will MOH consider increasing funding to: (a) Health Promotion Board to boost its "My Healthy Plate" initiative to now complement the Nutri-Grade mark for reduction of sodium and saturated fat intake of Singaporeans across all ages through developing healthier versions of recipes of our favourite cuisines and dishes that I have earlier described; and (b) will MOH invest in Singaporean researchers in developing healthier and affordable versions of specialty food additives that can make Singaporeans' favourite dishes still taste good but without the long-term harms and chronic diseases risks that sodium and saturated fat can lead to?

Strengthen Ageing Care Support in the Community

In September 2023, MOH launched the Shared Stay-in Senior Care Services sandbox to explore the feasibility of having a foreign live-in caregiver to help care for several seniors in one apartment. This is to better support families with caregiving needs amidst shrinking family sizes and expand options for seniors to age in place in the community.

I would like to ask: one, having reached the sandbox one year mark in September 2024, (a) what are the costs of caring for a senior annually under this sandbox model compared to that in a nursing home; (b) what plans do MOH have to mainstream this sandbox and what scaling plans do MOH have to benefit more seniors using this model?

Two, for seniors with mild to moderate ageing needs but cannot or do not want to be living alone or cared for in their own homes anymore, what are MOH's views on private operators' (a) interests in developing other new models like retirement villages and retirement homes, common in European countries which are also facing fast ageing population; and (b) the private operators' feedback that the current nursing homes licensing regime is too onerous, costly to comply with and the licence tenure of two years too short, to give certainty to operate with financial sustainability for such potential retirement villages and homes; and (c) their concerns that dependencies on high MOH subsidies for seniors like those in the nursing homes currently will continue to increase healthcare costs exponentially in fast-ageing Singapore?

Three, will MOH consider sandboxing a new licensing and operating framework with interested private operators who are keen to innovate into more sustainable models for seniors with mild to moderate ageing needs, like how MOH did for telehealth? What may be the timeline to do so and the selection criteria of private operators who are interested in participating?

Long-term Care Affordability

Long-term care costs have been steadily increasing. With our ageing population, we can expect the demand for such services to keep increasing. I would like to ask: one, what automation has been tried and tested in long-term care facilities, such as nursing homes and day care facilities, including those for seniors with dementia?

Two, how deliberate and how fast is MOH enabling the scaling of successful automation that can help augment the manpower, especially foreign manpower-intensive long-term care facilities, for a hope to blunt the cost increases when demands continue to rise?

Three, how many innovation projects for long-term senior care with some form of Government grants, whether it is under MOH or the National Research Foundation are there currently in Singapore and under the purview of which parts of MOH? Are there any of them that are testing using frontier technology, like AI. If yes, what are they?

My fourth question. While we look towards technological advancements to search for ways to blunt the cost increases of long-term care, we must not forget the wisdom of our forefathers in using traditional medicines to also deal with long-term chronic conditions and illnesses. In this regard, I have spoken since my 2023 Committee of Supply cut for MOH on the importance of understanding the efficacy of Traditional Chinese Medicine (TCM). I am very encouraged that MOH has since made progress in enhancing TCM practices in Singapore, including having the one-stop TCM Portal. I would like to ask if MOH plans to review the TCM Practitioners Act, which was passed 25 years ago in this Parliament?

My last question. As multiracialism and multiculturalism are unique strengths of Singapore, I have also taken an interest in the traditional medicines and therapeutic practices passed down through generations among our Malay community, like the concept of semangat, herbal remedies and urut.

The Chairman: Please round up.

Ms Ng Ling Ling: For our Indian community, there are what we call Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), which is increasingly known in India. My question is, does MOH sees wisdom in beginning studies and understanding into such traditional medicines of our Malay and Indian communities too?

The Chairman: Mr Yip Hon Weng, take your three cuts together.

Mr Yip Hon Weng (Yio Chu Kang): Chairman, Singaporeans deserve to age with dignity. That means ensuring long-term care is accessible, high-quality and financially sustainable. I have consistently championed this issue, raising it in Parliament through speeches and questions.

Our entire ecosystem matters, from supporting caregivers and strengthening palliative care to enabling ageing in place through a robust network of community-based services, like Active Ageing Centres, day care, telehealth and remote monitoring. The urgency grows as family sizes shrink and the cost of living rises, adding strain on sandwiched families struggling to care for their loved ones.

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While I recognise the Government's initiatives to review MediSave, enhance CareShield and improve palliative care and caregiver support, the fundamental challenge remains. How will the Ministry ensure long-term care remains affordable for all Singaporeans in the face of escalating medical costs?

Many will depend on Government subsidies, ElderShield, CareShield Life and personal savings. But are these really enough? Are CareShield Life payouts keeping pace with the soaring costs of nursing homes, home-based care and assisted living? How frequently does MOH review these schemes to ensure they stay relevant as inflation and care needs evolve?

Cost efficiency is just as critical as affordability. What strategies are in place to reduce unnecessary spending? Have we fully explored models like public-private partnerships or outcome-based funding to ease the financial burden on families and the system?

Other ageing societies have implemented progressive co-payment systems to supplement insurance. Are we considering such measures? If not, why? Could a tiered co-payment approach, where higher-income individuals contribute more while lower-income groups receive greater subsidies, create a more sustainable model?

Caregiving costs go beyond medical bills. Home modifications, assistive devices and caregiver support all add up. How will MOH integrate these into a holistic financing model and framework? Are there plans to expand MediSave coverage or introduce new financial tools to help Singaporeans prepare for ageing in place?

At its core, this is about fairness and sustainability. Are we striking the right balance between personal responsibility and Government support? Should we rethink risk-pooling and cost-sharing across generations to ensure our system remains equitable and future-proof?

We cannot afford to take a short-term view. Our long-term care financing model must not only meet today's needs but remain viable for future generations. I urge the Government to take bold, decisive steps to strengthen and future-proof our system.

Strengthening Ageing-in-place

At the last COS debate, I spoke about the need to improve home-based care for seniors with higher needs. I have also pushed for better support for their caregivers.

The reality is harsh. Families are getting smaller, but the number of seniors needing care is rising. We need new solutions. The Shared Stay-in Senior Care Services Sandbox is one such initiative offering a more affordable option. I would like an update from MOH on its progress. What has the Ministry learnt so far? What is working and what is not? I want to hear from caregivers and seniors. How do they feel about the quality, affordability and accessibility of these services? What can be improved?

More importantly, what is next? How will MOH scale this up? What is the timeline? What support will be given to providers and how does this model fit into the larger strategy for long-term care and a broader ecosystem alongside home-based and centre-based options?

Lastly, what safeguards are in place to ensure good care and protect seniors' well-being? How is MOH tracking and evaluating the programme's effectiveness?

This sandbox is a promising step forward, but clear updates and a strong plan for the future are key to making it work.

MediSave for Outpatient Needs

As our nation ages, we face two pressing challenges: a growing elderly population and rising healthcare costs. MediSave plays a critical role in healthcare financing. But do current withdrawal limits truly meet our seniors' needs? The Ministry aims to balance affordability with future needs, but are these limits keeping pace with actual expenses?

We live longer and face more age-related health conditions, requiring complex and costly treatments. As we shift towards outpatient care to ease hospital congestion, outpatient medical costs invariably rise, putting significant financial pressure on individuals and families.

Take Flexi-MediSave. Fewer than three in 10 eligible seniors reached the $300 annual limit in 2023. Does this reflect adequacy or are seniors delaying essential treatments due to financial concerns? Are we unintentionally discouraging necessary care?

Similarly, the $200 monthly MediSave Care limit for severe disabilities may fall short of long-term care needs. Does this truly support a dignified quality of life for our most vulnerable?

Some residents have also raised concerns that the $600 annual cap on MediSave use for health insurance premiums is insufficient. Could this be increased?

The Ministry fears premature MediSave depletion if limits rise, but we must balance prudence with compassion. What good is saving for a rainy day if the storm has already arrived? Could a more flexible, needs-based approach be fairer? Could safeguards prevent fund depletion without denying relief? Could temporary fund depletion for essential treatments be allowed, with options to replenish accounts later?

As Singapore ages, our healthcare financing must evolve. How do we ensure no Singaporean forgoes necessary care due to financial constraints? How can we make MediSave more sustainable and responsive to changing demographics and healthcare needs?

Affordability of Long-term Care

Mr Xie Yao Quan (Jurong): Chair, the Ministry of Foreign Affairs COS discussed three frontier technologies that will shape our foreign policy in the coming years. Well, in my mind, there are also three frontier policy domains that will transform our social support system for Singaporeans going forward. They are: adult education, social mobility and long-term healthcare.

For long-term care, our needs will only grow sharply because of our ageing population, longer lifespans but not necessarily healthspans, and changing family structures. So, we got to get this frontier domain right and ensure that, well into the future, Singaporeans can continue to access and afford long-term care services of high quality.

To this end, I have a few questions.

First, could the Ministry set a clear policy goal for affordability of long-term care? Today, we say no one will be denied appropriate services because they cannot afford it. But that is an assurance for Singaporeans with the least means. It is not a policy goal for affordability for the vast majority of Singaporeans. Today, we do have such policy goals for affordability for other domains of social support. In housing, we peg affordability to various levels of income. In retirement support, we crystallise the notion of adequacy in figures like the Basic and Full Retirement Sums. For long-term care, what is our policy goal for affordability? It is about time we define such a goal.

Second, taking a leaf from the fee cap framework that has been in effect for the preschool sector, would the Ministry consider a fee cap framework as well for the long-term care sector?

Third, on the enhanced subsidies for long-term care services and the Home Caregiver Grant, can the effective dates be brought forward to bring earlier relief to Singaporeans? Also, when can we expect details of the higher subsidies for dialysis services to be announced?

Finally, on the quality of long-term care, how does the Ministry plan to further develop both skilled manpower and a quality assurance framework for the sector even as more providers enter the space?

MediSave Withdrawal Limits

Ms Hazel Poa (Non-Constituency Member): Chair, last November, I asked the Minister for Health whether MediSave withdrawal limits can be adjusted every year, in line with inflation for healthcare costs, similar to the way the CPF Basic Retirement Sum and Full Retirement Sum are adjusted annually to take into account inflation.

The Minister replied that the MediSave withdrawal limits for co-payment of hospital bills are typically reviewed every three years while other MediSave features are reviewed periodically. He said, "This approach is favoured over automatic annual adjustments, to better account for other healthcare financing adjustments and enhancements that are continuously being implemented."

However, I hope that the Minister can reconsider this. Automatic adjustments indexed to inflation would help many Singaporeans, especially the elderly. Many elderly Singaporeans prefer to conserve their cash in retirement and pay for their healthcare needs using their MediSave savings. It is, after all, what they saved up for. However, if MediSave withdrawal limits do not keep up with inflation in healthcare costs, then the elderly may be faced with escalating out-of-pocket healthcare expenditures.

Automatic annual adjustments in line with inflation would only ensure that the real value of the MediSave withdrawal limits remain constant over time. The Government could still make additional adjustments based on changes in healthcare financing. These are not conflicting. I urge the Government to reconsider its position.

In particular, many elderly Singaporeans find the withdrawal limit for outpatient care insufficient. It is beneficial for outpatient treatment to be sought early before conditions deteriorate and hospitalisation becomes necessary. I urge the Government to set higher outpatient withdrawal limits for older Singaporeans and adjust them annually to keep up with healthcare cost inflation. Chair, in Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.]: I urge the Government to adjust MediSave withdrawal limits every year, in line with inflation of healthcare cost. This will benefit many Singaporeans, especially seniors.

Many elderly Singaporeans find the withdrawal limits for outpatient care insufficient. We should encourage people to seek outpatient treatment early before conditions deteriorate and hospitalisation becomes necessary. Hence, setting higher withdrawal limits for older Singaporeans is beneficial.

I hope the Government can consider raising outpatient withdrawal limits and adjust them annually to keep up with healthcare cost inflation.

Preventive Dental Care

Mr Gerald Giam Yean Song (Aljunied): MediSave generally does not cover dental treatments unless they involve surgery and are medically necessary. Non-surgical procedures like extractions, crowns, dentures and braces are not MediSave claimable.

Singaporeans are not seeing their dentist regularly enough. Over 50% of Singaporeans visit a dentist at least once a year. However, 40% of these visits are for reactive treatment rather than preventive care. This means many seek dental care only when they experience pain, often leading to more complex and costly procedures.

I am also concerned about tooth loss among seniors. About 13% of over 60-year-olds are completely toothless. Edentulism impacts the nutrition, social confidence and overall well-being of our seniors.

MOH launched Project Silver Screen in 2018 to provide functional screening, including oral health checks, for seniors aged 60 and above. How effective has this programme been in addressing dental health issues among older Singaporeans? Are there plans to expand or improve on it?

Oral health is an essential part of overall well-being. Yet, it is not included in the Healthier SG programme. Studies have shown that poor dental health is linked to an increased risk of cardiovascular disease and diabetes complications. Preventive dental care should be encouraged to reduce these long-term health risks.

I urge the Ministry to review how dental subsidies are structured, expand MediSave coverage for essential treatments and integrate dental care into Healthier SG.

More public awareness efforts are also needed to ensure that all Singaporeans seek regular checkups instead of waiting for problems to arise. Making dental care more affordable and accessible will improve the well-being of all Singaporeans.

The Chairman: Mr Ang Wei Neng. Take your four cuts together, please.

Dental Services

Mr Ang Wei Neng (West Coast): Many residents share their frustrations, including Nanyang residents, that the orange Community Health Assist Scheme (CHAS) card offers little benefit for private dental treatments while Government dental clinics face months-long waiting times. This leaves many, especially our seniors, struggling to access timely and affordable dental care.

To ease the burden on Government clinics and improve accessibility, I urge MOH to extend subsidies for preventive dental procedures at private clinics. This will not only reduce waiting times but also ensure that more Singaporeans can receive the dental care they need.

However, expanding subsidies raises an important question. Does Singapore have enough dentists to meet the increased demand? If not, what is MOH's plan to grow the pool of dentists?

During one of my Chinese New Year visits, I met an overseas dentistry student. She highlighted that unlike medical students, dental students do not receive pre-employment grants from MOH. With an ageing population and growing demand for dental care, this is a missed opportunity to attract talent back to Singapore.

4.00 pm

I urge MOH to consider offering pre-employment grants to overseas dental students from good universities abroad. This will help us build a strong pipeline of dental professionals to meet our nation's needs and ensure that every Singaporean has access to quality dental care.

Vaping

While we commend the Health Science Authority's (HSA's) efforts to curb vaping, it remains alarmingly widespread. We can see people vaping on our streets, in smoking areas and even in schools. A key issue is the dangerous misconception that vaping is "cool" or less harmful than smoking.

To address this, I urge MOH to collaborate closely with the Ministry of Home Affairs (MHA), including the Police and Central Narcotics Bureau (CNB), to tighten controls on illegal imports of vaping products and enforce stricter penalties against offenders. Let us act decisively to protect our youth and public health.

Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is widely accepted in Singapore, but remains outside our mainstream healthcare system. For example, TCM medical certificates (MCs) are not recognised by most employers, including the Civil Service. It is time to rethink TCM's role and take bold steps to integrate TCM more effectively in our healthcare system.

