ATTENDANCE FEES AT ACCIDENT AND EMERGENCY DEPARTMENTS AND OUTPATIENT DISPENSARIES AND DENTAL SERVICE CHARGES
Mr Deputy Speaker, Sir, I am most grateful to you for giving me this opportunity to raise this matter which is of grave concern and has caused much anxiety to Singaporeans. In this House that ill-fated day, 23rd March last, the Hon. Minister saw fit in his Ministerial Statement to unfairly and to the detriment of Singaporeans revise upwards attendance fees at Accident and Emergency Departments and Outpatient Dispensaries and Dental Service charges. That was an unwarranted revision which has left a most sour taste in everyone's mouth. On the 1st, April fool's day, Singaporeans had to pay more at A & E, OPD and for Dental Services and this, Sir, was no joke. 604,492 employed persons in Singapore earn $399 and under, of the 870,442 employed, according to the Ministry of Labour's "Report on the Labour Force Survey of Singapore 1976". So, some 69% of employed persons are now faced with the possibility of scraping the bottom of an already empty pot if they or their families should have the misfortune of being ill or having teeth problems. That April 1st, staff at A & E and OPD, especially the nurses, and dental nurses, not the Hon. Minister, came under severe and heavy fire from patients or their parents for the most inconsiderate hikes in rates. This still carries on. Is the Hon. Minister aware of the buffers that protect him from the public wrath? Let us examine the hike in A & E charges closely. It shot up from $4 to $10, a 150% increase. For whatever reason, a hike of that extent is profiteering. But the Minister will contend that A & E Departments are heavily subsidised. What would the subsidy be and should accidents and emergencies not be subsidised? Accidents are unplanned events leading to injuries or damages. No sane person would want to be involved in an accident and it could be caused at any time or place. So treatment, if necessary, is as essential as food or drink. But the prohibitive charges will most certainly force many who need treatment to keep away, much to their immediate and long-term detriment. Those who are poor are so because they earn less. They have lesser skilled jobs due to lesser education and educational achievements. Most of them, therefore, due to lack of knowledge in matters pertaining to health either panic when the ailment is slight or seek no treatment until it is too late. The introduction of this excessive charge at A & E Departments will most certainly result in their taking the latter recourse. And this I am sure is not what the Hon. Minister wants. Or is it? For those who can afford, raising fees would only inhibit them for a short period of time or if they have cash to spare, not at all. Has the Minister any figures to show the success of his sieving method introduced on 1st April to cut down on unnecessary visits to the A & E Departments? Has he also figures to show the income brackets of those who visited the A & E Departments these lest seven days? In his Ministerial Statement on the 23rd March, he mentioned that 61.9% of patients were discharged after treatment, but he did not mention what portion of these deserved treatment as accident and emergency cases. Are we to understand that only those warded are termed by him bona fide accident and emergency cases? He has allowed them to be credited with the $10 deposit which patients have to pay on admission. How does he propose to implement the waiver of charges for destitute patients? Does he expect patients presenting themselves at the A & E Departments to produce documentary evidence of their destitution? How many patients have obtained this waiver since the implementation of that unfeeling rate? Is the Hon. Minister aware that some of the nurses and staff at the A & E Departments have contributed towards the payment of attendance fees for patients who had just no money to pay for emergency treatment? Is there really a criterion to determine who indiscriminately utilises the A & E Departments? Who can actually determine whether patients turning up are serious or emergency cases? The Hon. Minister did mention that doctors require longer time to examine patients to determine whether a stomachache is due to acute appendicitis. How much time does a layman therefore require to determine whether he should consult a doctor immediately when he suffers from an unbearable stomachache in the middle of the night? Does he wait for it to subside or should he proceed to the A & E Departments? Until the Hon. Minister can come up with a sensible sieving method to prevent the indiscriminate use of the A & E Departments, he should revert to the status quo which prevailed before 1st April. Is it not his objective to stop this indiscriminate use of the A & E Departments? Or is it his objective to prevent those who cannot afford to pay from visiting the A & E Departments? Allow me now, Sir, to turn to the increases in dental service charges. For 21 years the scheme for the fluoridation of the water supply of Singapore has been an excellent preventive measure for the control of dental decay among the Singapore population. The