Eligibility Criteria for Subsidies for TCM Consultations and Ensuring Quality Assurance Standards for These Treatments within Healthier SG

10 Mr Gerald Giam Yean Song asked the Minister for Health (a) what eligibility criteria will determine access to subsidised Traditional Chinese Medicine (TCM) consultations under Healthier SG; (b) whether medical certificates issued by TCM practitioners will be accepted; (c) what quality assurance measures will ensure TCM treatments within Healthier SG meet the required standards; and (d) what steps will be taken to boost Healthier SG enrolment among older residents, including through partnerships with TCM practitioners.

The Minister for Health (Mr Ong Ye Kung): Mr Speaker, Sir, my response will also cover the matters raised in the questions by Dr Wan Rizal¹ and Mr Yip Hon Weng, which are scheduled for a subsequent Sitting. I will invite Members to seek clarifications at the end of my answer, if need be. If the questions have been addressed, it may not be necessary for them to proceed with the questions for future Sittings.

Mr Speaker: Please proceed.

Mr Ong Ye Kung: In my speech at the Public Free Clinic Society's 50th Anniversary Charity Dinner, I announced the Ministry of Health's (MOH's) plan to carefully integrate selected Traditional Chinese Medicine (TCM) interventions into our mainstream Western-centric healthcare system, as we have done for acupuncture for lower back and neck pain. Our effort will focus on two areas: first, for preventive care under Healthier SG; and second, for acute settings in hospitals.

Let me start with preventive care. About 20% of Singapore residents aged 40 and above visit TCM practitioners every year. TCM clinics are hence, useful touch points to engage residents to join Healthier SG and practise good preventive care.

I mentioned in the speech that under Healthier SG, health screening, vaccinations, chronic disease management, being Western medicine interventions, will have to be performed by general practitioners (GPs). Where TCM practitioners can play a useful role is lifestyle changes, given the holistic approach to health in TCM. MOH will consult Western doctors and TCM practitioners on how they can collaborate to care for our residents.

The training and support for TCM practitioners under Healthier SG will depend on the eventual model of collaboration. A fruitful collaboration should lead to an increased uptake of preventive care, such as screenings and vaccinations, as well as adoption of healthier lifestyles among Singaporeans.

MOH and the TCM Practitioners Board will be launching a voluntary accreditation system to accredit TCM service providers that can participate in Healthier SG collaboratively with Healthier SG clinics. The accreditation will ensure good governance, adherence to established protocols and the maintenance of professional competencies for high quality and safe TCM practice.

At present, under the Employment Act, employers are legally required to recognise medical certificates issued by registered medical or dental practitioners after proper clinical assessment for the purposes of granting paid sick leave. Although TCM practitioners are not registered medical and dental practitioners under the Act, employers have the discretion to also recognise medical certificates issued by them.

Next, is acute hospital settings. Today, only acupuncture for lower back and neck pain are integrated into our public health institutions. There has been much scientific research on TCM and we should review them and explore the possibility of further integration, provided that the interventions are proven to be safe, efficacious and cost effective. If and when we decide to do so in a public hospital setting, proper referral and review protocols will be established, no different from the integration of medical subspecialties that are ongoing.

Mr Speaker: Mr Giam.

Mr Gerald Giam Yean Song (Aljunied): Mr Speaker, I thank the Minister for his reply. Sir, in addition to the elderly citizens who are consulting TCM practitioners, anecdotally, I know that not just senior citizens, but also younger Singaporeans, many non-Chinese residents and even competitive athletes are consulting TCM practitioners. So, when will the accreditation framework be in place to identify qualified TCM practitioners within Healthier SG?

Will employers be required to accept medical certificates (MCs) from these accredited practitioners? Because this could assure Singaporeans who prefer using TCM, that their medical choices will be recognised and respected.

Can patients be given more flexibility to combine TCM and Western treatments, especially for chronic conditions, and receive government subsidies or use MediSave for both treatments? This could allow the preventive and lifestyle-focused approach of TCM to complement Western interventions.

Lastly, could MOH facilitate opportunities for TCM practitioners and Western-trained doctors to receive some cross-disciplinary exposure and training in each other's medical principles, as is done in places, like China and Taiwan? This could foster mutual respect, encourage collaboration and strengthen confidence in each other's standards.

Mr Ong Ye Kung: I did not realise there are four questions. So, I am now trying to take stock what are they.

The first question is about accreditation, when will it be done? As you know, TCM is a self-regulatory system, so it comes under the TCM Practitioners' Board chaired by Dr Teo Ho Pin. So, they are working very hard. I am afraid I have to give you an answer not different from how Minister Chee gave the answer on Bukit Panjang LRT which is, I think, as soon as possible, hopefully, next year, sometime next year.

I do have to clarify even with the accreditation system, this is an accreditation system under a self-regulatory framework. So, it does not follow that if you are accredited, your MC will be recognised.

Be mindful. We are taking a very practical approach here. All round the world including in China, the regulatory system is a Western-centric one. It is a result of the Renaissance. But TCM, on the other hand, lots of people use it, I agree. I use it myself. But if we say let TCM be regulated under today's healthcare regulatory regime, I think it will wither and die because the Western regulatory system is just not compatible with TCM.

Therefore, we take a practical approach to say "take you out of the system and you self-regulate" and then you can thrive. But it comes with some catches. Once you are outside of the mainstream system, there is no subsidy, there is no MediSave, your MCs are not recognised. So, it is part of the arrangement. It comes as a package. You are allowed self-regulation, you can thrive, you can serve a quarter of Singaporeans but some of these privileges, including recognition of MCs, do not follow.

But what I mentioned earlier, if there is accreditation and people are confident of TCM practitioners' assessment, employers are free to exercise discretion to recognise them. These are the Member's first two questions.

The next two questions are what I had addressed in my speech recently and in my reply. I will just reiterate the key points. There is now a lot of research, scientific research on TCM. We will review them. And some of them, I think if we can study them and ensure that they are safe, efficacious, cost-efficient, we can start to integrate them into our mainstream regulatory system, mainstream healthcare system, including the management of chronic disease. It is possible.

As we do so, it is quite an involved process. For every disease, we need to bring TCM and Western doctors together, work out referral protocols. They cannot contradict. We must make sure it is well integrated and we can implement them; and when we implement them, if they are integrated just like acupuncture for lower back and neck pain, it is and it can be subsidised. It is subject to MediSave withdrawal.

So, we are taking this step by step and as we do so, I think they will also learn from each other, which is a good thing.