Firstly, we need to build a strong pipeline of TCM physicians to meet growing demand. This requires attracting and nurturing talent through scholarships, training programmes and career development opportunities.

Secondly, we must ensure high standards of practice. The TCM Practitioners Board could require physicians to treat a minimum number of patients monthly and attend periodic refresher courses. This will keep them updated on advancements in TCM and maintain quality care.

Thirdly, we should recognise senior TCM physicians for their expertise. MOH and the TCM Practitioners Board could establish a framework to certify experienced practitioners, granting them higher status and potentially integrating them into the Healthier SG initiative. This recognition could pave the way for employers to accept MCs issued by these senior TCM physicians.

By enhancing TCM's credibility and integration, we can boost public confidence and strengthen TCM's role in Singapore's healthcare system. Let us take these steps to ensure TCM is not just accepted but valued as a vital part of our healthcare ecosystem.

Psychological Services

I was part of the second batch of psychology students at the National University of Singapore (NUS) when the programme started in 1986. Since then, NUS has produced many esteemed psychologists who serve critical roles in MHA, MOH, the Ministry of Education (MOE), the Ministry of Defence (MINDEF) and the private sector. During my time in the Singapore Police Force, I helped establish the Police Psychology Unit, which has since evolved into the Home Team Psychology Division, employing numerous psychologists.

Today, psychologists play a vital role in mental health – a field that is gaining increasing national attention. However, as in any profession, there are both competent and less competent practitioners. Worse, platforms like Carousell are flooded with posts claiming to provide clinical psychological counselling, many of which may not be authentic, as widely reported in the press.

This is deeply concerning. Vulnerable individuals seeking help deserve to be protected from unqualified practitioners. So, to ensure high standards of professionalism and safeguards, it is time for MOH to regulate the psychology profession. Let us act now to protect those in need and uphold the integrity of this very critical field.

The Chairman: Ms He Ting Ru, you can take your three cuts together.

Regulating Mental Health Providers

Ms He Ting Ru (Sengkang): Madam, calls to regulate mental health providers are not new and I recently did so in early 2024. Such professionals include psychologists, therapists and counsellors, the roles and work of whom many lay people struggle to grasp. Concerns that the shortage of professionals will be exacerbated by introducing regulation have to be balanced against the real potential harm to already vulnerable clients seeking support from inadequately trained individuals purporting to provide therapy and the like. Just last week, worrying reports, emerged about unqualified individuals offering counselling services on platforms like Carousell.

Regulating this area also means that clients seeking help know that a professional has met a baseline level of training and understanding of the often-challenging ethical concerns that arise. It is also a first step for our existing financial health for healthcare financing to be used to expand access to such services. I, therefore, hope that the Ministry will develop a long-term plan to regulate the industry, taking into account the views of professional bodies while keeping an eye to make sure that barriers to entry are not overtly high.

A key part of this is to work with training providers and to increase the supply of qualified professionals to ensure that Singaporeans' mental health needs are adequately and safely met.

Improving Mental Health Tracking and Outcomes

The National Mental Health Office has committed to tracking indicators measuring access to mental healthcare, such as medium treatment delay for common mental disorders. While access is important, the quality of mental healthcare services has to be ensured. A United Kingdom (UK) study of nearly 40,000 patients from 2010 to 2013 found that an above-average therapist can achieve a recovery rate of above 80% over 16 sessions, instead of close to 0% for a below-average therapist. The UK has also set a recovery rate target of 50% for all mental health services. Having real-time data about the efficacy of our mental health services allows both practitioners to recognise how they are performing and will inform the Government when developing a plan that includes standards on service quality.

I have two areas of clarification for the Minister. First, how will the National Mental Health Office track indicators relating to the quality of mental care, which should include recovery rates and deterioration rates? Will the office also set minimum standards of quality across the services outlined under the tiered care model? Second, can the data be readily made available in order for practitioners to use it to identify areas of strength, concern and ultimately, provide service quality.

Precision Medicine

Cutting-edge research and development (R&D) in the medical and health sciences appears to show great promise. Of these, developments in precision medicine has shown up the potential to, in the words of the Singapore National precision medicine strategy, benefit groups and individuals through early detection, refined diagnosis and tailored treatment.

We have had announcements, such as the introduction of the Helix platform, to consolidate healthcare data and the SG100K initiative launched to log the blueprint of 100,000 participants through time, specifically, with the aim of understanding interactions of the genome within the Asian context. These are welcome, but one area that warrants attention is how gender affects health and illness. This goes beyond our obstetrics and gynaecological conditions. I brought this up in this House previously, how researchers now know that the same condition can present differently in men and women.

As a Time magazine article notes, women are not just smaller men. And while progress has been made, there is still a long way to go. Apart from reacting differently to medication and vaccines, there remains significant gaps in areas, such as autoimmune disorders, which affect women more; and also mental health, where, for example, women are more likely to suffer from post-traumatic stress disorder, but most pre-clinical studies on treatment were done on men.

I would, thus, like to seek an update from the Minister about whether and how our efforts in personalised medicine will also cater to these gender gaps in medical research and treatment.

Additionally, for precision medicine to fulfil its promise, it must go beyond collecting and analysing data to deliver real, tangible benefits to patients, and possibly even be used as tools to tackle concerns about ageing demographics and increasing care costs. A data-driven approach is valuable, but it should serve as an enabler, not an end-point.

While we move towards turning research into more effective treatments with fewer side effects, such as precision gene therapies, these treatments remain expensive, raising concerns about inaccessibility, which would only accelerate as the field advances. Aside from increasing inclusivity in research, our health systems need to cater to the risks of inadvertently leading to greater disparities.

I would, thus, like to seek clarification from the Minister about the plans to ensure that advances in precision medicine translate into real benefits for those who need them most. Singapore has the potential to make great strides and lead in precision medicine. But leadership is measured not by infrastructure alone, but participating in global research, increasing our ability to develop and test new treatments and most importantly, ensuring that the accessibility of these advancements are available to all Singaporeans. We have to move beyond data collection to implementation, working to make the promise of precision medicine a reality for patients.

The Chairman: Dr Wan Rizal, you can take your two cuts together.

Our Mental Health Ecosystem

Dr Wan Rizal (Jalan Besar): Madam, mental health has been a key focus throughout my time in Parliament. In my first Adjournment Motion in 2020, I introduced the LAST framework: Literacy, Accessibility, Screening and Time-out. I am glad that these four areas are continually addressed. Awareness has grown and more people recognise the importance of mental well-being.

However, many who know still hesitate to seek help when they need it. They worry about stigma, who to see or whether their struggles are serious enough to warrant an intervention. There is still much to do. Therefore, we need to strengthen our mental health ecosystem. One that is accessible, professional and safe; one that help seekers not struggle with long wait-times or uncertainty about who and where to go to.

With this in mind, I seek MOH's response on several key areas. The National Mental Health and Wellbeing Strategy and National Mental Health Office were launched to improve coordination and access to mental health services. How have the reception and adoption of the strategy been so far and what initiatives has the Office undertaken, and what can we expect from the Office moving forward?

Madam, mental health support must move into spaces where the people are already there, in community spaces or in youth hubs where the youths are there or even sports facilities. Could more of these spaces be leveraged to provide timely, accessible support? Another space to consider is, of course, the digital space, but such support must be human-led.

Oftentimes, I hear help-seekers saying they turn to recorded messages or AI chatbots. Certainly, we can do better. How is MOH ensuring that the digital space outlet remains one that provides real professional human support?

Madam, with the growing demands for mental health services, how is MOH ensuring that individuals receive help from qualified professionals, not unregulated providers or even those from Carousell?

We need to distinguish between psychologists and private counsellors and start considering formal regulations for psychologists and strict consumer protection measures for private counselling services. Could MOH share its stance on this and what are we going to do moving forward?

Madam, our youths face barriers with seeking help due to parental consent requirements. Could structured guidance be developed to support both parents and youths in navigating this process. When youths are in crisis, they could end up in Emergency Departments, which are not the best environment for them. Could we explore alternative crisis response spaces designed specifically for youths?

A growing demand for these services simply means that we need a well-trained workforce. Could MOH provide updates on efforts to boost training capacity, particularly through the National Competency Framework and psychological first aid for frontline responders?

A workplace can either be a source of stress or pillar of support. Some companies have made strikes in supporting employee well-being, but workplace mental health efforts must go beyond talks and campaigns. How can we embed mental health support more deeply into workplaces' policies, whether through structured accommodation, supervisor training or through pathways for employers for mental health-related absences?

Madam, I have mentioned about religiosity in mental health support and I ask whether we could provide structured training for them as they engage their congregants. Could there be clear referral pathways to link religious organisations with professional mental health services?

Children's Health and Well-being

Madam, children's mental health and well-being is about giving them the best possible start in life, ensuring they grow up healthy, resilient and supported. What happens in childhood shapes lifelong health, including mental well-being. Therefore, we must ensure that the right support structures are in place at home and in the community to help children thrive.

Could MOH provide updates on efforts to expand preventative health measures and nutritional support for children? Could MOH provide an update on efforts to strengthen early intervention for children's mental health? And how are Healthier SG initiatives being extended to support early childhood mental wellness?

Madam, screens have been perceived as a central part of childhood, which I totally disagree. Unhealthy digital habits can impact mental well-being and physical health as well. How is MOH working to strengthen digital wellness efforts, particularly through resources, like the Parenting for Wellness Toolkit?

Madam, investing in our children's health today means a stronger, healthier Singapore tomorrow. Such efforts in mental, digital and physical well-being will ensure that every child grows up with the right foundation for lifelong health. I look forward to MOH's update on these critical areas.

4.15 pm

Grow Well SG

Mr Neil Parekh Nimil Rajnikant (Nominated Member): Mdm Chair, the Grow Well SG, a new national health promotion strategy to enhance preventive care and inculcate healthy lifestyles in children and adolescents is a very welcomed, move as we celebrate SG60.

The strategy aims to help our children eat well, sleep well, learn well, exercise well and to bond well to support and reinforce healthy lifestyles through purposeful screen use, a Health Plan for every child and enhanced support for schools. Grow Well SG will work hand-in-hand with families, educators, healthcare professionals and community partners to create supportive environments where our children can thrive and sustain healthy living habits.

While the updated guidelines are very helpful, many families require practical tools to integrate good lifestyle habits, especially around digital usage, into busy routines.

I have two questions for the Minister for Health. First, can MOH share what has been the receptiveness of Grow Well SG thus far? What is MOH’s target reach for the whole of 2025 for a start? Second, can MOH share how Grow Well SG will be further reinforced with families, particularly in terms of practical resources and tools? And would these resources be made easily accessible for those who want to refer to them?

Affordable and Accessible Mental Health

Mr Yip Hon Weng: Chairman, mental health is critical for a thriving society. During last year’s Motion on Advancing Mental Health, I highlighted the need to address seniors’ and caregivers’ well-being, particularly social isolation, loneliness and dementia. I also called for better insurance coverage and subsidies, and welcome the assurance of up to 80% subsidies at public institutions and ongoing efforts to expand public healthcare capacity. However, subsidised options often involve longer waits, while private therapy costs remains a barrier. How can we ensure affordable support is readily available?

Community Outreach Team (CREST) teams play a vital role in early intervention. With over 70 teams island-wide, how can we expand their reach and public awareness?

Finally, how is the Ministry measuring progress in mental healthcare? Tracking accessibility, early detection and long-term well-being is essential.

The Chairman: Mr Keith Chua, please take your two cuts together.

Improving Suicide Prevention/ Postvention

Mr Keith Chua (Nominated Member): Madam, suicide prevention requires a whole-of-society approach, given that not everyone who presents with suicidal behaviours has a mental health condition.

The working group for Project Hayat presented its recommendations for a national suicide prevention strategy, per the S.A.V.E. L.I.V.E.S. framework to the Government. Madam, I am a member of the Working Group and Board member of the Singapore Anglican Community Services and Caring for Life. In his response to Project Hayat, the Minister for Health agrees we can do more in areas like research, the use of AI technology and means-restriction.

I would like to ask the Minister the following questions, please.

How will the National Mental Health Office work in the area of suicide prevention? Will the National Mental Health Office establish KPIs specific to seeing a reduction in the number of suicides? Will the National Mental Health Office take the lead in further policy-making across various Ministries and agencies, such as setting up a national suicide prevention framework? Will the office consider going beyond the current framework centred on clinical services and mental health interventions outlined under the Tiered Care Model, and put in place systemic interventions targeted at suicide prevention? For example, ensuring there is a holistic strategy addressing societal pressures and taking into account protective factors at each life stage from children to teenagers, to young adults and to the elderly?

Lastly, how will the Office ensure adequate postvention support for individuals and families, that is, care provided following a suicide attempt? Countries with comprehensive postvention support, such as England and South Korea, find that the continuity of care for suicide survivors and those close to them are essential to preventing further suicide attempts.

Support for Mental Well-being

In last year's COS debate, the Ministry of Culture, Community and Youth updated that there were 12 Well-Being Circles as part of the SG Mental Well-Being Network and more than 3,000 people have been supported. These initiatives are designed to help prevent the development of mental health conditions for all Singaporeans as part of the Tiered Care Model.

In the White Paper I mentioned earlier proposing a national strategy for suicide prevention, one key recommendation is to involve families and communities in such efforts. This includes strengthening collaborations with religious and community leaders, and the continuity of care for suicide survivors as well as families, friends and communities affected by suicide.

May I ask the following? How does the Ministry measure the efficacy of community mental health efforts, such as the Well-Being Circles and peer support circles? Will the Ministry ensure that every Singaporean has access to such community initiatives? And thirdly, Will the Ministry plan to leverage such community initiatives to ensure the continuity of care for suicide survivors and others affected by suicide?

Mental Health First Aid Resources

Mr Ong Hua Han (Nominated Member): Mdm Chair, we all know the importance of first aid in medical emergencies. But not many know about its mental health equivalent, Mental Health First Aid, which trains people to support those in distress or facing a mental health crisis. While there are increasingly more courses available online, access to Mental Health First Aid remains limited.

In Singapore, we are familiar with apps that facilitate emergency first aid response. Take, for example, the myResponder app by the Singapore Civil Defence Force, with over 210,000 registered community first responders. Their focus remains largely on physical health emergencies. But what about mental health?

Mental health emergencies can also happen anywhere and to anyone. In those critical moments, the ability to respond quickly and appropriately is just as important. Yet, no widely recognised platform exists to guide people through a mental health crisis. This is a missing piece in our response framework, but we do not need to start from scratch.

Integrating mental health first aid into existing emergency response apps is a practical solution with manifold benefits.

First, destigmatisation. Mental health is health and this ensures it is treated as equally important as physical health.

Second, increased accessibility and awareness. A widely-used platform increases the availability of mental health resources, reaching even those who have never encountered or attended formal training.

Third, timely intervention. With step-by-step guidance readily available, users will be able to identify signs of distress and respond before a crisis escalates.

Fourth, emergency contacts at your fingertips. Just as we know to call 995 for medical emergencies, mental health helplines should be easily accessible through the app, to connect users to professional help immediately.

Madam, awareness is also key. Collaboration with mental health organisations and other health apps can gradually expose more people to mental health first aid. Social media campaigns can also help to promote this in creative ways. For example, Tampines Fire Station has been making viral Instagram videos for a while now, and they are quite funny. Perhaps, we could leverage on their expertise and do the same for mental health first aid.