Public and School Dental Services have been developed over the years and dental care is now afforded to practically every Singaporean, especially primary school children in more than 110 school dental clinics. Campaigns, publicity and the like have achieved much over the years and the difficulties faced by the dental nurses who worked hard to convince parents of the necessity of dental care for their children, and to break down the psychological fears, were bearing much fruit. The turn around is now beginning with the infinite percentage increase in dental services charges for primary school children. Treatment used to be free but now an extraction costs 60 cents. a simple filling, scaling, polishing, repair of denture each costs $1, a single root canal treatment, $3, a partial upper or lower denture, $5, and a space maintainer. $15. For other treatments, various charges have also been revised upwards. Does the Hon. Minister realise that this is a retrogressive step towards enhancing dental care among the young? The role of the dental nurses has been reversed. They were responsible for promoting good dental habits, the brushing of teeth, regular visits to the dental clinics and so on. But now they have to stand with outstretched hands collecting money first and then treating the patients later, I believe, since the imposition of fees for dental services in primary schools, some children have even absented themselves from school on their dental appointment days. This rarely happened before. I also believe that few pupils are responding to the treatment, which used to be free, offered by the Institute of Dental Health. Prior to 1st April, the vans sent by the Institute to schools returned with sufficient numbers for the student dental nurses to treat. The experience gained by the student dental nurses enhanced their skills for their future stints in school dental clinics. With the lack of pupils to sharpen their skills, the Institute might run foul of their main objective of producing skilled dental nurses. A student dental nurse would require some five patients to work on a day and there are some 40 student dental nurses being trained at present. A pupil visits on average the school dental clinic ten times a year if he needs treatment. This would at the present rates cost between $6 to $10 yearly at the minimum. At this cost, which most certainly would revive the impression in most parents, especially those in the lower income groups, that dental treatment is not essential. There would consequently be a dwindling of numbers visiting the school dental clinics. Has the Hon. Minister mustered enough figures to show that this imposition of his has not caused a reduction in visits to school dental clinics and the Institute of Dental Health? As extractions are cheaper than fillings and as most parents feel that milk teeth would come off after a time anyway, preference would be for extractions and this could be detrimental to the permanent set of teeth. School Dental Nurses now wear badges sporting the cliche "Sedia Berkhidmat", which when translated means "Ready to Serve". When the service was free this could have applied, but now we would need to redo the badges to read "Pay and we will be ready to serve". I believe, Sir, I must inform the Minister for Education that charges should now be levied on the Ministry of Health for the utility services, space and so on that were previously supplied free-of-charge by the Ministry of Education to the Ministry of Health. When a free service was provided by the Ministry of Health to pupils, levies would be unfair. But now that the Health Ministry is doing business in schools, should they receive gratis all these facilities? I believe the NTUC and the AUPE will also need to come into the picture now that School Dental Nurses, skilled persons who deal with oral cavities, have been imposed the additional task of administration and accounts. They have to collect monies, issue receipts, bank in monies and so on. The added responsibilities and hazards merit salary, insurance and escort coverage. Is the Hon. Minister considering these? I could, however, offer a much better suggestion - rescind the dental service charges and all will be well. There is also the question of waste of material. Where before a phial of anaesthetic could be used to extract two teeth and a batch of amalgam for filling in two teeth, half of each of these are being wasted as most children, the ones that can afford, want to pay for only one extraction or one filling at a time. The introduction of school dental service charges has, therefore, increased costs for the Ministry in the form of wastage. Mr Deputy Speaker, Sir, much hardship has been caused to many Singaporeans by the Hon. Minister over the last seven days and much greater hardship will be caused if he fails to rescind the charges he has levied for attendance at the A & E Departments and school dental clinics. I hope the Hon. Minister truly realises this. The question, therefore, Mr Deputy Speaker, Sir, is that the Hon. Minister should now consider rescinding the Ministerial Statement made on that ill-fated day of 23rd March.