Lastly, such apps need to be regularly updated with the latest information and resources to keep the platform fresh and relevant.

Maternity Fees for Mothers of Singapore Citizens

Ms Sylvia Lim (Aljunied): Madam, Singapore's total fertility rate stands at 0.97, yet delivery costs vary widely by maternal nationality.

Foreign mothers married to Singaporean fathers whose children will be Singaporean by birth, face significantly higher expenses. At KK Women's and Children's Hospital, a normal delivery in a C class ward cost Singaporean mothers $1,390, which is fully MediSave covered. Permanent Residents (PRs) pay $2,870, with most of it MediSave claimable and $120 being payable in cash. Non-resident mothers must pay more than $8,000, claiming less than $3,000 from MediSave and paying about $5,300 in cash.

The gap widens for Caesarean deliveries. Singaporeans pay about $2,270, fully MediSave covered. PRs pay nearly $5,000, of which $410 must be paid in cash, and non-Residents pay nearly $12,000, with about $7,300 in cash. Many C-sections are unplanned emergencies, compounding financial stress.

Given Singapore's low fertility rate, it seems counterproductive to impose such steep delivery fees on families whose children are Singaporeans from birth. Indeed, these costs send the wrong signals that Singaporean children are not welcome if their mothers are foreign.

This burden is heavier for citizen father, foreign mother families. The 2019 SG LEED study found that these families have the lowest per capita income at about $1,700 compared to citizen couples at about $2,600 and citizen mother, foreign father families at $3,100.

Furthermore, 17% of foreign mothers with Singaporean children still held a Long-Term Visit Pass (LTVP), despite being married for an average of eight years. The Government's stance, as indicated in November, is that foreign spouses who do not qualify for PR can apply for LTVP or LTVP+, showing no defined pathway to permanent residency.

Madam, I request MOH to review the cost differentials for these foreign mothers of Singaporean children.

The Chairman: Ms Mariam Jaafar, please take your three cuts together.

Healthcare Costs

Ms Mariam Jaafar (Sembawang): Madam, I declare my interest as managing director and senior partner of a management consulting firm that does work in the healthcare space.

We are all aware of the pressures that rising healthcare costs place on our families, the healthcare system and Government finances. An ageing population, coupled with medical advancements and the increasing complexity of care, managing healthcare spend is exceedingly challenging, and healthcare may soon become the largest Government expenditure.

First, let me say that we have done very well in achieving a high-quality healthcare system, one that is admired worldwide. The 3Ms form the bedrock of the healthcare financing model, where which we have continued to evolve the system to deliver world-class care, without compromising affordability or sustainability.

The roll out of Healthier SG is a key pillar. Another key pillar is the shift to deliver more care at the community level – community hospitals, polyclinics and intermediate and long-term care facilities. Value-based care, integrated care models, technology and digital healthcare solutions and procurement reform efforts are also inflight to reduce costs. Enhancements to MediSave and MediShield Life, have also been made and will no doubt continue to be refined, to reduce the financial burden on both individuals and the Government.

While we have reason to hope that these efforts will help to bend the cost curve in the long run, it is also important to achieve costs efficiencies in the short term. What level of shorter-term cost efficiencies have been achieved from current efforts? What are we doing to ensure that healthcare remains accessible, affordable and sustainable for all Singaporeans?

Public-private Share and Healthcare Costs

The share of public healthcare versus private has been growing over the years, with the Government’s increased investments in healthcare. Public healthcare institutions now provide a broader range of services, from primary care to highly specialised treatments and indeed, some of the top doctors in certain specialisations are found not in the private hospitals, but in our public hospitals. Our public hospitals do also take in private patients.

It raises the question. What is the optimal public-private mix that best serves the needs of our people and keeps healthcare costs sustainable?

Madam, this optimal mix has several considerations, including access and affordability, financial sustainability, quality and equity. For example, allowing public hospitals to take on private patients should not come at the expense of long waiting times for subsidised patients, which could in turn lead to pressure to build more hospitals, putting a strain on state coffers. Ancillary services too, something as simple as meals, must not drive up costs for the masses. We must continue to monitor how public and private sectors impact overall healthcare expenditure. At the same time, as we saw during COVID-19, and also with the integration of GPs in Healthier SG, greater collaboration between the public and private sector can help streamline patient care and make the best use of resources. Healthy competition between the private and public sector also drives innovation and patient outcomes.

Madam, the public sector must continue to be the cornerstone of our healthcare system, but the private sector’s role cannot be denied. Does the Ministry have a view on the evolution of the public-private mix going forward? And how will the Ministry ensure that both sectors work together to continue to provide accessible, affordable and sustainable healthcare for every Singaporean?

Closing Gaps in Mental and Physical Health

Mental health and physical health go together. We have made significant strides in how we address mental health in the last few years. Yet, there remain gaps in the level of attention, resources and recognition that mental health has received versus physical health, whether it is in terms of access to care, societal attitudes and in the way mental and physical health services are integrated.

First, the access gap. Wait times for mental health services remain long. I have had many residents and mental health professionals tell me that even urgent cases can face delays in securing appointments. And while MediSave and MediShield Life now help with hospitalisations and chronic diseases, outpatient mental health consultations and therapy sessions remain quite costly. Last year, we heard that the Government is expanding mental health services, including in the polyclinic and primary care setting, as well as in the community. I urge the Government to expand and accelerate this further.

Second, the gap in the Healthier SG framework. Mental health is yet to be integrated in Healthier SG. This is needed if we are to promote a truly holistic well-being approach. Our GPs and family doctors need to be equipped to diagnose and manage common mental health conditions. We should have mental health screenings in Healthier SG checks and more resources and incentives for mental wellness programmes in the community.

A related gap is the integration of mental health and physical health in integrated care teams. Doctors, psychologists, social workers and allied health professionals must work together to provide holistic treatment for patients with both mental and physical health needs.

The Chairman: Please round up, Ms Mariam Jaafar.

Ms Mariam Jaafar: Yes, Madam. Our physical healthcare system is truly world class, our mental health system must match that standard. What steps is the Government taking to close these gaps?

4.30 pm

The Chairman: Dr Lim Wee Kiak, please take your three cuts together.

Affordable Healthcare for All

Dr Lim Wee Kiak (Sembawang): Chairman, I declare my interest as an ophthalmologist in private practice. We all know the Government has given its commitment to keep healthcare costs affordable, as to make healthcare available to everyone. It has rightly set up the three pillars of our healthcare financing system, namely, MediSave, MediShield and MediFund (3Ms).

Indeed, many Singaporeans are benefiting from the 3Ms. However, we still occasionally encounter residents who have sufficient MediSave, but are cash poor, lamenting why can they not be allowed to use more of their MediSave to pay for their medical bills.

Over the last few years, with advances in medical care, improvement in drug efficacy, higher staff costs, higher clinic rentals, these have all pushed up the healthcare costs in Singapore. We have moved from branded drugs to generic drugs, among others, to help to mitigate the costs.

The knock-on effect is seen in the cost of healthcare insurance, where premiums grew by 13.7% in 2022 and in 2024 by 12% – a double digit growth over the years. It is projected to grow by another 12% this year, according to the Willis Towers Watson survey.

While it appears to be in a stable trend, but it gives little comfort to Singaporeans, young and old alike. There are young employees who only after a hospitalisation, find that they have expanded their healthcare coverage for the year. Their company had bought a policy is at the lower range because of high premiums.

There are certainly lessons we can learn looking at other countries, such as in the UK's National Health Service, where the problems they are facing are somewhat similar up to a point – staff shortages, evolving healthcare needs, ageing population. How can we learn from other's predicament and avoid getting into the same situation?

Can the Minister share with the House what is the current medical inflation rate? Will MOH carry out a review of the 3Ms system and see how they can further enhance the system to help Singaporeans? The 3Ms work well currently, but how can it meet our future needs?

[Mr Speaker in the Chair]

Can MOH also help young Singaporeans, who have not only bear healthcare costs for their families, but also of their aged parents? What can the Government do to help to slow down medical inflation and lower the out-of-pocket expenses of Singaporeans?

Smart Healthcare System

With rapid advances in technology, especially in AI – these are certainly making in-roads across all professions and the medical profession is no exception. How it is adopted may not be as simple as substituting the search engine on your computer.

In healthcare setting, we are dealing with a human life. Medical practitioners know that building trust with patients can be a slow and painstaking task. You need to listen attentively, show empathy and understanding, and ask the right questions respectfully, among a whole host of others, including your body language. These are areas that AI will not be able to substitute for the human touch.

Thus far, much of our AI has been in the areas for administration, from registration, to other data collection and information systems. There are robotics, which are certainly already in used in several medical procedures with good outcomes, and others in the area of data analytics.

And if I may quote a paper that was published in 2023 on the web of the SMA by Assoc Prof Tan Cher Heng as well as Prof Benjamin Seet, both from Lee Kong Chian School of Medicine: "An important guiding principle is that the patient should remain at the centre stage. While most app developers and code writers have claimed that their solutions will change clinical practice, we need an evidence-based approach to systematically evaluate the costs and benefits of adopting any such technology. The clinical demand and utility have to be clear, so that we do not end up with a 'technology push' seeking new applications and solutions."

MOH has said it is partnering the Health Promotion Board (HPB), Synapxe, the public healthcare clusters and national clinical translational programmes, to leverage on cutting-edge technology while maintaining public trust in and security of the Singapore healthcare system.

Apart from these, can MOH share what else is the Government currently looking to apply these technologies, including AI, to address various issues facing the medical services, from shortage of manpower, to improving treatment outcomes for patients, and to mitigate the high cost of medical care? Is there a need to relook at the legal responsibilities of the medical professionals in the application of these technologies, especially in AI, in patient care?

Healthy Longevity

When 64-year-old American Dan Buettner, author and longevity researcher co-produced the three-time Emmy Award winning documentary TV mini-series "Live to 100: Secrets of the Blue Zones" in 2023 on Netflix, it certainly has created a stir among all those who are interested in looking at longevity. Buettner identified five original Blue Zones areas, these are areas where people lived the longest and the healthiest, including in Japan, Italy, as well as Costa Rica, Greece and California.

Then in 2024, the spotlight fell on Singapore when it was the first new region to be added to the Blue Zones in decades, dubbed as "Blue Zone 2.0" by Buettner. A noteworthy point was that our city-state is not in the same genre as the other Blue Zones. Unlike the other Blue Zone communities like those in Greece, in Japan, in Costa Rica, which were based on long-established cultural traditions, for Singapore, our longevity is more of an outcome of forward-thinking policies.

If we look at our achievement on longevity, it is more than just healthcare. We have policies like public transport, which encourages commuters to walk daily as an exercise. We do put emphasis on keeping our country clean and build beautiful parks, jogging tracks as well as exercise parks to get everybody to enjoy the outdoors around our neighbourhoods. Public places like these are well-lit, residents get a sense of security and calm when they frequent these areas. Swimming pools, open fields for soccer, these are found in all Housing and Development Board (HDB) estates and there is creatively curated greenery everywhere.

In December 2024, BBC noted: "few places have seen such a drastic jump in life expectancy as the island city-state in Southeast Asia". It went on to report if a child that is born in Singapore before 1960 was only likely to live up to, at that point in time, to 65. However, a child that is born in Singapore today can enjoy a life expectancy of more than 86 years old or more, according to estimates. Not only that, the number of centenarians in Singapore has doubled from 2010 to 2020. And all these leaps in longevity "is largely driven by intentional government policy and investment."

The point I want to make here is that given that we have one of the longest lifespans in the world now, and there is a correlation with an ageing population and chronic diseases, are there plans to explore and develop the emerging fields of regenerative medicine and healthy longevity?

I believe there is great potential in this field for medical tourism as well as for our medical advances, because of the strong international interest of living well and living longer lives. With Singapore's reputation as a Blue Zone 2.0, together with our excellent healthcare infrastructure and medical talent, Singapore certainly has all the pre-requisites to establish healthy longevity, regenerative medicine as a field of excellence over here. Would MOH consider setting up a sandbox looking at how can we explore healthy longevity, regenerative medicine for further development?

The Chairman: Minister Ong Ye Kung.

The Minister for Health (Mr Ong Ye Kung): Mr Chairman, the most active exchange during this Budget debate has been over fiscal policies – saving as a nation or budget marksmanship, temporary vouchers versus structural support, increasing the Goods and Services Tax (GST) earlier or later. As Health Minister, I feel that I have a duty to somewhat weigh in.

Chairman, in the course of my speech, may I display a few slides on the LCD screens please?

The Chairman: Yes, go ahead. [Slides were shown to hon Members.]

Mr Ong Ye Kung: Thank you. When I first joined this Chamber 10 years ago, in 2015, the Government's annual health budget was about $9 billion. I was then-Minister for Education; my Ministry was in second place, at $12 billion. The Ministry of Health (MOH) was very far behind at $9 billion.

This year's healthcare budget is $21 billion, moved to second behind the Ministry of Defence (MINDEF). By 2030, it is estimated to be over $30 billion – at least another $10 billion increase. In comparison, a two-percentage point increase in GST gives us about $5 billion more in revenue today.

We need the additional GST revenue, paid for mostly by those who are better off, foreigners and tourists, to continue to support universal and affordable healthcare for Singaporeans. The support given in healthcare is practically all structural, instead of vouchers.

We can argue about the perfect timing for raising tax revenues. However, if we do not raise the revenue in time while the population ages and healthcare expenditure escalates, we will not be debating budget marksmanship then. There will not even be a balanced Budget target board to aim for, as our fiscal position will be deep in the red.

That said, we cannot let the healthcare expenditure curve escalate uncontrollably. It is a bill all of us, ultimately, have to pay, as taxpayers, as patients or as insurance policy holders. But it is very difficult to rein in escalating healthcare expenditure, especially when it is a matter of life and death for ourselves or for our loved ones.

Further, all round the world, people have high expectations of the public healthcare system. Our three biggest wishes are for healthcare to be available when we need it, of high quality and affordable. I have spoken about these objectives in earlier COS speeches, but let me talk about our plans in the coming few years, for each of these objectives.

First, affordability amidst rising costs and inflation. Dr Lim Wee Kiak, Mr Yip Hon Weng, Ms Mariam Jaafar and Ms Hazel Poa asked about this. We therefore have the S+3Ms framework – Government Subsidies, MediShield Life, MediSave and MediFund – to cushion patients from healthcare cost increases.

Today, seven in 10 patients in subsidised hospital wards pay nothing out-of-pocket, zero; while eight in 10 pay less than $100. We constantly review and enhance the S+3Ms framework, to adapt to emerging clinical practices and also, new circumstances.

Last year, we updated the income thresholds to allow up to 1.1 million Singapore residents to qualify for higher subsidies. A few months ago, we announced significant adjustments to MediShield Life, to better protect Singaporeans against major hospitalisation episodes, and then defray costly outpatient treatments like dialysis. Most recently, we announced subsidies and MediSave withdrawals for vaccinations against Shingles.

Today, I will talk about further adjustments that we are making. One, I start with MediSave withdrawal limits for outpatient scans. Over the years, Magnetic Resonance Imaging (MRI) and Computed Tomograph (CT) scans have become more commonly used for diagnosis of certain conditions, such as cancer, as they are more detailed and accurate than X-rays. But they are also more costly. To ensure these remain affordable, we will double the MediSave withdrawal limit for such outpatient scans, from $300 to $600 per year, starting in 2026.

Next is Flexi-MediSave. A few Members of Parliament (MPs) have asked about this. This scheme provides seniors aged 60 and above the flexibility to use their MediSave for outpatient treatments at polyclinics, public Specialist Outpatient Clinics, as well as Community Health Assist Scheme (CHAS) clinics. This limit was last raised in 2021, from $200 to $300. Since then, outpatient medical needs have grown further. We will therefore increase the withdrawal limit to $400 per year, from the fourth quarter of 2025.

Dental health is another area where affordability is becoming a concern. Several MPs have raised this and asked if oral health can be part of Healthier SG. Actually, preventive dental care predates Healthier SG. All of us remember in primary school, the dreaded moment the dental nurse comes in and calls your name, that was preventive care, long ago. There has been a longstanding collaboration between the MOE schools and MOH to protect the teeth of the young. However, in adulthood, oral health deteriorates.

Generally, a person needs at least 20 natural teeth to chew effectively. Unfortunately, only about half of our older population have them. We will take further steps, therefore, to encourage preventive oral care and hopefully, preserve more teeth.

Currently, only Pioneer Generation, Merdeka Generation and CHAS Blue cardholders enjoy subsidies at private dental clinics for preventive procedures, such as scaling, polishing and filling. We will extend subsidies for these dental procedures to CHAS Orange cardholders.

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I have met many residents, and these includes my own Citizens’ Consultative Committee Chairmen, who suffered from tooth decay and then decided to extract their tooth. I asked them, "Why don't you save the tooth?" It can be done via a root canal procedure, which is quite common now. This means the dentist will remove the decayed parts of the tooth, including the nerves in the roots of the tooth, and then fill it up, and then cap it with a protective artificial crown. The tooth is, therefore, saved. It adds to your 20 teeth; 20 teeth include those that you save.

They said no, because extraction was cheaper and it involves fewer trips to the dentist. But this is penny-wise and pound-foolish. We will have fewer and fewer teeth as we grow old if we take this approach. This diminishes our ability to chew effectively and in our old age, affects our nutritional intake.

We will, therefore, increase the CHAS dental subsidy limits for restorative procedures, such as root canal, for Pioneer and Merdeka Generation as well as CHAS Blue and Orange cardholders. We will also allow Flexi-MediSave to be used for costlier treatments like root canals and permanent crowns at CHAS dental clinics and public healthcare institutions.

The next slide shows the net impact for a typical Merdeka Generation cardholder, someone with a tooth decay but decides to save it. For this senior, a molar root canal after subsidy costs about $700 at a CHAS clinic, that is the leftmost column, which he must pay by cash today. After the subsidy enhancement, the out-of-pocket payment will be about halved, to $370. He can also use up to $400 in Flexi-MediSave, so there may not be any cash payment required, and that is the rightmost column.

When subsidy goes up, we must prevent some providers from raising prices sharply and creaming off the subsidy. We will, therefore, have to strengthen governance to prevent abuse, by introducing fee benchmarks for common dental procedures. So, MOH will follow up with this. Both the enhancements and fee benchmarks will be implemented around the fourth quarter of 2025. Use of Flexi-MediSave will be effective sometime in the middle of 2026.

The final area is long-term care services. The Prime Minister mentioned this in the Budget Statement, so let me elaborate.

Long-term care is for seniors who have become frail, disabled and dependent on others to carry out daily activities, such as eating, showering or changing. They are cared for in two main settings; one is nursing homes, or, at home, with support from community and home care services.

Mr Xie Yao Quan asked if there could be fee caps for these services. In fact, both services today are heavily subsidised by the Government, with co-payment by users. With an ageing population, our annual national long-term care operating expenditure has almost doubled over the last five years, from $1.7 billion to about $3 billion today, and it continues to rise. This is because as one gets older, our care needs intensify.

There is also considerable upward pressure on fees. This is mainly driven by manpower costs, especially post-COVID, where salaries of healthcare workers globally were reset to a much higher level.

To ensure affordability, MOH has been increasing funding to support nursing home providers, while also quietly imposing caps on fee increases for existing residents. We did not announce this but, quietly, we have been doing that to keep fees low. So, nursing home providers also absorb part of the higher costs for these existing residents.

As for seniors newly admitted to nursing homes over roughly the past one year, they have been paying higher fees and this can be a financial burden to their families. This arrangement is not sustainable. It is also not fair to the providers, most of which are charities. It is time for us to improve our subsidy framework and significantly expand our structural support for seniors and their families.

The next slide illustrates the changes we are making. The left side is nursing homes, the right chart is for home and community care subsidies. The X-axis on each slide is the per capita household income bands, while the Y-axis is the subsidy percentages. The white boxes show the current subsidy percentages, the blue and orange boxes are the additional subsidies. So, you see everything moving up.

In short, we will, as indicated in blue, increase subsidies by five to 15 percentage points for almost all eligible households; expand eligibility for maximum subsidy of 75% to 80% from about two in 10 to about three in 10 households. So, you see the leftmost two columns of each chart are now of the same height. So, the maximum subsidy is now expanded to a larger group.

Provide additional subsidies of five to 15 percentage points, as indicated in orange, for those born in or before 1969 as seniors in these cohorts are not well covered by MediShield Life; and expand eligibility to cover from six in 10 today to about seven in 10 households, so more can benefit. [Please refer to the clarification later in the debate.]

The increases in subsidies will be effective from July 2026. It is more than a year from now. So, between now and then, we will provide interim rebates, which will keep the fees low for Singaporeans using long-term care services. Similar enhancements will apply to community dialysis services too.

We will also increase the Home Caregiving Grant and expand the coverage of the Seniors’ Mobility and Enabling Fund, as announced by the Prime Minister in the Budget Statement. The enhancements for these schemes will be implemented progressively from January 2026.

With these enhancements, over 80% of seniors, especially those being cared for at home, will pay less for their long-term care services. Let me illustrate with three examples.

Example one is a lower-income family supporting a moderately disabled grandpa receiving home and community care. They pay about $600 a month today. In 2025, the interim rebates kick in, and their out-of-pocket payment will drop to about $500. In 2026, when the full enhancements are implemented, it will drop to $200. Thereafter, fees will continue to rise in tandem with inflation and income.

Example two is a lower-income family who recently admitted their severely disabled grandma to a nursing home. The monthly out-of-pocket payment now is about $1,300. In 2025, when the rebates kick in, this will decrease to $1,150. In mid-2026, when the full enhancements are implemented, payments will further drop to about $1,000.

Example three is a disabled grandma from a lower-income family who has been staying in nursing homes for a few years now. Instead of $1,300 a month, today they pay a discounted amount of about $900, because MOH caps their fee increases. The upcoming enhancements will formalise this temporary arrangement.

We will continue working closely with providers to manage the fees that families have to pay, which should not change much this year. Over time, their fees should rise gradually in tandem with inflation and income. The entire package of long-term care enhancements will benefit more than 80,000 seniors, who can expect to receive support of up to $2.1 billion, from 2025 to 2030.

Chair, let me move to the second objective of public healthcare, which is to ensure availability. Post-COVID-19, like many countries in the world, we saw many more seniors with complex conditions. A couple of years of isolation and neglect of chronic conditions have taken their toll. The average length of stay in hospitals jumped abruptly from six days to seven days post-pandemic. Sounds like one day, but it means a 15% increase in workload for hospitals. Worse still, COVID-19 delayed our infrastructure development.

We have been doing major catch-up in infrastructure development. Expanding capacity, however, does not mean just building hospitals. We need smart capacity, across a spectrum of care needs and, especially, in the community. Only then will we be able to give the most appropriate care for different types of patients.

Over the past five years, we have expanded capacity by over 6,300 beds, as shown on the slide. This includes 1,200 acute hospital beds with the opening of Woodlands Health and across other hospitals. This is the part in white. We rolled out Mobile Inpatient Care@Home and commissioned 200 beds. We opened new community hospitals and added 600 new beds and we also added 4,300 nursing home beds. And adding nursing home beds is a major move, because if a senior cannot find a nursing home bed, they will end up in the hospital.

This capacity makes a huge difference. With Woodlands Health, the capacity crunch at Khoo Teck Puat Hospital has finally eased after many years. Bed occupancy has fallen from the typical 100% or more to now a healthier 85%. Average waiting times have thus fallen.

Recently, the Singapore General Hospital opened an 80-bed acute medical ward to support its Emergency Department. It caters to patients who have suffered, say, a fracture or you met with an accident and you are in shock. So, they are not in any danger, but they just need a short stay in hospital. So, this acute medical ward caters to this kind of patients and immediately provided relief to the Emergency Department.

During COVID-19, Singapore General Hospital had to convert this link bridge between two blocks into bed space for Emergency Department patients that overspilled. And no more space, we put them along the link bridge. Not many people knew that. Dr Tan Wu Meng knows that. The beds were recently removed and the bridge is now open to pedestrians again and one of the final harrowing memories of COVID-19 has now been removed from SGH.

From 2025 to 2030, we plan to add another 13,600 beds to our system. This includes about 2,800 public acute and community hospital beds to be added to Singapore General Hospital, Changi General Hospital, Sengkang General Hospital and also Woodlands Health. It will also include beds in the redeveloped Alexandra Hospital and the new Eastern General Hospital, which will open progressively from 2028 and 2029 respectively. This will bring public hospital beds from 12,000 today to 15,000 in 2030. That is a 25% increase.

We will also add around 10,600 more nursing home beds. That is a huge number. But that is the number that we have to deal with as our population ages.

In the following decade from 2030 to 2040, the new Tengah General Hospital will open. Singapore General Hospital campus and the National University Hospital Kent Ridge campus would have undergone major redevelopment to further improve national healthcare infrastructure.

The third and final objective is to ensure high quality. This means that illnesses are effectively treated, patients’ preferences respected and innovative technologies leveraged to ensure patients can recover and get back to health quickly.

The intangible aspects also matter. Kindness and care must fill our wards and clinics so patients do not feel alone in their journey of convalescence. When a patient nears end-of-life, we walk the last mile with them and ensure that they leave peacefully.

What matters most to quality is actually our people. Our healthcare workers, they are the driving force behind good care. We saw that during COVID-19, and they deserve all our respect, appreciation and encouragement.

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We are not doing badly in retaining and attracting talent. We are fortunate that Singaporeans want to join the healthcare sector. Our healthcare education programmes see healthy intakes. I always say, if you go to a primary school, for every 15 young students you see, one is likely to join healthcare. For every 20 students you see, one is likely to become a nurse.

Regionally, we are an attractive place for foreign nurses. We worked with the Singapore Nursing Board to significantly reduce the processing time of registration applications from six months in the past to now, 30 days. We moved examinations online. With these moves, we become even more competitive.

In 2023, we recruited about 4,500 new nurses. Last year, we continued this momentum with another 3,800 new nurses and introduced the Award for Nurses' Grace, Excellence and Loyalty (ANGEL) scheme. That was introduced in 2024 to encourage nurses to continue viewing their profession as an attractive long-term career.

Over Chinese New Year, I also announced salary enhancements for pharmacists, allied health professionals, administrative and ancillary staff later this year. About 37,000 staff will benefit.

Doctors are another key area. We have increased the intake across our three medical schools from about 500 in 2020 to 550 in 2024. We have expanded the list of recognised overseas universities, so we can welcome more Singaporeans studying medicine overseas to return to Singapore to practice.

Our healthcare workers, including junior doctors, they are dedicated and work very hard. Heavy workload is a phenomenon in all developed countries, which are ageing and experiencing rising patient load.

Mr Faisal Manap spoke up about the difficulties that junior doctors are facing. I thank him for caring for our doctors. But let me state a few facts.

One, the Employment Act does not cover professionals, managers and executives (PMEs), including doctors. The hours that you mentioned do not apply. I think many PMEs, including Members in this House, we work quite a number of hours, beyond what is specified in the Employment Act.

Number two, I hope Members do not go away thinking that we are facing a major outflow of doctors. Our attrition, post-COVID-19, is about 7%. It is healthy. I wish it can be slightly lower, but actually, it is quite healthy. [Please refer to the clarification later in the debate.]

Thirdly, salary adjustments for doctors were implemented 1 February 2024 only recently and we try to make sure we are competitive.

I want to emphasise: MOH has cared for our people and invested in them heavily for decades. From the moment they enter medical school, the subsidy we provide, the investment we made in our talent when they come into the system, going through housemanship, as a junior doctor, going through residency. We invested heavily and we continue to invest heavily in our doctors.

But in championing the welfare of junior doctors, I urge Mr Faisal, too, to consider the interest of patients.

Remember, healthcare is not like aviation. When pilots need to rest, passengers just have to wait for the next flight. All of us have experienced that in airports before. If we do that for doctors, patients will be left untreated and their lives can be in danger.

So, for MOH, we constantly have to balance the welfare of healthcare workers as well as patients. If we suddenly limit the working hours of doctors, patients will suffer. There have been many efforts for us to better manage these tensions, which the Senior Minister of State Dr Janil Puthucheary will elaborate on.

Transformation of our medical workforce is key to maintaining and improving quality of care. The profiles of our patients are changing – generally older, with multiple health conditions requiring simultaneous management and coordination. We are, therefore, re-organising the healthcare workforce.

This means complementing specialists, who are very skilled in managing specific organ systems, with doctors with a broader breadth of expertise who can anchor, coordinate and manage cross-specialty issues for patients, which Dr Tan Wu Meng talked about. This will enable us to deliver more holistic and integrated care, and it will be a key priority in the coming few years.

Besides the organisation of people, the ingenuity of our people matters just as much in driving quality. Technological breakthroughs, like AI and genomics, are ushering a scientific revolution in healthcare. Dr Lim Wee Kiak spoke about this.

We are now working on new legislative protections to safeguard the use of genetic test information. These are important and sensitive personal data. In my view, these data should not be used to decide on issues, such as insurance underwriting, hiring people or granting of university places. But we will need broad public consultation for this legislation. Such a law is important to anchor the moral foundations of our society even as medical science breaks new grounds.

With sufficient legal assurance, we will have the confidence to actively explore and experiment with the use of technology. Finding the right use cases is critical. We are not waiting for the legislation. We are starting now. In fact, we started some time ago.

Many good applications are emerging. Singapore General Hospital is deploying an AI-powered app for parents to screen their babies for jaundice at home using their handphone with an app. The app is trained with Singapore's multi-ethnic data and is sensitive to different skin tones. At the National University Hospital, doctors use AI to recommend treatment for patients by tapping into a vast database of historical caseload. With this tool, some doctors quipped that a junior doctor can now perform almost at the level of a senior doctor, because the experience is granted to them through AI.

In all these projects, the healthcare professionals remain in control of patient care and are enabled and enhanced by AI tools. Where an application is workable and is effective, we will expand it throughout the healthcare system.

Hence, by the end of this year, we hope all public healthcare institutions will adopt generative AI systems that can automatically transcribe doctors' conversations with their patients and summarise them for doctors' review before they are entered into patients' healthcare records. By the end of this year, too, we hope all public health institutions will be able to use AI to automate and improve the accuracy of imaging scans, such as chest X-rays and mammograms.

Mr Ang Wei Neng and Ms Ng Ling Ling asked about TCM. The quality of our system can also improve if we can successfully integrate aspects of TCM proven to be safe and effective to complement Western medicine as part of mainstream healthcare.

Singapore is a multicultural country, open to learning from all parts of the world. If there is a jurisdiction outside of Greater China that can blend and integrate Western medicine and TCM, it should be us. We made a lot of progress in recent years. We now have our own TCM degree delivered by the Nanyang Technological University enhanced professional training, we streamlined examination requirements and we are strengthening the TCM accreditation framework.

Today, certain acupuncture treatments are already incorporated in mainstream public hospital treatment.

Later this year, SingHealth and the Academy of Chinese Medicine, Singapore will be co-organising a forum on the integration of TCM and western medicine. It will be attended by both TCM practitioners as well as Western doctors. I think it will be a great platform to explore further opportunities to identify further steps to synergise the strengths of both systems. Mr Chairman, my speech now in Chinese.

(In Mandarin): [Please refer to Vernacular Speech.]: For seniors, a major concern is medical expenses. Most of them have retired and live on their savings. When they need to use their savings to pay for medical expenses, they inevitably worry about not being able to afford them. Therefore, over the years, we have implemented many policies, including the Pioneer Generation and Merdeka Generation packages, as well as the Healthier SG and Age Well SG initiatives to reduce medical costs for our seniors.

Last year, we adjusted the CHAS eligibility criteria, allowing more CHAS Orange cardholders qualify for CHAS Blue cards. I also just announced several new measures. First, we are increasing the withdrawal limit for the Flexi-MediSave scheme from $300 per year to $400. Second, we are increasing subsidies for certain dental services. Singaporeans can now also use their Flexi-MediSave to pay for root canal treatments and dental crowns. Third, we are increasing subsidies for long-term care services.

From time to time, Singaporeans ask MOH to provide more subsidies. We understand this request and where reasonable and feasible, we will adopt these suggestions. But as the saying goes, there is no such thing as a free lunch. Whether it is more subsidies, more insurance payouts, or even free services, they all cost money. And these costs are ultimately borne by citizens through fees, insurance premiums or taxes.

Through a multi-pronged approach of subsidies, insurance, MediSave and co-payment, we will continue to strive to reduce wastage of resources and avoid unnecessary treatment or overtreatment. By containing healthcare inflation, we can control the burden of cost for our people. For most people, the best way to ensure they can afford medical expenses is to maintain a healthy lifestyle and stay away from illnesses. Therefore, we launched the Healthier SG initiative. Many Singaporeans have actively participated, and more are starting to exercise more, which I find very encouraging.

Today, I hope to convince more seniors to stay physically and mentally active. Besides doing exercise, seniors also need social circles to surround themselves with laughter. That is why we have established Active Ageing Centres across the country. We are providing these centres with more resources, to allow them to organise more activities and gatherings for seniors.

In my constituency, I am a loyal promoter of Active Ageing Centres and have gained some insights through this. Inviting seniors to Active Ageing Centres is somewhat like making multiple visits to win someone over. When seniors first hear about Active Ageing Centres, they may ask out of curiosity, "What are these centres? Who built them?" Some might even ask volunteers, "Are you a property agent?"

As we further explain the activities at Active Ageing Centres, seniors often become increasingly open to the idea of them. When we then tell them the centre has weekly communal meals and tell them, "Please come, it is on us", we then see the joy on their faces.

In ancient times, martial arts masters would fight and kill each other to obtain martial arts secrets. But today, what we need are the secrets to good health, not martial arts. These health secrets are in fact readily available – eat healthily, get sufficient sleep, exercise regularly, go for regular health screenings and visit Active Ageing Centres when you can. These are the secrets for good health.

(In English): Mr Chair, let me conclude. I spoke about our plans to achieve our three big objectives of public healthcare. The problem is that they are competing objectives, a trilemma. It is impossible to achieve all three fully. Something has to give.

Indeed, in the UK, patients do not have to pay for public healthcare. But as a result, demand shoots up and they now have seven million public patients on the waiting list for elective treatments. Healthcare is affordable, but not so available.

Dr Lim Wee Kiak asked what can we learn from other countries, including the National Health Service? I think what we can learn from the National Health Service is to try not to be in the position they are in now.

Switzerland adopts novel medical technologies and ranks top in the world for quality. But about a quarter of the population chooses not to be treated, citing high cost. Hence, high quality healthcare in Switzerland, but not so affordable.

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These countries offer an important lesson. If we are dogmatic and want to achieve one objective 100%, we pay a big price in the other objectives. But if we take a more practical approach, we can balance the trade-offs and try to maybe achieve all three at 80%. A key to achieving these lies in a healthy population. With better health, we can achieve all three at the same time without trade-offs.

Mr Chairman, Dr Lim Wee Kiak talked about healthy longevity. A friend of mine, in his 70s and an avid golfer, once said that the perfect way for him to go is when he is 100 years old, playing golf, hits a beautiful shot, scores a hole-in-one, he is so happy, he collapses and dies. He may sound like he is joking, but I think he is dead serious. What he essentially described is the “holy grail” of healthcare where healthspan equals lifespan and you are healthy enough to do what you love until the last day.

We are far from that scenario. Singapore, indeed, has one of the highest average lifespans in the world at 84, but our healthspan is only 74. This gap is quite consistent with most developed countries, but we must try to narrow it. We need policies that improve population health. Individually, too, we can all practise better preventive care and take better care of our own health.

Nationally, we need a major programme, hence Healthier SG. After one and a half years, we enrolled almost 1.2 million Singaporeans onto Healthier SG, about half of the eligible population. Three-quarters of our enrollees have also since completed their Health Plan consultation. Health screening, vaccination rates, they are all rising. Discernibly, more Singaporeans are exercising. We are happy with this good start.

A lot of hard work lies ahead. We are inculcating more good habits amongst our population. We have cut down sugar consumption, including in the Members' Room. We are labelling packaged drinks. People are much more conscious. We are moving soon to sodium and saturated fats. We implemented Grow Well SG to improve health habits of our young. We are tackling the mental health challenge.

And at some point, AI models will analyse our medical or even genetic data to predict 10 years ahead if we are likely to get a stroke, heart attack or cancer. And then, it will alert our Healthier SG doctor, who will, in turn, advise us what are the preventive steps to take. This is predictive preventive care – Healthier SG 2.0 – and we are not far away at all.

Mr Chairman, we are determined to expand healthcare capacity. So, even though we are rapidly ageing, healthcare must be available when Singaporeans need it. We will develop our people, transform medical delivery and harness technology to continue to deliver high quality healthcare that Singaporeans deserve. Through our S+3Ms framework, we will ensure no one is denied appropriate medical care because they cannot afford it.

This Government understands that healthcare is a basic and essential public service that Singaporeans value. We have the experience, wherewithal, determination, ideas and policies to upkeep and strengthen this key tenet of our social compact. Our agenda for healthcare is transformative and long term and will take us well beyond this Budget year. I hope to have the continued strong support of this House, as we work together to overcome the mounting challenge of an ageing population, to cure sickness, to bring comfort to those in need and strengthen the health and happiness of all Singaporeans. [Applause.]

The Chairman: Minister Masagos.

The Second Minister for Health (Mr Masagos Zulkifli B M M): Mr Chairman, supporting the health and well-being of every Singaporean continues to be our approach to achieve a healthier nation and a more sustainable healthcare system. Our approach spans all life stages and today I will share our initiatives to support both the health of children and seniors.

Last year, we announced the completion of the Child and Maternal Health and Well-being Strategy and Action Plan that is applicable to children, adolescents and their families. Forty-eight new initiatives to support children and mothers were recommended, especially for vulnerable and at-risk groups. To date, 38 initiatives have been implemented.

We have sought to do more. There is compelling evidence showing that poor lifestyle behaviours in childhood can impact children’s health and development, making early adoption of healthy habits crucial to their long-term health. This is why MOH, MOE and MSF launched Grow Well SG in January, a new population health effort to help children and families inculcate healthy lifestyles, with a stronger focus on preventive care, targeting children below 12 for a start.

Mr Neil Parekh asked about how Grow Well SG has been received thus far. I am happy to share that it has been well-received. Many welcome this timely move to improve child health, especially MOH’s updated screen use guidance and refined practices on screen use management in preschools, primary and secondary schools.

We agree with Dr Wan Rizal and Mr Neil Parekh to reinforce families with practical resources and tools to support their children in building healthy habits, including good screen use habits, to improve their physical, mental and digital well-being. With work and family commitments, it can be difficult for parents to wean children off screens. We have, therefore, lined up tips and best practices to strengthen digital wellness efforts on various platforms, such as the Parent Hub websites, MOE Parents’ Gateway and MSF's Families for Life parenting programmes. The Parenting for Wellness initiative is one example of the support available to families shared by MOE earlier. We strongly encourage parents to adopt these strategies and actively foster healthy habits in their children.

We will continue to work with preschools, schools, healthcare institutions and the community to educate and support families and children in reinforcing healthy habits. Two initiatives announced earlier are the Health Plan and Childhood Health Behaviours Checklist.

In January, we introduced personalised Health Plans with lifestyle prescriptions for Primary 1 to 3 students. I am happy to share that since its launch, 22,000 students have been given their Health Plan as of end-February. We are on track to roll out Health Plans to all Primary 1 to 3 students by end-2025.

Azizan, the son of Ms Nurhaslinda Wati, is one Primary 3 student who has benefited. The Health Plan motivated Azizan to continue his practice of healthy habits and taught him other interesting health tips. During the lifestyle discussion, Azizan was advised to continue his daily practice of choosing water as his preferred drink. The lifestyle prescription played a pivotal role in encouraging Ms Nurhaslinda Wati to proactively work with Azizan to achieve his daily goal of choosing water over sugary drinks. Their experience highlights how parents can engage their children to improve their health.

Dr Wan Rizal and Mr Neil Parekh also asked about our future plans for Grow Well SG. Parents will be excited to know that the Health Plans will be expanded to Primary 4 and 5 students. As the needs of upper primary students differ from those in lower primary, we will pilot this with some students this year to allow for calibration of the Health Plans and resources before full implementation in 2026.

Beyond schools, we are rolling out the Childhood Health Behaviours Checklist (CHBC) at Childhood Developmental Screening visits for children up to six years at all polyclinics, general practitioners and paediatric clinics from 2 May 2025. Parents are encouraged to complete the checklist before or during visits. This will allow them to discuss their child’s health behaviours on screen use, sleep, physical activity and nutrition with the healthcare professionals, and plan positive lifestyle changes at home. Parents can also benefit from the resources on the recommended lifestyle behaviours via the weblinks and QR codes on each checklist.

The CHBC aims to encourage families to build healthy daily habits from young and will complement the personalised Health Plans children receive in primary schools. We hope parents will tap on the Health Plans and CHBC to build and sustain healthy habits in children from birth through schooling years. These small, consistent efforts can make a difference to your child’s health over time.

Apart from growing well, it is equally important to help our seniors age well in their communities. Assoc Prof Razwana Begum Abdul Rahim asked about the initiatives to promote healthy ageing. Our national programme, Age Well SG, was rolled out to support our seniors, including older women, and $3.5 billion has been set aside over the next decade for this.

A key part of Age Well SG is our Active Ageing Centres. By the end of this month, we would have set up 223 centres, up from 154 when the scheme was announced. We are devoting more resources to each centre, setting up more and working with the Ministry of National Development (MND) to locate them close to seniors’ homes. This includes private estates which Ms Ng Ling Ling has asked about, so that they can better reach out to seniors and organise more and better activities.

Beyond this, more seniors are volunteering as Silver Guardians at Active Ageing Centres. To date, we have more than 1,400 Silver Guardians volunteering at the Active Ageing Centres and are one step closer to achieving our goal of 2,400 Silver Guardians by 2028. Let us continue to make each Active Ageing Centre a vibrant hub for our seniors to gather with their friends, volunteer, keep active and stay healthy.

Our infrastructure has also been enhanced to make our flats, neighbourhoods and streets more senior-friendly, with various initiatives updated by MND and MOT. An example is the Community Care Apartment. We have completed our first Community Care Apartment, Harmony Village @ Bukit Batok, and are building more over the next few years.

One resident at Harmony Village is Mdm Chia. After her husband passed away, she wanted to live in a place where she could retain her independence while receiving care support. This led her to choose the Community Care Apartment. Today, Mdm Chia is thriving at Harmony Village. She made many new friends, developed a close relationship with the Community Manager and actively participates in the activities, such as morning exercises, karaoke and communal lunches organised at the Community Care Apartment.

Mdm Chia’s care needs are also taken care of by the Shared Caregiving Services package, an optional care service designed to support elderly residents who require help with activities of daily living. I am happy that seniors like Mdm Chia found the Community Care Apartment to be a home that caters to her needs, allowing her to age confidently and gracefully in the community.

Ms Ng Ling Ling and Mr Yip Hon Weng asked about the plans for Shared Stay-in Senior Care Services Sandbox. Since its launch, over 200 seniors have enrolled in this service. The service has been well-received by families, who play a key role in the caregiving journey by partnering providers in making caregiving decisions for their loved ones. Seniors are also glad that they are able to age with peace of mind as their caregiving needs are taken care of around the clock.

I am happy to announce that we will mainstream this service. The sandbox phase will be ended and we will continue supporting existing providers with work pass flexibilities while bringing new providers on board. To better support providers, families and seniors, we will work with industry providers to formulate and publish a guide on the recommended good practices when providing or seeking such a service. This service will not be licensed, as it provides caregiving support very much similar to how family members would care for their loved ones at home. Interested companies can look forward to the application details and good practice guide from second half of 2025 onwards.

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We welcome all providers to work with us on similar innovative care models to support ageing-in-place. This complements existing options to provide care at home through video consults or home visits by healthcare providers, as raised by Dr Tan Wu Meng.

Beyond innovative care models, we support the adoption of automation and technology solutions to increase productivity in the long-term care sector, as raised by Ms Ng Ling Ling. The Productivity and Digitalisation Grant, launched in 2022, is one such example, which has supported more than 200 projects across this sector, benefiting 48 community care organisations thus far.

As pointed out by Mr Xie Yao Quan, it is also important to ensure the quality of our long-term care service. This is why we support providers to develop skilled manpower through a structured skills standards framework and subsidised training.

We agree with Dr Tan Wu Meng that care coordination is important to deliver good care. This is why we are introducing the Integrated Community Care Provider (ICCP). ICCP has three key functions. First, it is a dedicated point of contact for seniors and coordinates care among providers to provide long-term care services, such as active ageing and befriending, day care, rehabilitation and personal care support for activities of daily living. Second, it allows seniors to receive a standardised care assessment for their long-term care needs. Lastly, it develops one holistic long term care plan for more coordinated delivery across services.

To implement this, we have divided Singapore into 85 sub-regions, with each sub-region having a dedicated ICCP appointed. For sub-regions with existing providers, we will facilitate partnerships. In other sub-regions, we have launched the process to select new ICCPs and will appoint them this year.

This year, providers in several sub-regions will start providing joint programmes across their Active Ageing Centres. Seniors with multiple care needs will also be seamlessly linked up across care partners in the same sub-region.

By end-2026, all seniors requiring long-term care services can progressively look forward to receiving the standardised care assessment and holistic long-term care plan coordinated across services.

We agree with Mr Yip Hon Weng that a key concern our seniors have when it comes to ageing well is their ability to afford long-term care services when they need these. The Prime Minister announced significant increases to long-term care subsidies and grants at the Budget to support seniors and their families, which Minister Ong has just explained.

Beyond these, we also have CareShield Life, our national long-term care insurance scheme that provides monthly cash payouts to policyholders who face severe disability. The scheme has not been reviewed since it was first launched in 2020. Long-term care costs have since risen and we need to ensure that the payouts continue to provide meaningful support. Therefore, the CareShield Life Council was asked to review the scheme. We will share more details in the second half of 2025 once the Council has completed its review.

Mr Chairman, in closing, we remain committed to provide the support needed for all Singaporeans. Together, we can build a society where every Singaporean can grow, develop and age well, to enjoy a life of health and well-being.

The Chairman: Senior Minister of State Janil.

The Senior Minister of State for Health (Dr Janil Puthucheary): Sir, Family Physicians have been and are central to the provision of primary, community and preventive medical services. The role they play will only grow as the care needs of our ageing population become more complex. They are critical to the Healthier SG initiative.

Today, family medicine is not listed as a recognised medical specialty in Singapore. The healthcare profession recognises the complexity of the work, the importance of our colleagues in primary care and that specialised training and experience is needed to perform this role well. Hence, the Specialists Accreditation Board has approved for Family Medicine to be recognised as a specialty, on par with other specialties. Together with the family medicine fraternity, we are now working out the accreditation and training pathways to recognise Family Physicians with advanced Family Medicine training and relevant experience as specialists.

With their broad skillsets and long-term relationships with patients, Family Medicine specialists will enable more patients with complex care needs to receive comprehensive care in the community. Further details on the entry criteria to become a Family Medicine specialist, training requirements and the implementation timeline will be shared later this year.

In advancing our primary care system, we will also ensure Singaporeans can access affordable care, including medications for chronic conditions. Today, the Healthier SG Chronic Tier offers enhanced subsidies for selected chronic medications at enrolled Healthier SG GP clinics. By mid-2025, we will expand the range of medications under the Healthier SG Chronic Tier, to include three Medication Assistance Fund (MAF) drug products for specific medication indications.

For example, eligible patients requiring Evolocumab for very high cholesterol levels, or Familial Hypercholesterolemia, despite being on other cholesterol-lowering medications, could see their monthly out-of-pocket expenses reduced from over $230 to about $30-$60, depending on their means test status. We will continue to review the expansion of the range of medications which are subsidised under the Healthier SG Chronic Tier.

To respond to Dr Tan Wu Meng, today, polyclinics provide multiple appointment booking options, including online booking with staff guidance, phone bookings and walk-in services. Designated caregivers can also manage their dependant's appointment from their own HealthHub or cluster app account.

Urgent cases and patients who are frail or who have mobility issues will continue to be prioritised, even if they do not have a polyclinic appointment. Non-urgent cases may be scheduled for a later appointment or advised to seek treatment at a nearby CHAS GP clinic. Subsidies for GP visits are also already available through CHAS, with enhanced benefits for Pioneer and Merdeka Generation seniors. Under Healthier SG, enrolled patients can access chronic medications at GP clinics at prices similar to polyclinics. MediSave can be used at both CHAS GP clinics and polyclinics.

Building on Minister Ong's earlier comments, let me elaborate our ongoing efforts to support our healthcare workforce. Generations of doctors have indeed built our healthcare system through dedication and hard work under quite demanding schedules. But they are not alone. This applies to all of our professional colleagues – the allied health professionals; the nurses; the many, many staff members, who work together to make sure that our healthcare system functions for our patients.

We recognise that times and expectations have changed and our practices must evolve accordingly.

However, our public hospitals see many patients every day, with many requiring urgent, time-sensitive care. Shorter working hours mean more frequent handovers between doctors, requiring careful management and changes to work processes to prevent risks to patient care and longer waiting times.

We have taken a measured approach to grow the healthcare workforce, including doctors, to meet the needs of our ageing population. We have already increased our annual intakes significantly. But we are mindful that, today, already one in 12 Singaporean students joins a healthcare programme and any significant expansion will require foreign healthcare professionals. We must take care not to deprive other important sectors.

And this raises a critical question: how do we balance our growing healthcare manpower needs against the many concerns raised in this House about foreign manpower dependency?

As we grow the workforce, we have progressively made improvements, such as limiting junior doctors to 24 hours of continuous work periods and establishing rest day guidelines. Nearly half of the clinical departments with junior doctors in public hospitals have adopted this and the rest will follow suit gradually.

I agree with Ms Mariam Jaafar, we must close the gaps in the treatment for physical health and mental health. This is why Healthier SG will include care for our residents' mental health. Healthier SG Care Protocols for major depressive disorder and general anxiety disorder are being developed and will be rolled out next year. These care protocols will ensure consistent and quality care are being delivered across primary care providers.

We have also begun pairing Healthier SG clinics with Community Intervention Teams (COMIT) who provide psychosocial interventions for mental health needs in the community. These pairings enable smoother referrals.

Sir, many Members asked for updates on our community mental health support and programmes. They asked about costs, public awareness of programmes, like the Community Outreach Teams (CREST), and how effectiveness and progress in mental health programmes and care will be tracked.

Last year, during the Parliamentary Motion Debate on Advancing Mental Health, I shared our plan to have 90 CREST and 50 COMIT teams by 2030, including 15 youth-oriented teams each. We are on track to achieve our targets. As of December 2024, there were 86 CREST and 32 COMIT teams, including the youth teams, in operation.

As one of the key first-stop touchpoints for in-person mental health services, CREST has strengthened local service linkages and networks across health and social care providers in the community, including GPs, polyclinics and hospitals.

To build greater awareness of CREST in the community, CREST teams conduct outreach to share information about their services. The Agency for Integrated Care (AIC) also promotes CREST through advertisements on social media, bus stops and HDB lift lobbies. To further promote CREST, AIC has developed a Community Mental Health Wayfinding Tool, available on various platforms, including realspace.sg, mindline.sg and MindSG, to help users find the right mental health services, such as CREST.

The performance of CREST and COMIT teams, along with other public healthcare institutions (PHIs), such as our public hospitals and polyclinics, are assessed through key indicators such as access, response time, volume of clients supported, improvement in patients' outcomes and client satisfaction. Patients' mental health outcomes are specifically measured through validated assessment tools, such as the World Health Organization (WHO) Disability Assessment Schedule and the Patient Health Questionnaire for depression, which assesses patients' functional levels and severity of symptoms. The National Mental Health Office works closely with our PHIs and our community service providers to track and analyse aggregated data for the purposes of policy review, service planning and evaluating the effectiveness of our national mental health initiatives.

Community mental health services provided by CREST and COMIT are fully funded by the Government with no out-of-pocket cost. Eligible patients can also receive subsidised mental health treatment at polyclinics and participating GP clinics for the management of mental health conditions under the Chronic Disease Management Programme.

At last year's debate, I also outlined our goal to train 130,000 frontline personnel and volunteers by 2030, to better equip them to identify individuals with signs of mental distress, provide a listening ear and refer them for support as needed. I share Dr Wan Rizal's view that religious organisations must be part of our mental health ecosystem.

Since September 2024, the National Mental Health Office, together with AIC, has partnered with the Ministry of Culture, Community and Youth to engage religious organisations and leaders, to provide them with mental health training programmes. The training equips participants with skillsets to provide basic emotional support, while ensuring that they understand when to refer individuals to professional mental health services. When professional mental health care is required, religious leaders are encouraged to direct individuals to formal mental health services within the community. This is part of our ongoing effort to strengthen community-based mental health support networks. We have exceeded our target, with over 137,000 individuals trained to date, including religious leaders and volunteers.

I agree with Mr Ong Hua Han that mental health first aid resources are crucial. I thank him for the suggestion to integrate more of such resources on existing apps and we will explore its feasibility. Meanwhile, we will continue to sustain our frontliner and volunteer training through structured mental health programmes, including e-learning modules developed by AIC and HPB, with psychological first aid training to be rolled out by mid-2025.

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For members of the public, mindline.sg and MindSG offer comprehensive mental health resources, including information on supporting others and self-help tools. Mindline.sg also provides clinically validated self-assessment tools for depression and anxiety.

To simplify the help-seeking process, we will launch the National Mental Health Helpline and Textline service in mid-2025 as a centralised mental health first-stop touchpoint. This round-the-clock service will feature an easy-to-remember four-digit number and offer chat support through the mindline.sg website. It will be staffed by trained counsellors. This service streamlines access and connects Singaporeans to necessary resources. More details will be shared when the service launches later this year.

Dr Wan Rizal asked about workplace mental health support. Government agencies and tripartite partners have implemented comprehensive workplace mental health initiatives like the Well-being Champions Network, which now consists of over 450 organisations representing 230,000 employees. Other initiatives include training employee peer supporters and conducting public education campaigns and workshops to combat workplace stigma, share best practices and facilitate employees' transition back to work.

Specialised employment support is available through agencies like Singapore Anglican Community Services, the Institute of Mental Health's Job Club and Singapore Association for Mental Health's MINDSET Learning Hub. These organisations offer customised vocational training and job placement services and have helped more than 6,000 individuals with mental health conditions gain and maintain employment.

The Tripartite Guidelines on Fair Employment Practices upholds employment fairness through merit-based recruitment, restricting unnecessary mental health declarations and providing proper grievance handling processes. These practices will be further strengthened by the Workplace Fairness legislation, which prohibits workplace discrimination based on mental health conditions.

Sir, if I may turn to the mental health of our youths. We recognise the crucial role parents play in the minors' well-being. However, the need for parental consent can sometimes deter minors from seeking help. After consulting medical ethics experts and mental health service providers, MOH has decided to take a nuanced approach by convening an expert group to develop guidelines in this area.

Parental involvement in their children's care journey is very important for better outcomes. For the Singapore Children's Society, for example, in their work, they have found that consistent parental engagement and parental involvement in case planning and family sessions have achieved sustained positive results and supported long-term recovery.

We are also introducing "grovve", an integrated wellness centre for youths at *SCAPE at the end of this year. Co-developed by the National Council of Social Service and various stakeholders, including youths, "grovve" will be the first centre to provide integrated intervention services alongside general wellness activities. Its youth-centric location seeks to improve accessibility and normalise mental health care. "grovve" will foster communities where youths can become champions and supporters for mental well-being.

Mr Keith Chua asked about continuity of care, especially for those affected by suicide, and the coordinating role of the National Mental Health Office. Suicide prevention and post-incident support requires a whole-of-Government and whole-of-society approach to address the issues holistically.

Existing community-based support available includes the Light in the Dark support programme by the Samaritans of Singapore (SOS) and the Live On! programme by TOUCH Community Services. Next-of-kin or loved ones affected by suicide may also benefit from suicide bereavement support programmes run by SOS, such as Healing Within and Healing Bridge, as well as Local Outreach to Suicide Survivors.

The National Mental Health Office coordinates with Ministries and agencies, including MOE, the Ministry of Social and Family Development (MSF) and the Institute of Mental Health (IMH) in implementing policies and reviewing data and trends.

A prime example of multi-stakeholder collaboration is the development of the Youth Crisis Facility. Expected to be operational in 2027, this 24/7 facility will provide intervention for youths in crisis, including those struggling with suicidal behaviour or severe self-harm. It will support youths referred from the community or discharged from acute hospitals, offering psychosocial intervention in a safe and non-stigmatising environment to aid community re-integration.

The multi-stakeholder project team is currently developing clinical protocols and operational details for this facility, which will be a bridge between acute hospitals and community care.

Dr Tan Wu Meng asked about insurers' practices for those with mental health history. Apart from MediShield Life, which covers all Singapore Citizens and PRs, regardless of pre-existing conditions, including mental health conditions, individuals can opt for additional coverage through Integrated Shield Plans (IPs) and other private insurance plans.

IP insurers' approach to underwriting persons with mental health conditions mirrors that of other conditions. It is based on reliable information relevant to the risks being insured. Factors considered may include age at the onset of condition, symptom severity, management of the condition and the presence of comorbidities.

After the assessments, insurers may choose to accept applications as is, apply higher premiums, exclude specific benefits or reject applications in view of the risks presented, with proper justification to customers. There are cases where IP insurers have offered cover to customers with mental health conditions, either with or without exclusions.

All IP insurers allow customers to request for a review of their exclusions or submit a fresh application if their condition has improved and they can provide favourable medical evidence.

All insurers, including IP providers, are to adopt sound and objective processes to assess applications received from their customers. For example, insurers should not reject an application solely based on the customer's declaration of a mental health condition.

Customers concerned about the underwriting decisions should raise the matter with their insurer for investigation or review. If they are not satisfied with the insurer's response, they can write to MOH or the Monetary Authority of Singapore to follow up and assess the full case details with consent.

Sir, we have been working to register psychologists to ensure high standards of professionalism and better protect clients. The increased focus on mental health in recent years has prompted changes in psychological practice, with more psychologists now working beyond traditional clinical settings in the community and private sector. Recognising this shift, we are working towards the registration of psychologists, focusing on psychologists who provide direct patient care, perform higher-risk assessments and interventions, and whose practices may span across various sectors.

An inter-agency implementation committee has been set up to look into this. This will raise professional standards, safeguard patient safety and increase public confidence in psychological services. Further details will be announced at a later date.

To prevent the public from being misled by services that are not licensed by MOH, the Healthcare Services Act (HCSA) currently prohibits providers of such services from advertising that they are able to "treat" a medical condition. However, certain professions, such as allied health and traditional Chinese medicine, are regulated under their respective professional Acts. Their interventions are low risk, because they manage conditions in accordance with clear standards of practice set by their professional bodies. We will review the HCSA advertising controls to enable these selected professions to advertise their services. Even so, they will still have to ensure the accuracy of their advertisement. We will share more details when ready.

To improve the online accessibility of public health care services, we are planning to consolidate the public healthcare clinical apps, Health Hub and the cluster-specific apps – Health Buddy, NHG Cares App and NUHS App – into a unified platform by 2027. Patients who now have to use different apps to access services at PHIs will be able to do so on this unified app in future for an improved, user-friendly experience. We will consider adding Healthy 365 to the unified platform in the future.

Ms He Ting Ru asked how we are harnessing the potential of precision medicine. MOH is taking steps to embrace precision medicine in a cautious manner as we identify appropriate precision medicine applications with clear evidence of public benefit for scaling up. One such application is genetic testing for familial hypercholesterolemia, which we will be rolling out nationally in mid-2025. We will also put in appropriate safeguards to mitigate risks, such as increased healthcare costs. To do so, we will only extend Government financing schemes, mainly subsidies, MediShield Life and MediSave, to precision medicine use cases that are assessed to be cost and clinically effective.

Dr Lim Wee Kiak asked about the potential of regenerative medicine. MOH has been supporting research in this through various schemes under the national Research, Innovation and Enterprise plans. However, we recognise the risks and ethical considerations associated with such nascent investigational therapies. We will continue to evaluate the evidence from both local and overseas studies for clinical efficacy and cost effectiveness.

Sir, the changing healthcare landscape presents both challenges and opportunities. Navigating these will require collective effort. We look forward to working closely with healthcare professionals, community partners and citizens to capitalise on these opportunities and effectively implement the initiatives I have covered today.

The Chairman: Minister of State Rahayu Mahzam.

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The Minister of State for Health (Ms Rahayu Mahzam): Mr Chairman, my speech will cover the Ministry's efforts in three areas: firstly, on reshaping our norms and choices in healthy living; secondly, on maternity costs and fertility preservation; and lastly, on ensuring a robust healthcare workforce.

We have made strides in our efforts to reduce sugar consumption. As shared by Minister Ong, we will also tackle the issue of excessive intake of sodium and saturated fat.

Ms Ng Ling Ling asked about the plans for extension of Nutri-Grade labelling for sodium and saturated fat in the F&B setting and the healthier alternatives that are available across cuisines.

We understand from engagements with the industry that tackling sodium and saturated fat content in eat-out dishes is challenging. Given the diversity of cuisines in Singapore, the different cooking processes and recipes can lead to variations in the amount of sodium and saturated fat in a dish.

Moreover, time is needed for consumers to adjust their palates to lower sodium dishes and for F&B operators to adopt healthier ingredients. Therefore, we are not applying the Nutri-Grade measures to dishes in the F&B setting for now. Instead, we are strengthening our engagements with F&B operators. This includes ramping up voluntary store-front labels to help consumers identify stores that offer healthier dishes, either by using healthier ingredients or using less salt or sauces when cooking.

Besides encouraging F&B operators across various cuisines to use healthier ingredients and provide more healthier options through the Healthier Dining Programme, HPB is also actively engaging our hawkers on the importance of sodium reduction and providing them with samples of lower-sodium ingredients. HPB has reached out to 60 hawker centres, with 50 more planned for 2025.

The availability and affordability of healthier ingredients for F&B operators and consumers are key to the success of our efforts. To this end, HPB's Healthier Ingredient Development Scheme supports manufacturers and suppliers in their reformulation efforts while reducing the price gap between healthier and regular versions.

These efforts have borne fruit. Today, over 1,700 eateries, including stalls in hawker centres, have switched to lower-sodium ingredients, compared to 500 eateries two years ago. We will continue to build on these efforts to advocate for healthier meals that are lower in sodium, saturated fat and sugar.

Besides healthy eating, we must support active living. Mr Chairman, allow me to share the broader picture of healthy lifestyles and our progress towards shaping an active nation.

I thank Ms Ng Ling Ling for her concerns on plans to increase participation in the HPB-led physical activity programmes and efforts to reach out to Healthier SG GP clinics to support these programmes as part of social prescription. HPB conducts regular fitness programmes that are accessible and convenient for residents in the neighbourhoods. These community physical activity programmes have been expanded to over 2,100 sessions each week, up from over 1,700 sessions in 2023. These activities are also now held at more than 1,300 locations.

HPB has also expanded their programme offerings to cater to different segments. These include programmes, such as Steady Lah and Healthy Ageing Promotion Programme for You (HAPPY), to address frailty for seniors, Active Family Programme for young families, and Start2Move programme for individuals looking to kickstart an active lifestyle. Everyone can now participate in activities suitable for their fitness level and at a convenient location.

We are heartened that the programmes have been well-received by Singaporeans. Alongside the increase in physical activity programmes, the weekly attendances for these have increased from 36,000 participants in 2023 to 47,000 in 2024.

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To support Healthier SG GP clinics in encouraging appropriate physical activities for residents, HPB has also developed a guide to Lifestyle Prescriptions available on the AIC webpage. The Healthier SG EventsGoWhere Portal was also launched last year to provide GPs and their care teams with a consolidated list of healthy lifestyle programmes from HPB, People's Association, SportSG and Active Ageing Centres to recommend to residents.

As we continue to build the infrastructure to encourage physical activity in the community, we have also been listening to residents' feedback. We understand concerns over late arrivals and registration capacity for physical activity programmes. Some residents may also be unsure about the sign-up process. In response, HPB will exercise greater flexibility. For low and moderate intensity activities, including yoga, Zumba Gold and resistance band exercises, latecomers and walk-ins will be allowed, subject to capacity limits. For safety reasons, higher-intensity activities like High Intensity Interval Training will still require punctual arrival, as proper warm-up and safety checks are needed to minimise injuries. We encourage everyone to sign up for the activities via the Healthy 365 app and arrive on time. Prior to participating, residents should also monitor their own readiness and refrain from exercising if unwell. With the changes, we hope more residents will join the variety of physical activity programmes conveniently located in their neighbourhoods.

We further recognise that some may prefer to exercise at their own pace and time. HPB offers virtual physical activity sessions on Zoom and self-directed digital programmes. An example is the 12-week Age Strong programme which was launched in November 2024 on the Healthy 365 app, catering to residents aged 50 and above. Participants can take part in customised workouts and learn about nutrient-rich diets and mental well-being. The programme also provides HealthPoints for completion of daily tasks.

In response to user needs, HPB has also enhanced the Healthy 365 app with a new goal-setting feature and a refreshed set of milestone-based challenges in October 2024. Users can set personalised activity goals for their physical daily activity and sleep duration to suit their preferences and daily routines and earn rewards for meeting their goals.

Today, more than 840,000 residents regularly use the Healthy 365 app to track their progress in meeting their activity goals, access lifestyle activities, recommended resources and programmes, and earn rewards from completing tasks and challenges. For those who have yet to come on board the Healthy 365 app, I urge you to be part of this journey to take steps towards better health.

An area of growing concern that impacts on health and lifestyle is vaping. Mr Ang Wei Neng has expressed his concerns on this matter and urged stronger enforcement efforts.

MOH, in collaboration with various stakeholders, has intensified our whole-of-Government approach to combat vaping through public education and enforcement efforts. As Mr Ang pointed out, there are some common misconceptions around vaping and, to this end, HPB has launched a series of campaigns over the last two years to increase awareness of the illegality and harms of vaping. To further amplify awareness, multiple channels, including social media and youth content creators, were engaged to more effectively reach the intended target audience. Relevant stakeholders will continue to work closely to raise awareness among children and youths on the harms of vaping.

On the enforcement front, the Health Sciences Authority (HSA) has increased enforcement operations, especially in public vaping hotspots, alongside other agencies, such as the National Environment Agency and National Parks Board. Collaboration with the Immigration and Checkpoints Authority has also been strengthened to combat the smuggling of e-vaporisers at the borders. In educational institutions, the Ministry of Education maintains a firm stance against vaping, with disciplinary actions taken and referrals to HSA for offenders.

Looking ahead, MOH and HSA will be reviewing legal penalties to bolster deterrence against the importation, distribution and use of e-vaporisers. Education and enforcement against vaping are a long-term effort, which will be continually monitored and reviewed to ensure we address the vaping issue effectively. Mr Chairman, allow me to say a few words in Malay.

(In Malay): [Please refer to Vernacular Speech.]: In our health promotion efforts, we should take an approach that is nuanced and suitable for the groups we are reaching out to. This can only be done effectively if we work with a variety of groups and organisations in the community.

For the Malay/Muslim community in Singapore, this is achieved through the Jaga Kesihatan, Jaga Ummah (JKJU) network, which comprises various organisations such as M³ agencies, Malay/Muslim bodies and religious organisations. This network, which initially started with just several mosques, has grown and continues to grow. The number of partners has increased from 100 in 2023 to over 160 in 2024.

At the Sihat Bersama JKJU event last February, we acknowledged our partners and encouraged them to collaborate. Our partners also had the opportunity to showcase their efforts at the various booths which were also open to the public. At the Townhall session with me, Dr Wan Rizal and Ms Nadia Samdin, we openly discussed the health issues our community faces, how there is a socio-economic impact and different ways we can enhance our efforts to stay healthy holistically. I am heartened by the discussions we had and our partners' commitment to making a difference as we move forward.

We have now entered the month of Ramadan and will continue with the programmes that have been planned. This year, I am encouraged to see our JKJU partners expand and move towards a more holistic approach to health, while tailoring their activities to the needs of the community. For instance, some of our M³ partners are collaborating with more JKJU Resource Partners like Caregivers Alliance Limited and the Stroke Services Improvement (SSI) Team under MOH to conduct talks on mental health and stroke awareness during this Ramadan, to promote heath screening and mental well-being.

Indeed, Ramadan provides a good opportunity for our community to make healthier choices a way of life. I urge the community to make the most of this time and bring about a positive shift in our lives.

(In English): For the next part of my speech, I will focus on family and fertility, which is an issue close to the hearts of many in this House. Ms Sylvia Lim asked about the differences in maternity fees for Singapore Citizens and PRs as compared to non-residents. We understand that healthcare costs are an important consideration in setting up a family, particularly for transnational families. Hence, foreign mothers who are married to Singapore Citizen fathers, and who are PRs, or on Long-Term Visit Pass Plus, LTVP+ in short, can receive Singapore Citizen–level subsidies for the delivery episode, in recognition that their child will be a Singapore Citizen and PR-level healthcare subsidies for all inpatient services.

In fact, the vast majority of foreign mothers married to Singapore Citizens, and with Singapore Citizen children, are PRs or LTVP+ holders, and they would be eligible for these subsidies. Expectant mothers married to Singapore Citizens may apply for an LTVP, and those who are eligible for an LTVP+ will be granted subsidies accordingly.

Beyond subsidies, the MediSave Maternity Package also allows couples to use their MediSave for their delivery and pre-delivery expenses. Singapore Citizen or PR fathers whose spouses are giving birth in Singapore may tap on their MediSave to defray the out-of-pocket cost of their maternity fees.

For some individuals, however, the ability to build a family may be irreversibly compromised by medical treatments that are required to treat conditions, such as cancer. Such treatments can significantly impair one's fertility. I thank Dr Tan Wu Meng and his healthcare worker peers for tirelessly advocating for young cancer patients seeking fertility preservation. We agree that no one should have to forgo the opportunity to have a child because of the side effects from a medically necessary treatment for a condition.

Hence, from June this year, we will extend subsidies for embryo, egg and sperm freezing for those whose fertility can be irreversibly affected by their medical treatment. From next year, we will also extend MediSave coverage for embryo freezing, and MediShield Life coverage to support embryo, egg and ovarian tissue freezing for such individuals. Those who still face challenges with the cost of their fertility preservation treatments arising from medically necessary treatments may also approach medical social workers at their public healthcare institutions for further assistance, including to apply for MediFund.

With these changes, we hope to assure patients facing medical challenges that their dreams of starting a family in the future are still within reach.

Mr Chairman, allow me to move on to healthcare manpower.

A strong healthcare workforce is vital to support both our preventive health initiatives and treatment needs, and we remain committed to building this capacity.

I thank Mr Louis Ng for his concern on rest time for nurses. The well-being of our healthcare workers, including nurses, continues to be a perennial concern. There are clear practices in our public healthcare institutions to ensure that nurses have sufficient rest during shifts. For example, nurses take staggered breaks during their shifts so that there is sufficient rest time for each nurse. Dedicated rest areas, separate from clinical spaces, are also provided to ensure breaks are uninterrupted.

Between shifts, the clusters limit the number of consecutive working days. Efforts have also been made to streamline processes and reduce administrative tasks so that nurses can complete their duties efficiently and end their shifts on time.

Today, the attrition rate of nurses in the public healthcare clusters has dropped from 9% during the pandemic years of 2021 to 2022 to around 6.7% in 2024. This decline in attrition, coupled with our sustained efforts to recruit new nurses, is helping to strengthen our nursing workforce and improve working conditions on the ground.

Mr Ang Wei Neng asked about dental manpower sufficiency. To meet Singapore's evolving dental needs, the National University of Singapore has increased its annual Dentistry intake by 50% from 2015 to 2024. The number of registered dentists also grew by 35% in the same period, bringing our dentist-to-population ratio to 0.5 dentist to 1,000 people. This is on par with other developed countries, such as South Korea and the UK.

Our local dentistry programme remains a steady and sufficient source of new dentists and hence, we do not currently provide pre-employment grants for dentistry. We will continue working with local Institutes of Higher Learning to meet national manpower needs for dental care. Nonetheless, Dentistry students who choose to study overseas are welcome to return to Singapore to contribute as our healthcare needs expand.

Mr Chairman, in closing, health is more than the absence of illness. It is about the quality of life for ourselves, our families and our communities. From nurturing healthy habits to family planning and ensuring the well-being of our healthcare professionals, we are building a system that supports Singaporeans at every stage of life. This journey requires our collective commitment and together, we can build a Singapore where every individual has improved opportunities and access to a more well-rounded, healthier life. [Applause.]

The Chairman: We have time for clarifications. Ms Ng Ling Ling.

Ms Ng Ling Ling: Chairman, I just have one clarification for the Minister for Health. I am really glad to hear about increase in healthcare subsidies for Singaporeans because it is always a good thing, but if it is on the back of continually increasing cost, then it begs the question of sustainability and the tax burden on our future generations.

So, my question is: what are MOH's cost management strategies with the healthcare clusters? And how are efforts, such as what I read about NUH's value-based healthcare framework which measures value-driven outcomes, how is this initiative informing MOH on cost management?

Mr Ong Ye Kung: Thank you. There is a range of things we do to manage healthcare cost. For example, we now do central procurement and it gives us a bit more bargaining power, keeping prices low. We have a very disciplined system of what we call Health Technology Assessment (HTA), because there are so many new drugs today, so many new treatments. Some treatments may be 10 times more expensive than current treatment but promised to cure another 2% to 5% more of the patient population. So, you have to really sharpen your pencil and calculate, and see if it is worth it and is it cost-effective. So, HTA has been set up as a discipline within MOH to make sure that whatever we approve and subsidise is cost-effective. If it is not cost-effective, we start to have very frank discussions with drug suppliers, for example, to tell them that they need to lower their cost, then we can subsidise, which was the case for shingles vaccination and that resulted in a good outcome.

Thirdly, as the Member mentioned, value-driven care actually is a major programme throughout our system. If the Member is interested, she can file a PQ and I will see what data we can share. But we are doing this across all institutions. We measure the KPIs against cost and then have a sense of how much we are spending to deliver the KPIs and the objectives that we want to achieve.

Another major avenue to moderate cost is step-down care. When capacity is misused, it leads to a lot of wastage and resources. We used to have many what we call "social" stayers in our hospitals. When I first joined MOH, we had something like 300 to 500 of them – basically, people who no longer needed to stay in hospital but they had nowhere else to go. So, we keep them in hospitals and sometimes, families even admit them. But today, with all the step-down care, we begin to be able to discharge them. Today, the numbers of social stayers are far fewer, 50 to 80. So, from 300 down to 50, that is almost half a hospital freed up.

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We do benchmarking now across the system to make sure that there is price transparency and patients have a basis of comparison, what is a more cost-effective healthcare. If you notice this, we have started doing some enforcement on doctors that have overcharged and overclaimed MediShield Life and MediSave.

Finally, the most important two factors: one is financial discipline. I mentioned the UK NHS system. When you say healthcare is free at the point of care, actually it is not free. Someone else still has to pay for it. But to make it free for the patient means it is very expensive for the nation, because it will lead to a lot of excessive treatment and unnecessary servicing. So, that is why we have S+3Ms, including co-payment, to restrain the system. So, today we can deliver very good health outcomes at 5%, or, in fact, under 5% of gross domestic product. Actually, that is very good value for money.

And finally, keep everybody healthy. Population health is critical. So, this is a summary of all the things that we are doing. I hope it is enough.

But the Member is right. Healthcare costs cannot go on escalating like that. I am hoping that this is a post-COVID-19 phenomenon, where healthcare costs escalated because manpower costs had jumped post-COVID-19. Everyone, every country in the world realised that they need more manpower, they are hiring like mad and they have pushed up, globally, the cost of healthcare manpower. But I hope, at some point, this will stabilise. You will start to track general inflation rather than leads general inflation.

The Chairman: Ms Hazel Poa.

Ms Hazel Poa: I welcome the increase in the MediSave outpatient withdrawal limits. I would like to check whether there will be adjustments to the MediSave $500 or $700 as well? These amounts, I believe, were also set in 2021.

Mr Ong Ye Kung: Chair, before I answer Ms Hazel Poa's question, I forgot that I need to clarify two factual errors in my speech.

First, when I was mentioning the attrition rate of junior doctors, I mentioned 7%. Actually, it is lower, at 3% to 6% over the past eight years. In fact, in the last two years, it was under 5%.

When I was showing a chart, I mentioned that for long-term care, for those who were born in 1969 or earlier, they have an additional subsidy. I said the reason is because they are less covered by MediShield Life. I misspoke. It is that they are less covered by CareShield Life.

As for Ms Hazel Poa's question, we are not adjusting the $500 to $700 yet. I know where she is coming from, because the Basic Retirement Sum and Basic Healthcare Sum are rising in tandem with inflation. Which is correct, because these are amounts of money that you want to save up for your old age and, therefore, when you spend, you must make sure what you set aside grows in tandem with inflation. However, when it comes to the claim limits of Flexi-MediSave or MediShield $500/$700, these are more policy-driven.

Take, for example, today, we just announce that you can use MediSave to co-pay for dental root canal. Sometime ago, we say, we are subsidising Shingles vaccination and, whatever is the co-payment, you can use MediSave. Once we allow that, suddenly the demand for MediSave spending goes up. Therefore we review it and the increase from $300 to $400.

So, if you look at what we have done, in 2021, it increased from $200 to $300; and now it increased from $300 to $400. Over five years, it has doubled from $200 to $400. So, if you have tracked inflation, actually, the increase will be much less. But because this is a lot more driven by policy, we adjust them instead every few years, taking into account general inflation. I think that is a much more practical approach.

The Chairman: Mr Ang Wei Neng.

Mr Ang Wei Neng: Chairman, I have two clarifications. First one is for the Minister on TCM. So, beyond acupunctures, how is TCM also being integrated with the mainstream healthcare system? Are there plans to develop specialist roles for TCM practitioners? And are there plans for the Civil Service to eventually recognise the MC issued by the TCM practitioners?

The second clarification is for Minister of State Rahayu on vaping. Did HSA discover any platform in Singapore that sell vapourisers or the operators in Singapore? If so, will HSA consider prosecuting the platforms to have a deterrence effect?

Mr Ong Ye Kung: On TCM first. TCM is a self-regulated field. So, the quality and the delivery of services has a big variation. So, I think we ought to be quite careful and always take an evidence-based approach. That is what we are doing now. Take certain treatments that we think has potential, has worked well in other countries, with evidence in existing literature, try it in our system, and if it works, we can then bring it into the mainstream. So, we are doing use case by use case, using an evidence-based approach.

The Member mentioned MCs. Because it is a self-regulated system, it will be difficult for Civil Service or otherwise to pass a law to say that TCM MCs will be recognised. In any case, I think good human resource practice is to be able to tell your employees that when you are ill, call in sick. You do not have to produce an medical certificate and make an additional trip, either to TCM or to the polyclinic just to get the medical certificate. Actually, the Civil Service has already moved towards that. I think there are a few days in the year that you actually do not have to produce an medical certificate. You can call in sick and I think that is a better HR practice.

Ms Rahayu Mahzam: Indeed, HSA does monitor regularly on the upstream sales that we see on the online spaces and HSA actually works closely with the platforms to ask them to take down all the postings on the illegal sales of such product. So, HSA collaborates with platforms, like Instagram, Carousell and Facebook, to remove the postings. And MOH and HSA are currently working with MDDI as well to see how we can encourage social media platforms to further strengthen this effort to detect and remove these online sales of advertisements on e-vapourisers. This is something that I understand is a worrying concern and we will continue to look at how we can enhance our efforts in this space.

The Chairman: Ms Sylvia Lim.

Ms Sylvia Lim: Thank you, Speaker. I have a clarification for Minister of State Rahayu about the cut on maternity fees which I filed. I filed this actually based on some ground feedback that came to me from my residents who are Singaporean fathers-to-be but their wives are foreigners. They may be holding LTVP, not plus, or something lesser. And from our research on the KK Women's and Children's Hospital website, it does appear that the maternity fees that are charged are actually tied to the residency status of the mother.

So, I do not know whether earlier, because I did not hear her that carefully, was the Minister of State Rahayu saying that somehow the father's status as a Singaporean can be taken into account to reduce the maternity fees in such situations? Because I did not hear that very clearly and I would like her to clarify that.

Ms Rahayu Mahzam: Let me refer to the portion that I responded to. So, actually, what I said was that foreign mothers who are married to Singapore Citizen fathers and, who are PRs or on LTVP+, can receive Singapore Citizen-level subsidies for delivery episode, in recognition that their child will be a Singapore Citizen; and PR-level healthcare subsidies for all in-patient services. So forth, for maternity care, when it is the delivery, they will actually get Singapore Citizen-level subsidies.

The Chairman: Mr Keith Chua.

Mr Keith Chua: I thank the Senior Minister of State for the response to suicide prevention. In a PQ I filed last year, the response advised that there is no tracking or cumulative data collated of the number of persons diagnosed with suicidal ideation, whether caused by mental health conditions or other triggers. Will MOH reconsider the current position, now that we have the National Mental Health Office, as this monitoring or tracking should be helpful in suicide prevention and, perhaps, more importantly, the provision of resources required for the support of these individuals? We should do all within our means to prevent the next suicide.

Dr Janil Puthucheary: Sir, I thank Mr Keith Chua for that and I do agree that we must do all that we can to prevent each suicide, as well as to study the factors that increase the risk in certain individuals. The ability to track such data in the past was limited. Now that we have this coordinating office as well as the various systems that we are putting in place coming out of the strategy, it should allow us to then better develop the framework to establish that data across a variety of service providers. So, we will be looking at this as part of how we set up and monitor the work of the National Mental Health Office, how to then get the right data and track it over time.

But I do not want to overstate it, that this particular data variable that Mr Chua has identified is already in the works. I will have to go and have a look at the kind of data that we can provide on a robust basis year-on-year. And part of the issue, of course, is that the providers that we have within the space are very varied, and this is not necessarily something that is always reported. So, we have got to look to see how we can make sure that we have this data in a robust manner, so that the number that we are reporting and tracking is something that informs what we do with our policy as well as our operations.

The Chairman: Mr Gerald Giam.

Mr Gerald Giam Yean Song: Sir, I appreciate the steps that MOH is taking to enhance preventive oral care and allow for more MediSave use. Does the Minister recognise that Singaporeans are not visiting their dentist frequently enough for regular checkups? As I mentioned in my cut, while over 50% visit a dentist at least once a year, 40% of these visits are for reactive treatment rather than for preventive care. Are there plans to encourage more frequent visits to the dentist of at least 12 to 18 months? And does MOH have plans to expand the capacity of public dental services to meet this increased demand?

Mr Ong Ye Kung: I would say, the polyclinics are quite busy, but we can leverage private clinics more for preventive oral care. My hypothesis is that when you go to a private clinic because you have a decayed tooth, the dentist says you need a root canal. It is more expensive today. It requires quite a few trips to the clinic, and so, you would rather extract or, in the first place, let us not go to the dentists. So, there is a bit of that behaviour.

That is why we are increasing the subsidy for such restorative treatment quite significantly. With this step and with some more education, including a national dental plan that we are now drawing up, we hope that more people are aware of the importance of oral health and understand that any restorative treatment, and for orange CHAS cardholder's preventive care treatment, they will all be better subsidised now. I think more people will come forward and we can better leverage and better use the capacity we have today in all the private dental clinics.

So, I think this is an important step we are first taking and we are still reviewing and drawing up our national dental plan.

The Chairman: Dr Tan Wu Meng.

Dr Tan Wu Meng: I would like to thank the Minister for Health, and I just wanted to raise some questions on our approach to value-based care, which is really another way of saying "getting value for money", part of fiscal discipline and fiscal prudence.

And can I ask MOH if, moving forward, there will be even greater attention given to how we measure value, not just in terms of a single Ministry policy at one point in time, but also looking at how it may shape the situation for the family. So, for example, if additional manpower and resources are needed so that a particular patient does not have to attend 36 appointments a year, but let us say, down to 18 or 12, those resources in streamlining and coordinating care can be looked in context of reducing the effort needed by the caregiver who accompanies the patient. Because, as I have said during the Budget debate, this can determine whether the caregiver goes from full-time to part-time employment, or whether a caregiver on flexible work leaves their career completely. And, therefore, the support to the patient can also be considered in terms of the outcomes for the family unit and the family unit's ability to continue being in employment.

Mr Ong Ye Kung: I can appreciate where the Member is coming from. When you have so many appointments, the toll on the caregiver is quite immense and it all looks a bit inefficient.

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But the Member also works in a hospital, there are so many specialties and sub-specialties, and when someone is senior, they start to have many different problems with many different organs. And therefore, while we can coordinate, they still require review by several specialists.

We will try to streamline as much as we can, but I do not think there can be a major streamlining and cutting down of appointments. I would moderate expectations on that.

Having said that, as I mentioned to Ms Ng Ling Ling, there are a range of things we are doing to moderate healthcare costs, and if we can do so and keep people healthy, we also will be able to reduce the burden of caregivers.

I would say we are going far beyond measuring value now. Value-driven care (VDC), as I was telling one consultant, is old technology for health system. And today, I think health economists do recognise that with VDC, you can eliminate operational or clinical or disease level wastage.

But with the ageing population we need to eliminate population level wastage. It means it is no longer just about how you treat this person in the most efficient way and cost effective way possible. It is about saying that this person should not be here in the first place. This is the level of efficiency that we are going to achieve now. It is many years of transformation ahead and we will work together.

The Chairman: Ms He Ting Ru.

Ms He Ting Ru (Sengkang): Thank you, Sir. A clarification for the Senior Minister of State.

I think Senior Minister of State mentioned earlier that they are working towards registration for a subset of psychologists, if I understood him correctly. So, I just wanted to check with the Senior Minister of State whether there are plans, as I mentioned in my cut, to also include other mental health professionals, such as psychotherapists and counsellors, just because these are also professionals who work with vulnerable clients. I believe that, anecdotally, some practitioners have also shared with me their concerns that there are people out there holding themselves out to be therapists after doing some online courses or a weekend class in an area. I think this causes a little bit of concern because, after all, the clients who come to them for help are usually pretty vulnerable individuals.

And relatedly, I was also wondering what sort of public or consumer education is being undertaken so that members of the public who are seeking help can understand, for example, what is the difference between a psychotherapist, a counsellor, a psychologist, a psychiatrist. A lot of my residents who come to me, struggle to understand the difference and know where is the best place to seek help. And also, if they have some concerns about the person they are actually seeking services from, where do they go if they have got a complaint or they have got some concerns about some of the sessions that they are having with them.

Dr Janil Puthucheary: I thank Ms He for the questions. We are early in the process, so some of these details have not yet been established. But let me try to perhaps explain how we are thinking about this. We do indeed want to protect vulnerable individuals, and she has highlighted how someone who is seeking these sorts of services may well be in a position where they are vulnerable if not dealt with properly or dealt with by someone who is not entirely professional. So, that is the perspective we are coming from. How do we protect individuals seeking these services and at the same time raise the standards and quality of the profession?

The categories of psychologists and professionals that we are likely to then want to regulate and license in a particular way are those where their risk is likely to be higher to the clients and the patients that they are treating, that they are seeing. And this, by definition, means that they are involved in issues to do with diagnosis, pathology, interventions – this is the higher risk end of the profession.

Then, to her point where there are other professionals who are advertising or purporting to treat these types of problems with these types of interventions, we will have to look and see how we craft the licensing regime and the regulatory regime as to what tools we might then have to then go after such individuals.

It is early days, but we are thinking in terms of the risks associated as a result of the professional work that someone does – the diagnosis, the risks and interventions – as well as the vulnerability of the individual that we want to protect.

Indeed, public education will be important, and we will have to think through how we set out the naming, the nomenclature and the details, how a member of the public can choose who to go and get their therapy from and then make available public information.

The resources then for further information actually are already available. I mentioned quite a few of them in my speech. The websites, the chatlines,and then later on this year we will have the hotline. So, a member of the public who is concerned about the therapies that they are getting can access any one of these resources or contact MOH directly and we can also provide advice.

The Chairman: I think all the clarifications have — Well, I spoke too soon. Ms Lim.

Ms Sylvia Lim: Thank you, Sir, for your indulgence to re-clarify with Minister of State Rahayu. Earlier she, she mentioned that citizen level subsidies would be available for delivery by foreign mothers if they are PRs or LTVP+ holders, in consideration of the fact that the child will be a Singapore Citizen. But I think she will also know that there are Singapore children also being born to mothers who are LTVP, but not plus. So, can that not also be considered in the fee setting?

Ms Rahayu Mahzam: Based on the information that we have from the Immigrations and Checkpoints Authority, the vast majority of foreign spouses with Singapore Citizen husbands and have Singapore Citizen minor children are actually LTVP+. So, in that sense, the vast majority of spouses are therefore eligible for medical subsidies already.

We generally receive very few appeals each year from Singapore residents for their sponsored dependants on LTVP. If you do have some of these cases, they can be surfaced, and they can approach medical social workers to request for MediFund. [Please refer to "Clarification by Minister of State for Health", Official Report, 7 March 2025, Vol 95, Issue 160, Correction By Written Statement section.]

The Member still looks very puzzled. I am happy to take this up separately and see if there are specific cases we can assist you with.

The Chairman: And with that I believe all the clarifications have been answered. I am very glad that this is the first Head where we have finished ahead of the guillotine time. Having said that, Dr Tan, would you like to draw your amendment?

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Dr Tan Wu Meng: Mr Chairman, I thank all who contributed to this debate. Our MOH leadership and MPs of all persuasions. Also want to express deepest thanks to our entire healthcare family, our front liners, the support team and our public officers. If I may briefly seek the indulgence of Speaker —

The Chairman: Dr Tan, I was not asking you to make a long closing, please.

Dr Tan Wu Meng: So, if I may just recall briefly what I said five years ago during the debate on the President's Address. Healthcare is about all our people's lives, your life and mine, the lives of our loved ones, the life of every Singaporean.

And with that, let us all hope for healthier and happier lives together. I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

The sum of $18,795,327,500 for Head O ordered to stand part of the Main Estimates.

The sum of $2,067,888,400 for Head O ordered to stand part of the Development Estimates.